病毒性肝炎人群重叠感染HCV的调查

为了解某市各型肝炎患者重叠感染HCV状况,为肝炎的防治提供科学依据,我们自1994年6月至1996年12月,对某市市级医院住院的2 938例各型肝炎患者进行了抗-HCV检测,结果报告如下.     

10816名中学生乙型病毒性肝炎感染状况调查分析

为了解我市城乡中学生乙型病毒性肝炎病毒 (HBV)感染情况 ,提供制定城乡学生乙肝防治措施的科学依据 ,我们对2 0 0 2年度中学新生进行了HBV感染调查分析。1　材料和方法1.1　对象　以德州市跃华学校、武城县实验中学等市县学校2 0 0 2级初中、高中新生为调查对象 ,共调查 10 816人。1.2　方法　清晨空腹抽取静脉血 ,分离血清 ,采用酶联免疫吸附 (ELISA)法检测乙肝五项。试剂为上海华泰生物工程实业有限公司生产 ,均在有效期内使用 ,操作与结果判定均严格按试剂盒使用说明书进行。2　结果2 .1　HBsAg阳性检出情况　见表 1。2 .2　血清H…     

南雄县病毒性肝炎血清流行病学调查

你总是奇怪，为什么你有时在吃过冷饮后会感到头疼？为什么会打嗝？……，在哥伦比亚广播公司“早间秀”节目中，玛里卡·马歇尔医生为我们指出5个医学上的小秘密。     

乙醇性肝炎合并病毒感染患者的病原学检测分析

目的 探讨乙醇性肝炎合并病毒感染的病原学分布特征,为肝炎的预防治疗工作提供指导依据.方法 回顾性分析1472例乙醇性肝炎的临床资料,采用酶联免疫吸附法进行病原学检查.结果 1472例乙醇性肝炎患者中188例感染各类型病毒,感染率为12.77％;男性126例,占67.02％,女性62例,占32.98％;单一感染149例,占79.26％,混合感染22例,占11.70％,未分型17例,占9.04％;单一感染中以乙型肝炎病毒(HBV)和甲型肝炎病毒(HAV)为主,分别占52.13％和14.36％;混合感染包括双重感染17例,三重感染4例,四重感染1例,分别占77.27％、18.18％和4.55％;混合感染中以HAV+ HBV和HBV+丁型肝炎病毒(HDV)最常见,分别占22.73％和18.18％.结论 乙醇性肝炎合并病毒感染的比例较高,其病原学仍然以HBV为主,但混合感染严重,临床应重点筛查乙型肝炎,并加强对未定型肝炎的检测.     

125例病毒性肝炎患儿的两对半检验结果分析

目的 了解我院病毒性肝炎患儿的感染情况,为制定预防乙肝防制措施提供依据.方法 采用两种方法检测我院收治的125例乙肝患儿的两对半标志物并对检验结果进行分析.结果 125例乙肝病毒性肝炎患儿中大三阳50例,小三阳31例.结论 两对半检验可以直接反映血液中病毒复制状态,在临床上应应用多种方法进行检测分析.     

南京市239例戊型病毒性肝炎病例分析

戊型病毒性肝炎(戊肝)发病近年来有上升的趋势[1]。为了解戊肝在南京地区的发病特点和分布规律,对南京市第二医院近3年来收治的戊肝住院病例资料进行了分析,报告如下。1材料与方法南京市第二医院近3年来收治的239例南京地区的戊肝住院病例资料,病例诊断按照病毒性肝炎诊断标准[     

北京市密云县病毒性肝炎病原学分型诊断调查

目的了解急性病毒性肝炎的分型诊断与疫情报告之间的差距,准确掌握北京市密云县各型病毒性肝炎发病情况的基线资料,为今后制定科学的防治策略提供科学依据。方法收集2005～2008年医疗机构网络直报的急性病毒性肝炎发病病例,对其进行流行病学调查或血清学检测。结果2005～2008年网报急性病毒性肝炎总例数为455例,核实确诊305例,符合率为67.03%。305例中甲型病毒性肝炎3例,占急性病毒性肝炎的0.98%;乙型病毒性肝炎161例,占52.79%;丙型病毒性肝炎27例,占8.85%;丁型病毒性肝炎1例,占0.33%,戊型病毒性肝炎58例,占19.02%;未分型肝炎55例,占18.03%。2005～2008年,密云县急性病毒性肝炎发病病例以乙型为主,甲型比例很小,但戊型肝炎的发病不容忽视。结论乙型肝炎、戊型肝炎应为当前病毒性肝炎防治重点;应进一步规范临床病毒性肝炎的诊断,同时继续定期开展病毒性肝炎的血清学监测。     

