九江市首例人感染猪链球菌病的病原学特征分析

摘要：目的 通过对九江市 １ 例人感染猪链球菌患者脑脊液标本分离的菌株进行鉴定分型，了解菌株的分子特征。 方法 提 取病例脑脊液标本中 ＤＮＡ，ＰＣＲ 检测 １６Ｓ ｒＲＮＡ、血清 ２ 型猪链球菌特异性荚膜多糖编码基因片段 ｃｐｓ２Ｊ、猪链球菌毒力基因溶 菌酶释放相关蛋白编码基因（ｍｒｐ）、溶血素基因（ｓｌｙ）及细胞外蛋白因子编码基因（ｅｆ），Ｅ?ｔｅｓｔ 条测定 １３ 种药物的敏感性，并进 行多位点序列分型（ＭＬＳＴ）。 结果 病例标本中猪链球菌 １６Ｓ ｒＲＮＡ、ｃｐｓ２Ｊ 和 ３ 种毒力基因（ｍｒｐ、ｓｌｙ、ｅｆ）均为阳性，药敏检测显 示对链霉素、壮观霉素、头孢克肟、庆大霉素、氯霉素、青霉素、利福平、万古霉素、复方磺胺甲噁唑和克林霉素敏感，红霉素、四 环素和阿奇霉素耐药， ＭＬＳＴ 分析结果为 ＳＴ１ 型。 结论 该病例的病原菌是携带 ３ 种毒力基因的 ＳＴ１ 型猪链球菌血清 ２ 型菌 株，具有较强毒力。     

人感染猪链球菌病例1例报告

2005年12月28日14∶30分,贵州省黎平县疾病预防控制中心(CDC)接到广西自治区三江县CDC的疫情通报:黎平县村民潘某,在该县中医院住院死亡,疑似为人感染猪链球菌病例。县疫情调查核实处理工作组,立即前往该村调查核实处理疫情,现将疫情调查处理情况报告如下。     

四川省83例人感染猪链球菌病患者的临床特征

目的 探讨四川省2005年7月下旬至8月上旬83例猪链球菌病患者的临床特征.方法收集83例住院患者资料,包括病原学、流行病学、临床表现、细菌学检查、毒力基因鉴定结果、药敏试验等,进行分析.结果 （1）从病死猪心血培养物和肝组织培养物分离到的细菌与从死亡患者脾组织培养物、患者血、脑脊液培养物分离到的细菌,经鉴定均含猪链球菌Ⅱ型的毒力基因：猪链球菌Ⅱ型荚膜多糖基因（cps2A）,溶菌酶释放相关蛋白基因（sly）,溶血素基因（sly）,且高度同源;来自人、猪的猪链球菌Ⅱ型对四环素、链霉素耐药,来自人的两株菌对环丙沙星中介.（2）83例患者均有宰杀、肢解病死猪和猪血浆成份（血、组织液）直接接触史,皮肤有可见伤口者,感染率高.（3）临床分为普通型、脑膜炎型、休克型、混合型四型.（4）普通型脑膜炎型预后良好,休克型、混合型预后相对较差,与本病相关的总死亡率是14.50%（12/83）.结论 （1）猪链球菌Ⅱ型是本次猪链球菌病病原体,传染源是患病死亡的猪.（2）主要传播途径是直接接触病死猪的血浆成份,无第二代患者产生.（3）重症患者早期就诊是提高存活率重要措施.（4）重视抗菌药物在家畜、家禽中的合理应用.     

江苏省苏州市1例人感染猪链球菌病例调查

目的 调查苏州市1例人感染猪链球菌病例的流行病学和病原学特点,为防控提供依据。 方法 现场访谈查看患者的感染途径和感染来源,并进行溯源调查;对患者及80份生猪扁桃体、鼻咽拭子标本中分离的菌株进行VITEK2 compact生化鉴定和聚合酶链式反应检测,检测种属特异性基因（16S rRNA）和4种毒力基因（cps-2J、sly、ef 和mrp）。 结果 经流行病学调查,患者可能在清洗猪肉过程中经手部伤口感染。患者分离株种属特异性16S rRNA 基因、毒力基因cps-2J、sly和 ef 基因均呈阳性。2份猪鼻咽拭子标本经生化鉴定为猪链球菌2型,毒力基因sly呈阳性。 结论 该病例可能为偶然感染强毒株。健康猪群猪链球菌2型检出率低、毒力低,不足以威胁健康人群;应保持警惕,做好生猪检疫工作,加强监测和宣传教育,在接触生猪制品时,做好个人防护,防止感染猪链球菌病。      

