类鼻疽伯克霍尔德菌致感染性动脉瘤3例并文献复习

目的总结类鼻疽伯克霍尔德菌致感染性动脉瘤的临床特征,为该病的诊治提供依据,以期减少误诊率和病死率。方法收集2013年1月—2017年12月海南省人民医院确诊的类鼻疽伯克霍尔德菌致感染性动脉瘤病例3例,同时检索自1990—2017年国内外类鼻疽伯克霍尔德菌致感染性动脉瘤患者的病例报道,回顾性分析以上所有病例的临床特点。结果共纳入23例患者,其中男性患者占95. 7%,平均发病年龄(62. 2±5. 8)岁,主要伴随疾病是高血压和糖尿病,均占39. 1%,动脉瘤主要病变节段是腹主动脉(65. 2%),其次是胸主动脉(17. 4%)和主动脉弓(13. 0%),21例患者(91. 3%)接受手术治疗,病死率21. 7%。结论类鼻疽伯克霍尔德菌致感染性动脉瘤病死率较高,患有高血压和糖尿病的中老年男性为其高危人群,主要病变节段为腹主动脉。早期经验性抗感染治疗应注意覆盖该菌,一旦确诊后应在积极抗感染的基础上手术治疗。     

类鼻疽伯克霍尔德菌耐药性变迁临床研究

[目的]了解本院临床分离的类鼻疽伯克霍尔德菌耐药性变迁情况,探讨其治疗。[方法]回顾性调查分析1999年9月～2009年9月临床标本中分离的120株类鼻疽伯克霍尔德菌的耐药性变化情况。[结果]类鼻疽伯克霍尔德菌对氨苄西林、替卡西林、头孢唑啉、庆大霉素、妥布霉素耐药率为100%,对环丙沙星、左氧氟沙星、头孢噻肟、头孢曲松的耐药率(55.8%～77.9%)有增加趋势,亚胺培南耐药率最低(0.01%)。[结论]类鼻疽伯克霍尔德菌对喹诺酮类及头孢菌素类耐药现象有上升趋势,需引起临床重视,亚胺培南对类鼻疽伯克霍尔德菌最敏感,应作为治疗类鼻疽首选用药。     

以“肾占位”起病的类鼻疽脓毒症合并噬血细胞综合征1例

类鼻疽病是由类鼻疽伯克霍尔德菌感染所致的传染性疾病,其临床表现多样,常反复发作及合并脓毒症,且易误诊误治,故病死率较高。本文分析1例类鼻疽脓毒症合并噬血细胞综合征的病例,并结合国内外文献对该病的临床特点、诊治思路等进一步总结,以期降低该病的误诊误治,提升患者存活率。     

常规消毒剂对类鼻疽伯克霍尔德菌的杀灭效果分析

目的分析评价临床及科研中常用4种消毒剂对类鼻疽伯克霍尔德菌的杀灭效果,为临床类鼻疽治疗和科研活动中对该病原体的生物防护和沾染消除提供参考。方法选取临床及科研中常用4种消毒剂:碘伏,新洁尔灭,75%乙醇,"84"消毒液,在不同温度、不同消毒液浓度条件下,观察其在单位时间内对不同浓度的类鼻疽菌菌液中活菌的杀灭效果。结果常温条件下,0.5%碘伏和0.3%氯己定处理10min能杀灭类鼻疽菌,0.5%"84"消毒液20min、2%"84"消毒液5min也能有效杀灭该病原体,PerasafeTM消毒液和75%乙醇的杀灭处理3min即能起到洗消的目的。结论临床常用消毒剂对致病性的类鼻疽菌的杀灭效果较好,以PerasafeTM消毒液和75%乙醇的灭菌效果最佳,该试验提示,在未到达足够安全级别的实验室中进行少量病原操作(如分子生物学相关实验)和非严格隔离的病房内进行类鼻疽的临床诊疗过程中,有效防范类鼻疽菌的播散和传染并不困难,但基于类鼻疽菌的严重危害性和感染的高风险性,常规消毒剂的有效性还需要在更全面的动物模型上进行评价。     