戊型病毒性肝炎35例临床分析

为了解长治地区戊型肝炎的临床特点，本文对３５例戊型肝炎患者进行了观察。全部病人均为散发，年龄绝大多数为青壮年，其中１３例为单项戊型肝病毒感染，全部在１月内治愈，戊型重叠甲型肝炎病毒感染８例，７例（８７％）在１月内肝功恢复正常，戊型重叠乙型肝炎病毒感染１４例，仅８例（５７％）在１月内肝功恢复正常。３５例中，戊型重叠甲型肝炎病毒感染及戊型重叠乙型肝炎病毒感染者共２２例，占６３％，提示戊肝病毒重叠其它肝     

84例病毒性肝炎临床分析

病毒性肝炎 (简称肝炎 )是由于多种肝炎病毒引起的以肝损害为主的传染病。其特点为常见、多发、易流行。现将本院 1995年 11月至 1997年 2月收治的临床资料较完整的 84例各型肝炎的流行病学调查 ,结合临床疗效分析及跟踪调查、随访 ,发现各具特点 ,有一定指导意义。并提示以适当休息 ,合理饮食 ,正确使用药物为基本治疗原则 ,力求达到用药得当 ,配伍合理 ,治疗费用低 ,疗效稳定、可靠、易被基层农村患者接受。1　一般资料1· 1　 84例肝炎患者 ,男 4 8例 ( 57 2 % ) ,女 36例( 4 2 8% ) ;发病年龄 3～ 7岁。住院治疗时间 15～90ｄ ,平均 52…     

肠毒素大肠埃希菌载体活菌疫苗的安全性和免疫性研究

目的 研究肠毒素大肠埃希菌活菌载体疫苗FE3、FE16的安全性和免疫原性。方法 通过肠毒素大肠埃希菌肠毒素毒力试验、新西兰大白兔免疫试验、小鼠口服和鼻饲途径免疫试验，检测载体疫苗的毒性、免疫原性和免疫效果。结果 毒力试验中所有检测均为阴性；免疫4次后大白兔血清对福氏2a型茵的凝集效价均不低于1：640，对肠毒素大肠埃希菌菌毛抗原的凝集效价均不低于1：1280；通过口服和鼻饲方式免疫小鼠后，血清中IgG显著升高，同时能够在粪便中检测到分泌型IgA，而灭活苗免疫未能检测到分泌型IgA。结论 活菌载体疫苗株FE3和FE16具有良好的安全性和免疫原性，同时能够刺激机体产生体液免疫和黏膜免疫反应。     

A systematic review of experimental infections with enterotoxigenic Escherichia coli (ETEC)

Volunteer challenge with enterotoxigenic Escherichia coli (ETEC) has been used for four decades to elucidate the pathogenesis and immune responses and assess efficacy of various interventions. We performed a systematic review of these studies and a meta-analysis of individual patient-level data (IPD) from a subset of studies using standard methodology.We identified 27 studies of 11 ETEC strains administered to 443 naive subjects at doses from 1 × 10⁶ to 1 × 10¹⁰ colony forming units (cfu). Diarrhea attack rates varied by strain, dose and enterotoxin. Similar rates were seen at doses of 5 × 10⁸ to 1 × 10¹⁰ cfu with the three most commonly used strains B7A, E24377A, H10407. In IPD analysis, the highest diarrhea attack rates were seen with strains B7A, H10407 and E24377A. The H10407 induced significantly higher stool output than the other strains. Additionally, the rate of output was different across strains.The risk of diarrhea, abdominal cramps, nausea and headaches differed significantly by ETEC strain. An increased risk of nausea, abdominal cramps and headaches was seen for females. Baseline anti-LT IgG titers appeared to be associated with a decrease risk of diarrhea outcomes, a trend not seen with anti-LT IgA or seen consistently with anti-colonization factor antibodies. Neither early antibiotic treatment nor diarrhea duration significantly affected the frequency or magnitude of serologic responses.These studies have served as an invaluable tool in understanding disease course, pathogenicity, innate immune responses and an early assessment of product efficacy. When designing and planning experimental ETEC infection studies in this age of increased ethical scrutiny and growing appreciation of post-infectious sequelae, better understanding of available data is essential.     