人感染猪链球菌病15例临床分析

目的: 探讨人感染猪链球菌病的临床特点.方法: 回顾性分析四川省人民医院医科院附院在2005年7月～8月确诊的15例人感染猪链球菌病的临床特点.结果: 15例患者均有接触病死猪肉史,潜伏期平均2～3天,临床表现分为普通型、脑膜炎型、休克型、混合型4型.患者血、脑脊液培养为猪链球菌2型.15例患者经抗感染、抗休克、降颅内压、对症支持治疗,除休克型1例死亡外,余14例均治愈.结论: 人感染猪链球菌病是由猪链球菌2型引起的,人经直接接触病死猪而发病,无人感染人现象发生.早期就诊,早期使用有效的抗生素治疗是提高成活率的关键.     

重视人感染猪链球菌病的防治

引起人感染猪链球菌病的主要病原体为2型猪链球菌，是一种能够引起人畜共患病的病原体，主要通过人与病猪接触进行传播。人感染2型猪链球菌后以败血症型和脑膜炎型多见，常伴有中毒性休克综合征（TSS），预后差、病死率高。对人感染猪链球菌病的治疗建议早期使用大剂量青霉素类合并第三代头孢菌素。预防以避免接触病猪、死猪，食用猪肉时要烹饪完全。     

人猪链球菌感染研究进展

猪链球菌（Streptococcus suis，SS）是链球菌属一员，是猪群正常的携带菌，有时会导致猪群发病和殃及人类，其所致的疾病属于人畜共患性疾病。至目前仝世界报道人的SS病已200多例；困内也见多地区的人群发生此病。2005年7至8月份，四川资阳地区的民众大规模地爆发此病，病例数达200多例，死亡39例；随后就有较多的有关此病的报道。作者就有关此病的若干现状扼要地综述如下。     

2例人感染猪链球菌病临床分析

<正>猪链球菌(Streptococcus suis)是一种人畜共患病原菌,人猪链球菌感染主要通过破损的皮肤或黏膜接触病(死)猪而感染。人感染该病原菌后可出现高热、寒战、头痛、腹泻、听力下降甚至耳聋、运动功能紊乱等症状,重症患者有中毒性休克、弥散性血管内凝血(DIC)、脑膜炎、败血症等临床表现,严重者可致死亡等。2013年5~7月,本院临床工作中发现2例猪链球菌感染引起的脑膜炎和败血症病例,桂林地区尚少见报道,现报道如下。1病例资料1.1病例简介患者1,男,55岁,2013年5月初发热2d后     

一例人感染猪链球菌病患者的护理

<正>人感染猪链球菌病是一种人畜共患的急性细菌性传染病,系由多种不同群的链球菌感染引起不同临床类型传染病总称,此病潜伏期短、起病急、进展快、病情重,休克型患者短时间可出现弥漫性血管内凝血(DIC)、急性肾功能衰竭(ARF)、急性呼吸宭迫综合征(ARDS),病死率高[1],及早给予有效治疗,进行充分隔离,严密护理观察非常重要[2]。2013年4月,我院收治1例人感染猪链球菌病患者,经积极抢救治疗及护理,患     

人感染猪链球菌病脑膜炎型临床特点分析

目的：分析四川省成都地区7～8月发生的人感染猪链球菌病脑膜炎型临床特点,为更好地控制、治疗该病提供依据。方法：对20例人感染猪链球菌病脑膜炎型进行回顾性分析。结果：20例人感染猪链球菌病脑膜炎型均为男性,平均年龄32～76岁,有皮肤伤口及与病死猪接触史。起病急,临床表现为畏寒、寒战、发热及头痛、恶心、呕吐及脑膜刺激征、病理征,部分病人伴听力下降和口唇疱疹。脑脊液呈化脓性脑膜炎改变,血液、脑脊液中分离出7株（35%）猪链球菌2型。头孢曲松钠联合青霉素治疗有效,全部治愈。结论：本次人感染猪链球菌病脑膜炎型由猪链球菌Ⅱ型所致,病死猪为传染原;脑膜炎型比例高,对头孢曲松钠联合青霉素治疗有效,早期治疗预后较其他亚型好。     

