一起腺病毒爆发疫情的调查报告

20 0 0年 5月中旬 ,京津之间一所学校 ,在 10ｄ内 ,相继有 12 0多人出现高烧、周身酸痛 ,部分病人有腹泻 ,少有咳嗽、扁桃体肿大和流涕等呼吸道症状 ,但是血象不高。从咽拭子获得的脱落上皮细胞 ,用免疫荧光试验检测腺病毒抗原 ,7例病人中有 3例阳性。用ＥＬＩＳＡ检测血清中腺病毒特异性ＩｇＭ抗体 ,68例病人中 52例阳性( 76.5% ) ,10 0例未发病人群中 37例阳性 ( 37% ) ,显示了较高的隐性感染率。从 1例免疫荧光试验阳性病人咽拭子用改进后的ＳＳＲ法测序 ,发现此株病毒是腺病毒 5型。现场调查发现病人发病时间非常集中 ,从 17日开始 ,19…     

美国《Emerging Infectious Diseases》2004年第10期有关人兽共患病论文摘译

P1745　医院住院的恢复期SARS病人标本的病毒特异RNA和抗体的检测 //HoeNamLeong ,KwaiPengChan ,AliSKhan ,等严重急性呼吸综合征即SARS由冠状病毒SARS CoV引起的。我们在垂直的横断面调查中 ,发现SARS恢复期病人各种分泌物及血清阳转的时间不同。我们每周收集结膜分泌物、咽拭子、粪便及尿液标本 ,采用实时PCR的方法从64例病人检测到SARS CoVRNA ,血清抗体用间接免疫酶和免疫荧光试验检测 ,总共收集到 12 6份结膜分泌物、12 4份咽拭子、116份粪便及 12 4份尿液标本。其中有 5例病人在5～ 9周的粪便中检测出阳性 ,2例病…     

无痰病人超声波雾化引痰法

在结核病的诊断和疗效考核中,常因病人无痰而不能达到检查的目的。已有的方法如抽取胃液和咽拭子机械刺激咽部等,因技术复杂或病人痛苦而未能广泛应用。1980年我们开始采用超声波雾化引痰来解决无痰病人的查痰问题,取得较好的效果,现介绍如下。一、对象 1.X线可疑肺结核而无痰的病人; 2.X线上疑有排菌可能,但由于痰标本不好的痰菌阴性病人;     

肺炎支原体感染与社区获得性肺炎合并急性心肌梗死的关系

目的探讨肺炎支原体(MP)感染与社区获得性肺炎(CAP)合并急性心肌梗死(AMI)的关系。方法采用酶联免疫吸附(ELISA)法检测CAP合并AMI病人30例、CAP未合并AMI病人30例及健康对照组30名MP-IgM抗体、白介素-6(IL-6)水平;采用实时荧光定量PCR(RT-PCR)法检测痰标本、咽拭子MP-DNA。结果 CAP合并AMI组MP-IgM阳性率高于CAP未合并AMI组,差异无统计学意义(P0.05);CAP合并AMI组痰标本、咽拭子MP-DNA阳性率明显高于CAP未合并AMI组,差异均有统计学意义(P0.05);CAP合并AMI组IL-6水平明显高于CAP未合并AMI组和健康对照组,差异有统计学意义(P0.05)。结论MP感染与CAP合并AMI的发生发展相关。     

4例新型冠状病毒感染病例咽拭子与痰标本病毒核酸检测的比较

目的比较分析新型冠状病毒病例咽拭子与痰标本的病毒核酸检测效果。方法对4例新型冠状病毒确诊病例的咽拭子与痰标本分别进行人体细胞GAPDH管家基因、病毒ORF 1ab基因、N基因及S基因Real time RT-PCR核酸检测与比较。结果4例病例的咽拭子和痰标本中,人体细胞管家基因GAPDH均呈现明显典型的扩增信号曲线;病毒ORF 1ab基因、N基因及S基因核酸检测中,痰标本的扩增曲线信号均比咽拭子强,扩增曲线的CT值均低于咽拭子,在病例1和4表现更加明显,而病例4的咽拭子标本检测中,商品化试剂呈现阴性结果,而痰标本则呈现明显的阳性结果。结论在开展新型冠状病毒实验室核酸检测中,痰标本的病毒含量高于咽拭子标本,其检测效果优于咽拭子标本。     

