儿童菌血症蜡样芽孢杆菌的分离及耐药性分析

目的了解儿童菌血症蜡样芽孢杆菌的感染状况、耐药性与耐药趋势。方法对临床送检标本进行分离培养,采用API 50 CH试验条进行菌株鉴定,采用K-B法测定细菌药物敏感性。结果 2006年1月—2010年3月从血液标本中分离蜡样芽孢杆菌共83株,其中儿童患者61株,占73.5%,61株中配方奶喂养新生儿为49例,占80.3%。蜡样芽孢杆菌对13种临床常见药物抗菌活性较好,对除青霉素、氨苄西林、一二代头孢菌素以外的抗菌药物耐药率均低于25%。结论蜡样芽孢杆菌引起人工喂养的儿童菌血症发病率较高,需严防漏检而贻误治疗时机,尤其应重视准确分离、鉴定菌株,测定其耐药谱,可为临床合理应用抗生素提供理论依据。     

Bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia.

PURPOSE: Hemolysis is so rarely associated with Bacillus cereus sepsis that only two very well documented cases have been reported. This article reports two unusual cases of Bacillus cereus sepsis with massive intravascular hemolysis in patients who had acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: A 20-year-old woman who was 9 weeks pregnant experienced a relapse of ALL. A therapeutic abortion was performed. During week 4 of reinduction the patient had abdominal pain, nausea, and vomiting, with severe neutropenia but no fever. Her condition deteriorated rapidly with cardiovascular collapse, acute massive intravascular hemolysis, and death within hours of the onset of symptoms. Blood cultures were positive for Bacillus cereus. Postmortem histologic examination and cultures revealed Bacillus cereus and Candida albicans in multiple organs. The second patient, a 10-year-old girl, presented with relapsed T-cell ALL. In the second week of reinduction, she had abdominal pain followed by hypotension. Again, no fever was noted. Laboratory studies showed intravascular hemolysis 12 hours after admission. Aggressive support was promptly initiated. Despite disseminated intravascular coagulation; cardiovascular, hepatic, and renal failure; and multiple intracerebral hypodense lesions believed to be infarcts, the patient recovered fully and resumed reinduction therapy. CONCLUSIONS: Bacillus cereus infection can have a fulminant clinical course that may be complicated by massive intravascular hemolysis. This pathogen should be suspected in immunosuppressed patients who experience gastrointestinal symptoms and should not be precluded by the absence of fever, especially if steroids such as dexamethasone are being given. Exchange transfusion may be lifesaving in Bacillus cereus septicemia associated with massive hemolysis.     

大剂量甲氨蝶呤化疗对急性淋巴细胞白血病患儿肠道菌群的影响

目的 探讨大剂量甲氨蝶呤(HDMTX)化疗对急性淋巴细胞白血病(ALL)患儿肠道菌群的影响.方法 收集36名HDMTX化疗前后ALL患儿及36名健康对照组儿童的粪便标本,并提取目标细菌DNA.用细菌的16SrRNA/DNA序列设计双歧杆菌和大肠杆菌的引物,行常规PCR完成细菌的定性,然后取准确定量的2种细菌DNA,经系列稀释后做荧光定量PCR,制作出标准曲线,待测样品同时进行荧光定量PCR反应,并和标准曲线进行比较,获得各样品中2种细菌的量.结果 ALL组HDMTX化疗前1 d、化疗后第3、7天和对照组的肠道双歧杆菌数量的对数值分别为(7.24±0.33)拷贝数/克湿便、(6.00±0.27)拷贝数/克湿便、(6.59±0.33)拷贝数/克湿便和(9.49±0.41)拷贝数/克湿便;而大肠杆菌数量的对数值,ALL组化疗前1 d、化疗后第3、7天和对照组的分别是(6.62±0.42)拷贝数/克湿便,(5.96±0.42)拷贝数/克湿便,(7.02±0.41)拷贝数/克湿便,(7.52±0.43)拷贝数/克湿便.双歧杆菌和大肠杆菌对照组均较ALL组高(F=739.61,88.67,P均＜0.01).ALL组化疗前和后,大便标本中双歧杆菌和大肠杆菌数量变化差异有统计学意义(P均＜0.01),其中化疗第3天下降最明显,第7天有所回升.结论 (1)HDMTX化疗方案对ALL患儿肠道双歧杆菌和大肠杆菌有明显影响,化疗后数量显著下降;(2)ALL患儿肠道菌群和健康儿童相比,益生菌明显减少.     