对奥谱托欣耐药肺炎链球菌的鉴定

目的对奥谱托欣耐药的肺炎链球菌和奥谱托欣敏感的其他α溶血性链球菌进行准确的鉴定。方法采用奥谱托欣敏感试验、胆汁溶解试验、乳胶凝集试验及生化鉴定试验进行鉴定。结果630株肺炎链球菌中有两株对奥谱托欣具有抗药性,占0.3%。31株对奥谱托欣具有敏感性的α溶血性链球菌包括13株缓症链球菌、6株口腔链球菌、6株孪生球菌、3株少酸链球菌、2株中间型链球菌、1株星座链球菌。对奥谱托欣敏感的α溶血性链球菌,其抑菌环直径绝大部分在14～17mm范围内,而肺炎链球菌对奥谱托欣的抑菌环直径绝大部分都在20mm以上。对奥谱托欣敏感的α溶血性链球菌对苯唑西林大都呈高度耐药(93.5%),而肺炎链球菌大都敏感(94.0%)。结论胆汁溶解试验和乳胶凝集试验鉴定肺炎链球菌的特异性高,试验结果可靠。APIStrept鉴定试条和VITEK·TWOGPC鉴定卡可用于耐奥谱托欣肺炎链球菌的鉴定。     

Identification of diarrheagenic Escherichia coli by a new multiplex PCR assay and capillary electrophoresis

Diarrheagenic Escherichia coli (DEC) is a set of the most common pathogens causing diarrhea. DEC strains are classified into five pathotypes based on the possession of different virulence genes: enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC) or Shiga toxin-producing E. coli (STEC), enteroaggregative E. coli (EAEC), enterotoxigenic E. coli (ETEC), and enteroinvasive E. coli (EIEC). The development of an easy-to-use method to detect the specific virulence genes and distinguish the pathotypes is essential for the diagnosis and surveillance of DEC infections. In this study, a multiplex PCR assay (mPCR) specific to nine virulence genes and an internal control was designed for the identification of five DEC pathotypes. A temperature switch PCR (TSP) strategy was used in the PCR amplification. The PCR products were detected by capillary electrophoresis. The limit of detection (LOD) of the 10-plex reaction was 5 × 10³ copies/reaction for stx2 and 5 × 10² copies/reaction for the other targets. The mPCR showed very high specificity, and inclusivity and exclusivity were both 100%. When the mPCR assay was used for the detection of 221 cryopreserved diarrhea specimens, DEC colonies were detected from 49 specimens, and the positive rate was 22.2%. The mPCR assay was sensitive and specific, and the amplified product could be analyzed easily. Thus, this method could be used effectively to identify the suspected colonies of DEC in the primary culture of the specimen.     

A specific polymerase chain reaction test for the identification of Streptococcus pneumoniae

Using an approach based on the comparison of arbitrary primer polymerase chain reaction (PCR) genomic profiles from oral streptococci and Streptococcus pneumoniae strains, we identified a 434-bp genomic fragment apparently specific for S. pneumoniae. From the nucleotidic sequence of this common fragment, a pair of primers was designed and tested on a set of strains comprising the major Streptococcus species. One species, S. anginosus, gave an amplification product of the same length as S. pneumoniae. Sequence comparison of the S. anginosus and S. pneumoniae amplicons revealed several variations which were used to define a new set of primers giving a 181-bp S. pneumoniae-specific fragment. The amplified fragment contains the 5' terminal part of a gene encoding a putative sugar-specific permease and an intergenic sequence. The PCR test was evaluated on 257 strains of invasive S. pneumoniae corresponding to clinical isolates and on 153 non-pneumoniae oral streptococci strains; in addition, 3 S. pseudopneumoniae strains were tested. With these primers, an amplification product was only obtained with the S. pneumoniae strains. Moreover, the test was successfully evaluated on 10 atypical S. pneumoniae strains related to pneumococcal diseases. In this study, we therefore established the capacity of a simple PCR test to discriminate S. pneumoniae from other Streptococci (including S. pseudopneumoniae), thus allowing rapid and accurate diagnosis.     

实时荧光定量聚合酶链反应检测血清2型猪链球菌的研究

目的 基于TaqMan-MGB探针实时荧光定量聚合酶链反应(Real.time PCR)技术,建立针对血清2型猪链球菌的快速检测方法.方法 针对血清2型猪链球菌的csp2J基因序列,应用Beacon Designer 7.0,设计了引物和TaqMan-MGB探针,建立Real-time PCR检测方法;把目的 片段克隆...     