1例小肠结肠炎耶尔森菌人畜感染情况研究

目的 研究小肠结肠炎耶尔森菌(Y.e)人畜感染情况,探索传染来源。方法 采集腹泻病人粪便标本和猪咽拭子进行Y.e常规分离鉴定。对分离株进行血清学分型,用PCR方法检测毒力基因,用脉冲场凝胶电泳(PFGE)进行分子分型。结果 从150例腹泻病人中分离到Y.e 3株,其中1株血清型为O∶3;从该O∶3株病患老家采集的222份猪咽拭子分离到Y.e 14株,都为O∶3血清型;PFGE分子分型显示病人体内分离到的致病Y.e与家猪分离株有较高的同源性。结论 证实1例小肠结肠炎耶尔森菌从家猪传染人的病例,并发现Y.e在治愈病人体内至少存在了2个月。     

从艾滋病患者和HIV感染者中分离2株支原体

目的：从病原学角度探讨我国HIV感染者和AIDS病人中是否存在发酵支原体、穿通支原体和梨支原体的感染。方法：采集江苏省HIV感染者和AIDS病人的咽拭子和尿液标本18份。咽拭子和经离心的尿液标本过滤后接种在SP-4培养基作上述三种艾滋病相关支原体的分离培养。阳性培养物用代谢抑制试验、PCR和序列测定等方法加以鉴定。结果：从5例AIDS患者的尿液中分离到1株穿通支原体，13例HIV感染者尿液中分离到1株发酵支原体，未分离到梨支原体。结论：江苏地区AIDS患者和HIV感染者中存在穿通支原体和发酵支原体的感染，在艾滋病防制工作中应考虑这些支原体的诊断和治疗。如能加以干预，将有助于减少HIV的复制和减缓HIV感染者向AIDS发展的进程。     

山东省首例人禽流感病例的诊断过程分析

目的对2009年1月15日山东省济南市发生的1例人禽流感病例进行实验室诊断过程分析,探讨实验检测过程中遇到的问题。方法采集病人咽拭子和呼吸道吸取物标本,利用RT-PCR和real-time RT-PCR检测病毒核酸。结果第2次采集的咽拭子标本采用H5HA引物的RT-PCR扩增呈阳性;呼吸道吸取物分别用H5NA等3对引物进行RT-PCR均阳性,real-time RT-PCR阳性。结论该患者为人感染高致病性禽流感病毒（H5N1）实验室确诊病例。呼吸道吸取物是禽流感病毒核酸检测的合适标本。     

脑膜炎双球菌性浆液性脑膜炎

作者从1973～1980年共收治脑膜炎双球菌性浆液性脑膜炎病人7例。患者入院前未应用抗生素治疗。所有病人脑脊液均培养出脑膜炎双球菌亦证实其诊断。3例病人脑脊液涂片查到脑膜炎双球菌,2例咽拭子培养也生长此菌。年龄1～2岁有3例,4～11岁3例,23岁1例。男5例,女2例。4例于发病后2～6天入院。重度2例、中度5例。临床表现为急剧发病,中毒症状明显、头痛、一般状态欠佳、周身不适、皮肤苍白、全身感觉过敏、头昏、有顽固性呕吐,吐后头昏症状不减轻。2例体温37～38℃,5例38℃以上,发热期为4～8天。4例病人形成脑膜     