湛江地区类鼻疽伯克霍尔德菌特征与流行病学研究

目的研究类鼻疽伯克霍尔德菌与常见其他伯克霍尔德菌间病原学特点及对药物敏感性的差异，为临床诊断、检验和治疗提供参考。方法对类鼻疽伯克霍尔德菌感染病例进行流行病学研究，并将其与常见医院感染皮氏伯克霍尔德菌、洋葱伯克霍尔德菌对常用抗菌药物的药敏结果进行比较分析。结果类鼻疽伯克霍尔德菌具有两端浓染，银白色菌落形态特征。在湛江，此菌感染以遂溪、廉江、吴川为主要疫区，好发于秋季，接触疫水、农民、免疫功能低下、年龄≥50岁为易感因素。其对复方磺胺甲嗯唑、头孢哌酮／舒巴坦、米诺环素、哌拉西林及其酶抑制复合制剂、头孢他啶、亚胺培南敏感率达100％，对氨基糖苷类、喹诺酮类和非抗假单胞菌属类药敏感性较差或耐药。结论类鼻疽伯克霍尔德菌感染属热带或亚热带地区传染病，水患易导致该菌流行；细菌具有染色、菌落形态特征，对药物的敏感性具有伯克菌属共同特征，易产生耐药，建议联合用药治疗。     

淮南市类鼻疽疫情流行病学调查报告

目的 通过对淮南市首起类鼻疽疫情进行现场流行病学调查,查找可能的传染源、传播途径,进一步评估淮南市类鼻疽爆发的风险,为今后类鼻疽防控工作提供基础资料.方法 通过对患者家属面对面的交流、对患家及周围环境进行现场调查的方式,对此起疫情进行现场流行病学调查,同时实地走访患者可能的感染环境,搜索可能的传染源以及可疑病例.结果 流行病学调查结果显示,此起疫情中涉及的2名患者发病前2个星期内一直呆在家中,无出国史,无海南、广东等地的旅游史,无与归国人员、赴海南、广东等地旅游人员接触史,无与病畜(马、牛、羊、猪等)接触史,无与被可疑污染的水、尘土接触史,未发现可疑传染源.结论 根据2名患者的生活史,发病时间,临床症状,结合实验室结果判断此起疫情为一起疑似同源暴露机会感染类鼻疽伯克霍尔德菌的散发疫情.     

非糖尿病肺类鼻疽病1例报告并文献复习

类鼻疽病是一种由假鼻疽伯克霍尔德菌所致人畜共患的地方性传染病,已被认为是发生致命性肺炎和脓毒症的主要病因之一。本文报道分析1例肺类鼻疽疾病的诊疗经过,并对其相关文献进行复习,以提高临床工作者对类鼻疽疾病的认识,避免误诊、漏诊。     

我国类鼻疽流行病学调查

笔者于１９７５～１９８９年对我国南方琼、粤、桂、湘四省区不同纬度的１３个县市进行类鼻疽菌分离，从１０个县市的水样品和人、畜病理标本中共获得７３株类鼻疽假单胞菌。血清学调查发现抗体阳性率与病菌的分布呈相关关系。井证实疫源地分布于粤、桂、琼的南亚热带和边缘热带地区。疫区人群抗体阳性率为３．８％～１５．２％，马为９．１％～１８．４％，牛为６．６％～３３．０％，感染猪群阳性率高达３５．０％，屠宰猪标本分离率为１３％。类鼻疽的危害调查表明，马、骡感染后会干扰鼻疽检疫。病菌污染肉品，危害公共卫生。在１９８９年９至１０月份的一次临床病例调查中，在湛江和海南三亚发现３例患者，２例因败血症死亡，１例为慢性下肢溃疡，可能还有显性感染患者被漏诊或误诊．     