Comparative evaluation of a vaccine candidate expressing enterotoxigenic Escherichia coli (ETEC) adhesins for colibacillosis with a commercial vaccine using a pig model

In this study, a comparative evaluation of a novel live vaccine candidate expressing enterotoxigenic Escherichia coli (ETEC) fimbriae and a commercial ETEC vaccine was carried out in suckling to weaned piglets. The E. coli K88ab, K88ac, K99, FasA and F41 fimbrial genes were individually inserted into an expression/secretion plasmid, pBP244. These plasmids were subsequently transfected into attenuated Salmonella, which were used as the vaccine candidate. Eighteen pregnant sows and 107 of their piglets were used in this comparative study. All the vaccinated groups of sows and piglets exhibited significantly increased antibody levels relative to specific antigens when compared with those in the unimmunized control. The experimental piglets with the vaccine candidate did not experience diarrhea following challenge with the virulent ETEC strains. However, diarrhea was observed in 36.8% of the piglets in the group immunized with the commercial vaccine and in 50% of the control group after challenge with the ETEC strains. These findings indicate that immunization of sows with the candidate vaccine can effectively protect their young pigs against colibacillosis.     

Safety and immunogenicity of intramuscularly administered CS6 subunit vaccine with a modified heat-labile enterotoxin from enterotoxigenic Escherichia coli

IntroductionEnterotoxigenic Escherichia coli (ETEC) is a common cause of infectious diarrhoea and a leading cause of morbidity and mortality in children living in resource-limited settings. It is also the leading cause of travellers’ diarrhoea among civilian and military travellers. Its dual importance in global public health and travel medicine highlights the need for an effective vaccine. ETEC express colonization factors (CFs) that mediate adherence to the small intestine. An epidemiologically prevalent CF is coli surface antigen 6 (CS6). We assessed the safety and immunogenicity of a CS6-targeted candidate vaccine, CssBA, co-administered intramuscularly with the double-mutant heat-labile enterotoxin, dmLT [LT(R192G/L211A)].MethodsThis was an open-label trial. Fifty subjects received three intramuscular injections (Days 1, 22 and 43) of CssBA alone (5 µg), dmLT alone (0.1 µg) or CssBA (5, 15, 45 µg) + dmLT (0.1 and 0.5 µg). Subjects were actively monitored for adverse events for 28 days following the third vaccination. Antibody responses (IgG and IgA) were characterized in the serum and from lymphocyte supernatants (ALS) to CS6 and the native ETEC heat labile enterotoxin, LT.ResultsAcross all dose cohorts, the vaccine was safe and well-tolerated with no vaccine-related severe or serious adverse events. Among vaccine-related adverse events, a majority (98%) were mild with 79% being short-lived vaccine site reactions. Robust antibody responses were induced in a dose-dependent manner with a clear dmLT adjuvant effect. Response rates in subjects receiving 45 µg CssBA and 0.5 µg dmLT ranged from 50 to 100% across assays.ConclusionThis is the first study to demonstrate the safety and immunogenicity of CssBA and/or dmLT administered intramuscularly. Co-administration of the two components induced robust immune responses to CS6 and LT, paving the way for future studies to evaluate the efficacy of this vaccine target and development of a multivalent, subunit ETEC vaccine.     

Immunization with recombinant Lactobacillus casei strains producing K99, K88 fimbrial protein protects mice against enterotoxigenic Escherichia coli