聚合酶链反应技术检测咽拭子标本中结核菌DNA的评价

为探讨聚合酶链反应（PCR）检测咽拭子标本中结核菌在诊断肺部疾病的价值。应用PCR法检测肺结核患者50例，非肺结核患者55例及100例正常健康人咽拭子标本中结核菌和咽拭子涂片找抗酸杆菌，并与痰涂片检查作比较。肺结核组、非肺结核组及正常健康人咽拭子PCR阳性率分别为60％、3O．9％及10％，涂片为6％、0％和0％。结核组及非结核组痰PCR阳，牲率为54％和10．9％，涂片为26％和0％。结果表明PCR检测咽拭子标本结核菌DNA是肺结核病早期诊断和鉴别诊断的一种有价值的检测手段。但应注意假阳性或假阴性出现的可能。     

一起学校内腺病毒引起的急性呼吸道感染疫情暴发调查

目的对一起学校内急性呼吸道感染暴发疫情进行流行病学调查和病原学检测,以明确诊断,控制疫情。方法开展现场流行病学调查,核实搜索病例,分析疫情特征;采用病例对照研究分析危险因素;采集咽拭子标本,运用RT-PCR方法进行病毒核酸检测。结果共有病例43例,学生罹患率为1.31%,病例分布在4个班级,有明显的集聚性。病例对照研究显示与病例密切接触是危险因素。12例的咽拭子标本病毒核酸检测显示,8例腺病毒阳性。结论本次急性呼吸道感染疫情暴发由腺病毒引起,学生间密切接触是主要的传播方式。     

Keratoconjunctivitis associated with adenovirus type 37: an extended outbreak in an ophthalmologist's office

An outbreak of epidemic keratoconjunctivitis occurred in three clusters among patients of an ophthalmologist during 1977-1978. Cases in the third cluster and possibly one case in the first were caused by infection with adenovirus type 37. Among 83 infected patients, the mean interval between a visit to the ophthalmologist's office and the onset of symptoms was 11 days. Conjunctival specimens from 64 (77%) of the patients yielded adenovirus type 37, and adenovirus hexon antigen was identified by counterimmunoelectrophoresis in pooled specimens from the office environment. Infected patients were older and had more glaucoma, and were therefore tested more frequently by tonometry, than noninfected control patients. The association of this outbreak with adenovirus type 37 was made in 1981, the year in which this new serotype was fully described and reference reagents were produced. This is the first report of infection due to adenovirus type 37 in the United States.     

A nosocomial outbreak of influenza during a period without influenza epidemic activity.

The objective of this study was to describe a nosocomial outbreak of influenza during a period without influenza epidemic activity in the community. Outbreak investigation was carried out in an infectious diseases ward of a tertiary hospital. Presence of two or more of the following symptoms were used to define influenza: cough, sore throat, myalgia and fever. Epidemiological survey, direct immunofluorescence, viral culture, polymerase chain reaction, haemagglutination-inhibition test in throat swabs and serology for respiratory viruses were performed. Twenty-nine of 57 healthcare workers (HCW) (51%) and eight of 23 hospitalised patients (34%) fulfilled the case definition. Sixteen HCW (55%) and three inpatients (37%) had a definitive diagnosis of influenza A virus infection (subtype H1N1). Among the symptomatic HCW, 93% had not been vaccinated against influenza that season. Affected inpatients were isolated and admissions in the ward were cancelled for 2 weeks. Symptomatic HCW were sent home for 1 week. On the seventeenth day of the outbreak the last case was declared. The incidence of cases in this outbreak of influenza, which occurred during a period without influenza epidemic activity in the community, was notably high. Epidemiological data suggest transmission from healthcare workers to inpatients. Most healthcare workers were not vaccinated against influenza. Vaccination programmes should be reinforced among healthcare workers.     