Intractable Bacillus cereus bacteremia in a preterm neonate

Although often regarded as a contaminant, Bacillus spp. have been implicated in serious systemic infections. The incidence of such infections is low with only a few cases reported in the literature. We describe the clinical course of early-onset Bacillus cereus bacteremia in a preterm neonate who was successfully treated with vancomycin.     

Bacillus species isolates from cerebrospinal fluid in patients without shunts

Of 849 CSF cultures done at Hartford Hospital, nine were positive for nonanthrax Bacillus species. Differentiation of true nonanthrax Bacillus species infection from contamination requires careful consideration of the clinical findings, the clinical course, and the laboratory data. In seven patients the nonanthrax Bacillus species represented contamination. In two patients the nonanthrax Bacillus species represented true infection. In one of these infected patients, nonanthrax Bacillus species complicated a cranial gun shot wound. Bacillus cereus meningitis developed in the second patient, a premature infant, following sepsis from a contaminated IV catheter. Nonanthrax Bacillus species, especially B cereus, can be resistant to penicillins and cephalosporins when nonanthrax Bacillus species infections are being treated, susceptibility testing should always be performed.     

Disseminated Bacillus Calmette-Guérin infection in a girl with hyperimmunoglobulin E syndrome

Disseminated Bacillus Calmette-Guérin infection occurs in few well-defined immunodeficiencies, such as severe combined immunodeficiency, chronic granulomatous disease and paediatric acquired immunodeficiency syndrome. This severe complication of immunization against tuberculosis has been lethal in the majority of children who had primary immunodeficiency. Our patient, a 9-y-old girl with hyperimmunoglobulin E syndrome developed disseminated Bacillus Calmette-Guerin infection in infancy. Patients with hyperimmunoglobulin E syndrome (HIES) are susceptible to serious staphylococcal and fungal infections. Disseminated Bacillus Calmette-Guerin infection has not previously been reported in this rare immunodeficiency.     

Bacillus cereus central line infection in an immunocompetent child with hemophilia

Bacillus species are increasingly recognized as pathogens in immunocompromised patients. The authors report a case of Bacillus cereus infection of a central line in an immunocompetent patient with hemophilia, which required line removal for complete cure.     

Über den Bordet-Gengouschen Keuchhustenbacillus,bes. Übertragungsversuche des Keuchhustens auf Tiere

Zusammenfassung 1. Mikroskopisch wurde unter 81 untersuchten Keuchhustenfällen der Bordet-Gengousche Bacillus 78 mal gefunden; negativ waren dabei nur drei Untersuchungen in spätem Stadium.2. Kulturell wurde derselbe Bacillus unter 77 untersuchten Keuchhustenfällen 68 mal nachgewiesen, das ist in 88%. Bei den innerhalb der ersten 14 Krankheitstage untersuchten 45 Fällen sogar 41 mal, also in 91%.3. Bei kulturellen Untersuchungen von 18 Fällen andersartiger Respirationskrankheiten fand ich den Bacillus niemals.4. Zur Isolierung des Bordet-Gengouschen Bacillus aus dem Sputum ist mein Nährboden am geeignetsten; dagegen zur Erzeugung größerer Mengen von Kultur ist der Shigasche Nährboden am besten zu empfehlen.5. Die Unterscheidung des Bordet-Gengouschen Bacillus vom Influenzalbacillus ist im Ausstrichpräparate nicht immer, aber in der Kultur stets leicht und deutlich auszuführen.6. Ein Übertragungsversuch des Keuchhustens auf einen jungen japanischen Affen ist mir mit Reinkultur des Bordet-Gengouschen Bacillus einwandfrei gelungen.Zum Abdruck gegeben von Herrn v. Pirquet.     

