威马逊台风经过地区集中出现的五例类鼻疽流行病学分析

目的：分析威马逊台风过后集中发生的5例类鼻疽，探讨台风对类鼻疽发病的影响。方法2014年8月海南省遭遇18级超强台风“威马逊”，台风过后发病来海口市第三人民医院就诊并确诊的类鼻疽5例，对患者的基本情况、临床特点、流行病学进行分析。对培养分离的菌株进行16SrDNA同源性测序比对、MLST多位点序列分型、TTSS1与BLF1毒力因子检测等分子生物学分析。4个月后家访了解患者预后情况，并采集患者居住地泥土和水培养做环境调查。结果威马逊台风是导致本次5例类鼻疽发病的重要因素。5例患者均来自台风中心经过海南东北部沿海一带，均在台风过后一个月内发病。5例均以肺部感染、脓毒血症为主要表现，死亡3例。5株分离菌株16SrDNA同源性比对均为类鼻疽伯克霍尔德菌，MLST分型分别为不同的ST型，毒力因子检测均为阳性。环境样本培养没有检出类鼻疽伯克霍尔德菌。结论威马逊台风是导致本次5例类鼻疽发病的重要因素，台风会加大类鼻疽水源性或吸入性感染的概率，导致散发、甚至爆发流行。

Epidemiological analysis of 5 cases of malleoidosis in affected areas of typhoon Rammasun

Objective To analyze 5 cases of malleoidosis in affected areas of typhoon Rammasun, and to inves-tigate the effects of typhoon on the incidence of malleoidosis. Methods Five patients with malleoidosis were diag-nosed in the Third People's Hospital of Haikou after super typhoon Rammasun in August 2014. The basic situation, clini-cal characteristics and epidemiology of the patients were analyzed. The isolated strains were analyzed by 16SrDNA ho-mology comparison, multilocus sequence typing (MLST), TTSS1 and BLF1 virulence factor detection. After 4 months, the patients were visited for prognosis, and soil and water samples in their residence were collected for environmental in-vestigation. Results Typhoon Rammasun was an important factor in the pathogenesis of 5 cases of malleoidosis. Five patients were from northeastern coast areas of Hainan which were slammed by typhoon center, and the disease in all the patients occurred within one month after the typhoon. The main manifestations of the five patients were pulmonary infec-tion and pyemia (3 cases of death). 16SrDNA homology comparison showed the five strains and Burkholderia pseudom-allei were highly homologous, of which the MLST types were different ST types and virulence factor test was positive. Burkholderia pseudomallei were not detected in the collected soil and water samples. Conclusion Typhoon Rammasun is an important factor in the pathogenesis of the 5 cases of malleoidosis. The typhoon will increase the chance of malleoi-dosis infection through water or inhalation, resulting in sporadic and even large-scale outbreak of the disease.