类鼻疽杆菌：一个有待认识的环境卫生问题

类鼻疽杆菌 (Ｂｕｒｋｈｏｌｄｅｒｉａｐｓｅｕｄｏｍａｌｌｅｉ)是广泛分布于热带和亚热带泥土中的腐生菌 ,农民在田间劳作的过程中通过皮肤粘膜感染引起类鼻疽病 (Ｍｅｌｉｏｉｄｏｓｉｓ)。类鼻疽杆菌为革兰氏阴性、有运动性的短杆菌。 1912年 ,Ｗｈｉｔｍｏｒｅ从仰光 38例类似鼻疽的病人中分离获得 ,3年后将其归入假单胞菌属 (Ｐｓｅｕ ｄｏｍｏｎａｓ)。 90年代初日本学者将该菌重新分类 ,将原假单胞菌属中的ＤＮＡ群Ⅱ中的几个种列入一个新属Ｂｕｒｋｈｏｌｄｅｒｉａ〔1〕,笔者在此第一次音译成中文属名“伯克”属。自从本世纪初发…     

太原市首例输入性类鼻疽病例流行病学分析

类鼻疽是由类鼻疽伯克霍尔德菌引起的一种人畜共患传染病, 主要是通过接触含有致病菌的水或土壤, 经破损皮肤感染, 食入、鼻孔滴入或吸入病菌污染物也可致病, 但人与人之间传播罕见[1]。该病易复发, 且病死率较高。有研究显示, 我国类鼻疽主要高发于海南省、广东省、广西壮族自治区、福建省、香港特别行政区及台湾地区等地[2]。山西省太原市属于北温带地区, 2022年之前从未有过类鼻疽病例的报告。2022年7月22日, 山西省人民医院报告了太原市首例输入性类鼻疽病例, 接到报告后, 太原市疾病预防控制中心和迎泽区疾病预防控制中心分别对该病例进行了流行病学调查和后续处置, 现将调查结果报道如下。     

Preliminary report on the northern Australian melioidosis environmental surveillance project

An environmental surveillance programme was developed to determine whether water supplies could be a source of Burkholderia pseudomallei as noted during previous melioidosis outbreak investigations. Water supplies to communities in the three northern Australian jurisdictions (Western Australia, Northern Territory and Queensland) were sampled periodically during 2001 and 2002. Water and soil samples were collected from communities known to have had recent culture-positive melioidosis cases and nearby communities where no cases had been diagnosed. Clinical isolates of B. pseudomallei obtained from northern Australian patients during 2001 and 2002 were compared with the environmental B. pseudomallei isolates by ribotyping and pulsed-field gel electrophoresis. B. pseudomallei was isolated from 11 distinct locations, all in the Northern Territory, seven of which were associated with culture-positive melioidosis cases (>1 case at three locations). Water was implicated as a possible environmental source of melioidosis in six locations. A variety of free-living amoebae including Acanthamoeba and Hartmannella spp. that are potential hosts to B. pseudomallei were recovered from environmental specimens. Culturable B. pseudomallei was not found to be widely dispersed in the environments sampled.     

The epidemiology of melioidosis in the Balimo region of Papua New Guinea

The distribution of Burkholderia pseudomallei was determined in soil collected from a rural district in Papua New Guinea (PNG) where melioidosis had recently been described, predominately affecting children. In 274 samples, 2.6% tested culture-positive for B. pseudomallei. Pulsed-field gel electrophoresis using SpeI digests and rapid polymorphic DNA PCR with five primers demonstrated a single clone amongst clinical isolates and isolates cultured from the environment that was commonly used by children from whom the clinical isolates were derived. We concluded that individuals in this region most probably acquired the organism through close contact with the environment at these sites. Burkholderia thailandensis, a closely related Burkholderia sp. was isolated from 5.5% of samples tested, an observation similar to that of melioidosis-endemic areas in Thailand. This is the first report of an environmental reservoir for melioidosis in PNG and confirms the Balimo district in PNG as melioidosis endemic.     

The use of bone marrow culture for the diagnosis of melioidosis

We have evaluated prospectively the contribution of bone marrow culture to the diagnosis of melioidosis. Bone marrow (BMC) and blood cultures (BC) were collected concurrently from 105 patients with suspected acute, severe melioidosis. 67 patients were subsequently proved to have the disease whilst other significant organisms were isolated from these specimens in 5 cases. Overall, 67.2% of BC and 64.2% of BMC from melioidosis patients grew Pseudomonas pseudomallei. Time to positivity did not differ significantly in paired BC and BMC specimens. These results do not support the routine use of BMC in the diagnosis of acute, severe melioidosis. In one patient with pulmonary melioidosis, however, blood cultures were repeatedly negative, whilst bone marrow grew P. pseudomallei, and this preceded the development of a distant focus of infection. This suggests that culture of bone-marrow may be of value in certain blood culture-negative patients with melioidosis.     