凝结芽孢杆菌活菌制剂在手足口病中的应用

目的观察和评价凝结芽孢杆菌活菌制剂治疗手足口病的临床疗效。方法将64例手足口病患儿随机分为治疗组(31例)和对照组(33例),两组均给予对症支持治疗,其中治疗组同时加用凝结芽孢杆菌活菌片,≤1岁,0.70 g/次,>1岁,1.05 g/次,3次/d。对两组患儿的疱疹、食欲、体温等变化情况进行统计和分析。结果治疗组患儿疱疹好转、消失时间,食欲和体温恢复正常时间均显著短于对照组;痊愈率、总有效率高于对照组,差异均有统计学意义(P均<0.05)。结论凝结芽孢杆菌活菌片辅助治疗手足口病疗效显著。     

Der Bordet-Gengousche Bacillus in der Ätiologie des Keuchhustens

Zusammenfassung 1. Der Bacillus von Bordet und Gengou findet sich mit bemerkenswerter Häufigkeit im Sputum keuchhustenkranker Säuglinge, besonders im Beginn der Krankheit und bei Fehlen komplizierender Erkrankung der Atmungswege.2. Das Serum keuchhustenkranker Säuglinge zeigt eine wenig konstante Agglutination für den Bordet-Gengouschen Bacillus, aber wenn die Agglutination vorhanden ist, ist sie ziemlich hoch.3. Das Serum keuchhustenrekonvaleszenter Säuglinge zeigt mit bemerkenswerter Häufigkeit eine positive Komplementbindungsreaktion gegenüber dem Bordet-Gengouschen Bacillus.Auf Grund dieser bakteriologischen und serologischen Tatsachen hat man allen Grund anzunehmen, daß der Bordet-Gengousche Bacillus wirklich der Erreger des Keuchhusten ist.Vortrag auf dem 7. italienischen Kongreß für Pädiatrie, Palermo, April 1911.     

Food poisoning as a cause of acute liver failure

We report a 9-year-old girl with cereulide-producing Bacillus cereus food poisoning, who developed fulminant hepatitis, renal and pancreatic insufficiency, shock, and prolonged seizures. She was transferred to our institution for hepatic transplantation before her diagnosis was established. As a result of rapid identification of the microorganism and supportive care, liver transplantation was avoided, and she recovered fully.     

Inhalational anthrax with acute respiratory distress syndrome

A 10-year-old boy presented with facial swelling, thick exudates in the nasal cavities with membranes covering the nasopharynx, shock and respiratory distress. X-ray of the paranasal sinuses showed opacification of both maxillary sinuses. Nasal diphtheria was suspected but culture of the membranes grew Bacillus anthracis. Chest X-ray showed mediastinal widening and extensive pulmonary infiltrates compatible with respiratory anthrax.     

Cytokines evaluation in nasal lavage of allergic children after Bacillus clausii administration: A pilot study

Respiratory infections are very frequent in children. Bacillus clausii has been demonstrated to exert some immunomodulatory activities and to be safe. We conducted a study to investigate whether B. clausii administration in allergic children with recurrent respiratory infections might modulate cytokine pattern. Ten children (mean age 4.4 yr) attending the nursery school were enrolled at the end of school year (i.e. in the summer). Bacillus clausii spores (Enterogermina): 2 billion spores per vial) were administered at the dosage schedule of two vials a day for 4 wk. A panel of cytokines, including interleukin (IL)-1, IL-3, IL-4, IL-6, IL-8, IL-10, IL-12, interferon (IFN)-gamma, transforming growth factor (TGF)-beta, and tumor necrosis factor (TNF)-alpha, was measured by immunoassay in the fluid recovered from nasal lavage, performed before and after the treatment. Bacillus clausii treatment induced a significant decrease of IL-4 levels (p < 0.01) and a significant increase of IFN-gamma (p < 0.05), IL-12 (p < 0.001), TGF-beta (p < 0.05), and IL-10 (p < 0.05) levels. Other cytokines were not significantly modified. In conclusion, this study shows that the B. clausii may exert immunomodulating activity by affecting cytokine pattern at nasal level in allergic children with recurrent respiratory infections.     