A community outbreak of epidemic keratoconjunctivitis in central Australia due to adenovirus type 8

A large outbreak of epidemic keratoconjunctivitis occurred in Alice Springs, Australia, between July and September 1989. Initially, there was a large outbreak within two child care centers, followed by a more prolonged outbreak within the community. A simultaneous outbreak occurred among staff at the local hospital. Infected children developed mild conjunctivitis, whereas adults developed typical keratoconjunctivitis. Conjunctival swabs from 30 cases were cultured and adenovirus was recovered from 18, all of which were typed by neutralization assay as adenovirus type 8. DNA restriction fragment analysis of the genomes of 5 isolates revealed they were identical, distinct from prototype adenovirus type 8, and nearly identical to adenovirus genome type 8C (Ad-8C), which was previously reported in the southern United States in the early 1970s. Ad-8C was present in another region of Australia greater than or equal to 1 year before the epidemic.     

Outbreak of respiratory tract infections on an islet in Korea: possible Chlamydia pneumoniae infection

In March 2004, we experienced an outbreak of Chlamydia pneumoniae infection on an islet of Korea. In order to assess the significance of the epidemic, we performed a mass examination of 137 students (7-16 years old; male, 69; female, 58) at a school. The examination consisted of a questionnaire inquiring about respiratory symptoms, a serum antibody test for C. pneumoniae using a microimmunofluorescence (MIF) method and enzyme-linked immunosorbent assay (ELISA), and nasopharyngeal swab tests to detect of the organism by specific PCR and cell culture. The results demonstrated that 72 (58.3%) of the students had respiratory symptoms such as rhinorrhea, a sore throat, and/or cough or fever. The PCR positivity of acute-phase patients was 63% (12/19) and PCR positivity using the culture sample was 94% (18/19). However, the existence of the organism was not confirmed fluorescein isothiocyanate (FITC). ELISA, one of the serological methods utilized, demonstrated, in the same patients, 48% (13/27) positive IgM antibodies at the acute phase of the outbreak, and 16% (3/19) positive IgM antibodies during the convalescent phase. The index value (ID) 3.0 for single-sera IgG was 19% (5/27) and that for IgA was 4% (1/27) at the acute phase; the corresponding percentages in the convalescent phase were 11% (2/19) and 5% (1/19), respectively. However, as regards paired sera, no patient demonstrated a 1.35 ELISA ID value at 2 weeks, or an increased value of 1.0 at 8 weeks after the onset of the outbreak. In the MIF experiment, the percent positivity of unpaired IgM from the acute phase was 58% (11/19). At convalescent phase, this percentage was 47% (9/19); however, the positivity of paired serum IgG was 26% (5/19). In the same sample, the percentage of positive cases demonstrated by both ELISA and MIF approaches for single IgM was 37% (7/19) at the acute phase and 11% (2/19) at the convalescent phase. We were unable to isolate C. pneumoniae by cell culture, but we did obtain sufficient serological and PCR data to consider C. pneumoniae as the causative agent of the outbreak. Meaningful results were acquired in terms of serology, and were compared to the healthy population in Korea. Although it remains necessary to investigate the possibility of co-infection and to determine whether or not this outbreak coincides with the prevalence of influenza, it was unequivocally concluded that this outbreak of C. pneumoniae infection has occurred on an islet of Korea.     

Bacteria and viruses that cause respiratory tract infections during the pilgrimage (Haj) season in Makkah,Saudi Arabia

objective To determine the incidence and type of RTI-causing bacteria and viruses during a period of epidemic infections. method A total of 395 sputum specimens and 761 throat swabs were collected during the 1991 and 1992 pilgrimage seasons (Haj to Makkah Al-Mukarama, Saudi Arabia) from patients referred to one hospital and three dispensaries with symptoms of respiratory tract infections. All 761 throat swabs of both Haj seasons were also screened for the presence of viral pathogens with monoclonal antibodies specific for 7 viruses known to cause respiratory infections. results Bacterial pathogens were detected in 118 (29.9%) specimens. During the 1991 Haj season Haemophilus influenzae was the most frequent bacterial pathogen detected (10%), followed by Klebsiella pneumoniae (5.2%), Streptococcus pneumoniae (4.8%), Staphylococcus aureus (3.8%) and Streptococcus pyogenes (2.4%). In the 1992 Haj season Klebsiella pneumoniae was predominant (15.1%), followed by Haemophilus influenzae and Streptococcus pneumoniae (12.3%). Screening of all sputum specimens for acid-fast bacteria showed that the overall incidence rate of tuberculosis was 1%. Cultures from the 761 throat swabs were largely negative for bacteria except for Streptococcus pyogenes isolated from 7 patients. Viruses were detected in 148 (19.5%) specimens with influenza A and adenovirus being the most common viruses. conclusion The pattern of virus prevalence in the 1991 and 1992 pilgrimage seasons was identical: influenza A and adenovirus predominated. Thus these two viruses should be targeted in future prophylactic measures.     