Melioidosis: an emerging infection in Taiwan?

From January 1982 to May 2000, 17 infections caused by Burkholderia pseudomallei were diagnosed in 15 patients in Taiwan; almost all the infections were diagnosed from 1994 to May 2000. Of the 15 patients, 9 (60%) had underlying diseases, and 10 (67%) had bacteremic pneumonia. Thirteen (76%) episodes of infection were considered indigenous. Four patients died of melioidosis. Seventeen B. pseudomallei isolates, recovered from eight patients from November 1996 to May 2000, were analyzed to determine their in vitro susceptibilities to 14 antimicrobial agents, cellular fatty acid and biochemical reaction profiles, and randomly amplified polymorphic DNA patterns. Eight strains (highly related isolates) were identified. All isolates were arabinose non-assimilators and were susceptible to amoxicillin-clavulanate, piperacillin-tazobactam, imipenem, and meropenem. No spread of the strain was documented.     

Diagnostic use of Burkholderia pseudomallei selective media in a low prevalence setting

Routine use of selective media improves diagnosis of Burkholderia pseudomallei, but resources may be limited in endemic developing countries. To maximise yield in the relatively low-prevalence setting of Kuala Lumpur, Malaysia, B. pseudomallei selective agar and broth were compared with routine media for 154 respiratory specimens from patients with community-acquired disease. Selective media detected three additional culture-positive specimens and one additional melioidosis patient, at a consumables cost of US$75. Burkholderia pseudomallei was not isolated from 74 diabetic foot ulcer samples. Following careful local evaluation, focused use of selective media may be cost-effective.     

Melioidosis outbreak after typhoon, southern Taiwan

From July through September 2005, shortly after a typhoon, 40 cases of Burkholderia pseudomallei infection (melioidosis) were identified in southern Taiwan. Two genotypes that had been present in 2000 were identified by pulsed-field gel electrophoresis. Such a case cluster confirms that melioidosis is endemic to Taiwan.     

Acute melioidosis outbreak in Western Australia

A cluster of acute melioidosis cases occurred in a remote, coastal community in tropical Western Australia. Molecular typing of Burkholderia pseudomallei isolates from culture-confirmed cases and suspected environmental sources by pulsed-field gel electrophoresis (PFGE) of XbaI chromosomal DNA digests showed that a single PFGE type was responsible for five cases of acute infection in a community of around 300 during a 5 week period. This temporal and geographical clustering of acute melioidosis cases provided a unique opportunity to investigate the environmental factors contributing to this disease. B. pseudomallei isolated from a domestic tap at the home of an asymptomatic seroconverter was indistinguishable by PFGE. Possible contributing environmental factors included an unusually acid communal water supply, unrecordable chlorine levels during the probable exposure period, a nearby earth tremor, and gusting winds during the installation of new water and electricity supplies. The possible role of the potable water supply as a source of B. pseudomallei was investigated further.     

Advances and remaining uncertainties in the epidemiology of Burkholderia pseudomallei and melioidosis

Major advances have been made in molecular studies of Burkholderia pseudomallei and the immunology of melioidosis. However, there remain large gaps in understanding of the epidemiology of this enigmatic disease. Identified global distribution boundaries of melioidosis continue to expand. Recent data suggest Australian strains of B. pseudomallei may be ancestral to those from Southeast Asia, but the ecology of this environmental bacterium remains elusive. Despite the potential for rapidly progressive septicaemia, the critical virulence factors in B. pseudomallei remain to be clarified. Inhalation following aerosolization of B. pseudomallei may account for the high mortality when melioidosis occurs after severe weather events.     

Burkholderia pseudomallei antibodies in children, Cambodia

Antibodies to Burkholderia pseudomallei were detected in 16% of children in Siem Reap, Cambodia. This organism was isolated from 30% of rice paddies in the surrounding vicinity. Despite the lack of reported indigenous cases, melioidosis is likely to occur in Cambodia.