解淀粉芽孢杆菌对婴幼儿潜在致病性的研究

解淀粉芽孢杆菌属革兰阳性芽孢杆菌,可污染医院75%酒精消毒液、潮湿损害的房屋、食品,造成新生儿、婴幼儿等免疫力低下的特殊人群感染和房屋污染健康综合征。文章从细菌对环境、食品的污染、院内感染三个方面来阐述其流行状况,从细胞毒素对哺乳动物细胞的毒性来描述其毒理作用,从细菌的芽孢结构特点来证明其特殊的理、化特性,从国外同类菌属的疾病动物模型来进一步探讨其致病性,以期引起临床上的重视。     

Über die Beziehungen des Gasbrandbacillus zur Melaena neonatorum

Zusammenfassung Anläßlich eines Falles von Melaena neonatorum, bei welchem aus der Milz der Bacillus Fränkel-Welch gezüchtet werden konnte, wird die Frage nach der ätiologischen Bedeutung des Gasbrandbacillus für die Melaena erörtert. Es wird die Vermutung ausgesprochen, daß der mit dem Bacillus Fränkel-Welch morphologisch und kulturell als identisch betrachtete Bacillus perfringens, der zur normalen Meconiumflora gehört, in dem blutigen Darminhalt des melaenakranken Kindes besonders günstige Wachstumsbedingungen findet und eine Abartung zu einer pathogenen, toxischen Variante erfahren kann. Eine andere solche Variante stellt der Erreger des echten Gasbrandes dar, von dem ein bei einem Säugling beobachteter Fall mitgeteilt wird.     

Bacterial Aetiology of Infantile Diarrhoea in Papua New Guinea

Bacterial examination of stools of children with diarrhoea was carried out at Port Moresby, Papua New Guinea, where little information is available concerning the causative bacteria of diarrhoea. Shigellae, enterotoxigenic Escherichia coli, Bacillus cereus, Staphylococcus aureus, Campylobacter jejuni, and Aeromonas hydrophila were isolated with the decreasing frequency in that order. Among these, enterotoxigenic E. coli and C. jejuni were isolated for the first time in this country. Although Vibrio parahaemolyticus was recovered from sea water, no cases suffering from this organism were found.     

Optimizing interpretation of the tuberculin test using an interferon-gamma release assay as a reference standard

The interferon-gamma release assays have greater specificity than the tuberculin skin test (TST), and at least equal sensitivity. We analyzed the sensitivity and specificity of the TST in immunocompetent children considering QuantiFERON as the referent standard. A TST cut-off point of ≥ 5 mm indicates excellent sensitivity (100%) and specificity (93%) in children without Bacillus Calmette-Guérin. In Bacillus Calmette-Guérin-vaccinated children, the TST cut-off point of ≥ 10 mm had poorer specificity (86%), and a cut-off point of ≥ 15 mm resulted in reduced sensitivity (60%).     

History and current situation of BCG vaccinations

Vaccination using Bacillus Calmette-Guerin (BCG) discovered at the beginning of the 20th century in France, saved many lives in a period where tuberculosis was extremely widespread in our country. Mandatory for children since the 1950s, the vaccination programme has now been revised and concerns only well-defined situations considered to be at risk.     

Neonatal meningoencephalitis caused by Bacillus cereus

The classic organisms associated with central nervous system infection in the neonate are herpes simplex, Listeria monocytogenes, Escherichia coli, and Streptococcus agalactiae; we describe an unusual case of neonatal meningoencephalitis caused by Bacillus cereus.     

Successful surgical drainage and aggressive medical therapy in a preterm neonate with Bacillus cereus meningitis

Bacillus cereus meningitis is a rare disease with a very high mortality rate in neonates. The authors present the rare case of a premature infant with B. cereus bacteremia and subsequent intracranial abscesses. In addition to aggressive medical therapy, surgical drainage was performed via a left frontal mini-craniotomy. At 15 months of age, the patient had mild developmental delay, cortical blindness, and sensorineural hearing loss. The clinical case is described and difficulties in the management of B. cereus meningoencephalitis in infants are discussed.