北京市顺义区细菌性痢疾临床诊断病例的感染致病菌检测分析

  目的  分析北京市顺义区细菌性痢疾临床诊断病例的感染致病菌构成及病原特征，为该类疾病的科学防控提供依据。  方法  收集细菌性痢疾临床诊断病例44例，进行志贺菌属、弯曲菌属、沙门菌属、副溶血弧菌、霍乱弧菌、致泻大肠埃希菌、小肠结肠炎耶尔森菌7种常见致病菌的分离培养，对分离菌株进行血清分型、分子分型及毒力基因检测。  结果  志贺菌属和小肠结肠炎耶尔森菌检出率为0，其他致病菌检出率由高到低依次为弯曲菌属（30.00%，9/30）、沙门菌属（18.18%，8/44）、副溶血弧菌（15.91%，7/44）、致泻大肠埃希菌（4.55%，12/44）、霍乱弧菌（3.13%，1/32）。 9株空肠弯曲菌分成9种ST型；8株沙门菌分成4种血清型，7种脉冲电场凝胶电泳带型；8株副溶血弧菌分成4种血清型，毒力基因特征均为tdh+/trh-；1株霍乱弧菌为非O1/O139血清型，毒力基因特征为ctx-/t3ss+。  结论  北京市顺义区细菌性痢疾临床诊断错误率较高。 细菌性痢疾临床诊断病例具有较高的致病菌检出率，以弯曲菌属、沙门菌属为优势构成。 志贺菌属与其他腹泻肠道致病菌的快速鉴别诊断应在临床尽快建立并推广应用。

Detection of pathogens in clinically diagnosed cases of bacillary dysentery in Shunyi,Beijing

  Objective  To analyze the composition and characteristics of pathogens of clinically diagnosed cases of bacillary dysentery in Shunyi, Beijing, and provide evidence for the effective prevention and control of bacillary dysentery.  Methods  A total of 44 clinical samples were collected from clinically diagnosed bacillary dysentery cases for the detections of Shigella, Campylobacter, Salmonella, Vibrio parahaemolyticus, Vibrio cholerae, Diarrhea Escherichia coli and Yersinia enterocolitica. Serotyping, molecular subtyping and virulence gene detection were performed for the pathogenic isolates.  Result  No Shigella and Yersinia enterocolitica were detected, and the positive rate was 30.00% (9/30) for Campylobacter, 18.18% (8/44) for Salmonella, 15.91% (7/44) for V. parahaemolyticus, 4.55% (2/44) for Diarrhea E. coli and 3.13% (1/32) for V. cholerae. Nine Campylobacter jejuni strains belonged to 9 STs; 8 Salmonella strains belonged to 4 serotypes and 7 PFGE patterns; 8 V. parahaemolyticus strains belonged to 4 serotypes and the virulence genes were tdh+/trh- and 1 V. cholerae strain belonged to non O1/O139 serotype and the virulence genes were ctx-/t3ss+.  Conclusion  The misdiagnosis rate of bacillary dysentery was high in Shunyi, to which close attention should be paid. The detection rate of pathogenic bacteria was high in clinically diagnosed cases of bacillary dysentery and the predominant pathogens were Campylobacter and Salmonella. The rapid differential diagnosis method between Shigella and other diarrhea pathogenic bacteria should be established and applied as soon as possible.