A large outbreak of epidemic keratoconjunctivitis: problems in controlling nosocomial spread

Between July 1985 and January 1986, 401 patients with adenovirus epidemic keratoconjunctivitis (EKC) were seen at the Illinois Eye and Ear Infirmary. Of the cases, 110 (27%) were nosocomial; the other 291 patients had community acquired infection. The highest attack rates of EKC occurred in patients attending specialty clinics; the overall attack rate among clinic patients was 4.7/1,000 clinic visits. All nosocomial cases were caused by adenovirus type 8; community acquired cases were a mixture of adenovirus types 8 and 37. Adenoviruses were isolated from conjunctival cultures up to 14 d after the onset of clinical illness. Initial efforts to prevent nosocomial transmission were unsuccessful. However, when a plan to triage all patients on entry to the infirmary and to sort patients and personnel caring for infected patients into cohorts was implemented, nosocomial transmission of EKC was promptly and effectively halted, despite the continuation of the community epidemic for another 4 mo. This outbreak clearly demonstrates the efficacy of rigorous infection control in preventing nosocomial transmission of adenovirus EKC.     

Bacteriology of sore throats in a Sudanese population

One hundred and eighty-six throat swabs were collected from patients with sore throats and 164 throat swabs were collected from healthy controls. All swabs were investigated bacteriologically, and sensitivity tests were performed on all pathogenic isolates. Group A Streptococcus pyogenes was the predominant pathogenic organism (24.7%) and Proteus vulgaris the least predominant organism (0.5%) isolated from patients with sore throats. Streptococcus pyogenes infection was found to be most common among school children between the ages of 9 and 12 (61.5%). The pathogenic organisms were found to be sensitive to erythromycin (92.6%).     

Serum anti-lPS antibody production in an outbreak of enterohemorrhagic Escherichia coli O157 infection among schoolchildren

Although there have been many reports of the usefulness of serodiagnosis of enterohemorrhagic Escherichia coli (EHEC) O157, the serotype of the bacteria detected and the increase in anti-LPS antibody have not always been consistent. In this study we investigated the diagnostic significance of measurements of anti-LPS antibody by ELISA in an outbreak of O157 infection among schoolchildren in whom the bacteriological test findings were clarified and the age groups were uniform. The anti-LPS antibody titer was measured in 31 patients (77 serum samples) in an outbreak of EHEC O157 : H7 infection (220 children infected) that occurred in a primary school in Morioka in 1996. The anti-O157 LPS antibody positivity rates of IgM, IgG, and IgA were 98.7%, 85.7%, and 98.7%, respectively. Between the time the meal that caused the outbreak and 19 days later, anti-O157 LPS IgM antibody and IgA antibody were detected in all patients. The specificity was investigated using control serum, and the specificity of IgM, IgG, and IgA was 93.5%, 93.5%, and 97.2%, respectively. Some samples contained antibodies against O111 and O26 LPS, but the titers were lower than the anti-O157 antibody titer. The anti-O111 antibody titer and anti-O26 antibody titer were highly correlated, suggesting that they were crossreactive antibodies for O157 LPS. No significant correlation was found between differences in clinical manifestations and the anti-O157 LPS antibody titer in this O157 outbreak in schoolchildren. It was clarified that an increase in anti-LPS antibody was found to support the diagnosis of mild cases of 0157 infection infection as well as severe cases.