肺炎链球菌TaqMan实时荧光定量PCR的建立及临床应用

目的：建立TaqMan实时荧光定量PCR检测肺炎链球菌的方法,应用于临床儿童社区获得性肺炎（CAP）标本的快速筛查。方法根据 GenBank公布的肺炎链球菌自溶酶基因（lytA）设计引物和探针,建立实时荧光定量 PCR,并对体系进行优化;同时以痰培养法做双盲对照,应用于1504份 CAP患儿标本检测。结果 TaqMan实时荧光定量 PCR菌液的最低检出限可达18.75 cfu/PCR,无交叉反应,特异度好;对1504份儿童CAP标本检测,141份肺炎链球菌实时荧光定量PCR阳性,其中140份肺炎链球菌痰培养阳性,该方法灵敏度为100％,特异度为99.93％。从样品处理到结果报告仅需2.5 h。结论 TaqMan实时荧光定量PCR快速、简便、灵敏度高、特异度强,可用于儿童CAP中肺炎链球菌的初筛和指导抗生素的的合理使用。     

应变和应变率成像结合冷加压试验对2型糖尿病患者肱动脉应变及应变率储备的初步研究

目的 本研究旨在探讨应用应变和应变率成像结合冷加压试验评价2型糖尿病患者肱动脉径向应变及应变率储备的可行性及其临床价值.方法 随机选取 49 例 2 型糖尿病患者作为病例组,58例健康志愿者作为对照组.全部进行应变和应变率成像及冷加压试验,获得冷加压试验前后肱动脉的最大径向应变和应变率,计算径向应变和应变率储备.对病例组和对照组的径向应变和应变率储备进行对比分析.结果 49 例 2 型糖尿病患者肱动脉的径向应变和应变率储备均低于健康对照组,两组比较差异有统计学意义(P<0.05).结论 应变和应变率成像结合冷加压试验可以获得肱动脉的径向应变和应变率储备,径向应变和应变率储备可作为评价2型糖尿病患者早期动脉壁机械运动特性改变的新指标,同时可以反映肱动脉内皮功能.     

Macrolide-resistant genes of <Emphasis Type="Italic">Streptococcus pyogenes</Emphasis> isolated from the upper respiratory tract by polymerase chain reaction

The growing number of macrolide-resistant strains of Streptococcus pyogenes is an increasing problem worldwide. This study evaluated 300 clinical isolates obtained from the upper respiratory tract. Minimal inhibitory concentrations (MICs) of erythromycin (EM), azithromycin (AZM), and clindamycin (CLDM), serotypes, and macrolide resistance genes of mefA, ermB, and ermTR were determined. The genetic relationship of EM-resistant and susceptible strains were also analyzed by pulsed-field gel electrophoresis (PFGE). Twenty-nine (9.7%) EM-resistant S. pyogenes were identified. Of the 29 strains showing resistance to EM, 22 isolates (7.3%, MIC 3.13–12.5µg/ml) expressed the mefA gene. The predominant serotypes among the mefA-positive isolates were T12, emm9 or T25, emm75-1. The two isolates (0.1%) that possessed the ermB gene were highly resistant to EM (MIC 100µg/ml). The remaining five strains (1.6%) possessed the ermTR gene (MIC 3.13–100µg/ml). Restriction fragment polymorphism analyzed by pulsed-field gel electrophoresis (PFGE) by SmaI and ApaI digestions showed several clones among the mefA-positive S. pyogenes. Our findings suggest that the mefA gene is the predominant mechanism for macrolide resistance and that this gene is horizontally transmitted among M phenotype strains of S. pyogenes. Consequently, macrolides would not be the first drug of choice for treatment of tonsillitis and other S. pyogenes-related diseases. Physicians and researchers need to take into consideration the macrolide resistance of some strains of S. pyogenes.     

Isolation of Beta-Lactamase from a Penicillin-Susceptible Strain of Staphylococcus aureus

It is generally accepted that strains of Staphylococcus aureus which are susceptible to penicillin G do not produce beta-lactamase. However, we have found that such a strain susceptible to 0.06 mug of penicillin per ml and 0.56 mug of methicillin per ml produces beta-lactamase(s) which hydrolyzes penicillin G, methicillin, 6-aminopenicillanic acid, and probably cephaloridine. The enzyme which is found only during very early log phase of the growth cycle is not inducible either by penicillin or methicillin and is cell bound and liberated only by disruption of the cell. The rate of enzymatic hydrolysis of methicillin was 60% that of benzylpenicillin. This finding suggests that the elaboration per se of beta-lactamase does not necessarily afford resistance to penicillin in this gram-positive-producing cell.