To exploit a safe and effective vaccine for the prevention against K99 or K88 infections of enterotoxigenic Escherichia coli (ETEC), we have developed a mucosal delivery vehicle based on Lactobacillus casei CICC 6105 using poly-γ-glutamate synthetase A (PgsA) as an anchoring matrix. To evaluate the immunization effect of the recombinant strains (harboring plasmids pLA-K99-K88-LTB, pLA-K99, and pLA-K88), anti-ETEC K99 or K88 antibody responses, T-cell proliferation, and cytokines by intracellular staining (ICS) were investigated after specific pathogen-free (SPF) C57BL/6 mice orally inoculated with these recombinant strains. After oral vaccination into C57BL/6 mice, all recombinant strains were proved to be immunogenic and able to elicit high levels of mucosal immunoglobulin A (IgA) titers in bronchoalveolar lavage fluids, intestinal fluids and prominent systemic immunoglobulin G and IgG subclasses (IgG1, IgG2b, and IgG2a) responses in sera. Using the T-cell proliferation assay, the stimulation index (SI) of groups immunized with pLA-K99/L. casei and pLA-K88/L. casei reached to 2.73 and 2.64, respectively, versus 2.56 in a group immunized with pLA-K99-K88-LTB/L. casei. A detailed analysis of the cell-mediated immune responses by ICS showed the number of specific CD8(+) T cells expressing cytokines (IFN-γ, TNF-α, and IL-2) and granule-associated proteins (CD107a) was higher than that of specific CD4(+) T cells secreted by immune spleen cells upon restimulation in vitro with peptides. Next, the results showed that DCs activated in vitro with recombinant L. casei enhance specific T-cell proliferation and promote T cells to produce both Th1 and Th2 cytokines. More than 80% of the vaccinated mice were protected after challenge with a lethal dose of standard strains C83912 and C83902. These results demonstrate that recombinant L. casei can induce specific humoral and mucosal antibodies and cellular immune response against protective antigens upon oral administration.     

三对引物同时PCR分型检测产毒素大肠杆菌的方法及在分子流行病学研究中的应用

在产毒素大肠杆菌肠毒素基因内设计合成三对引物，建立了三对引物同时ＰＣＲ检测ＥＴＥＣ的方法，一次ＰＣＲ即可扩增出６２７ｂｐ（ＬＴｈ）、２４０ｂｐ（ＳＴ Ｉａ）和１６９ｂｐ（ＳＴ Ｉｂ）三种肠毒素基因片段，可同时分型检测出ＬＴｈ，ＳＴ Ｉａ、ＳＴ Ｉｂ、ＬＴｈ－ＳＴ Ｉａ、ＬＴｈ－ＳＴ Ｉｂ五种基因型的ＥＴＥＣ，与非ＥＴＥＣ对照菌无交叉反应，最小检出量为１０ｃｆｕ，显示了很高的特异性和敏感性。将建立的     

Contamination of potable water by enterotoxigenic Escherichia coli: qPCR based culture-free detection and quantification

Tourists visiting to endemic zones may acquire Enterotoxigenic Escherichia coli (ETEC) infection resulting into diarrhea due to consumption of contaminated potable waters. In this study, a qPCR assay (SYBR Green), targeting LT1 and ST1 genes was designed to quantify ETEC in potable waters derived from civic water supply. The assay could detect lowest 1 CFU/PCR targeting LT1/ST1 gene from ten-fold diluted culture of the reference strain (E. coli MTCC 723) and is ten-fold more sensitive than the conventional PCR. The quantification of the ETEC in potable waters collected from civic supply of a major city of the northern India exhibiting high flow of tourists reveals that all the sites that ran along sewage line were contaminated by the ETEC. Contamination was due to percolation of sewage. The assay could be used for the regular monitoring of potable water in places exhibiting heavy flow of tourists to prevent ETEC induced diarrhea.     

Enterotoxigenic Escherichia coli associated diarrhoea among infants aged less than six months in Calcutta, India

The role of enterotoxigenic Escherichia coli (ETEC) as etiologic agents of diarrhoea in infants aged less than six months was assessed in a hospital based study in Calcutta, India. Of the 218 cases examined, ETEC strains were isolated from 26 (11.9%) cases. Among these, in 17 cases ETEC was the sole infecting pathogen (p = 0.0085). Of the 26 isolates (each isolate representing a case), 24 were distributed among seven different O:K:H serotypes and two different colonization factor antigens (CFAs) I and II. Two of the remaining isolation were untypable, non-haemagglutinating, and were nonhydrophobic as measured by the salt aggregation test (SAT). Of the 26 ETEC strains detected, 15 (57.7%) produced heat-labile toxin (LT) only, 8 (30.8%) liberated heat-stable toxin (ST) only, and the remaining 3 (11.5%) produced both LT and ST. No ETEC strain was isolated from the 102 age-matched controls included in this study. All the ETEC isolates were multiple drug resistant. The study showed that the diarrhoea due to ETEC was of brief duration, mostly within the range of 3 to 7 days.     

Emergence of Escherichia coli isolates producing conjugative plasmid-mediated DHA-1 beta-lactamase in a Korean university hospital

Seven isolates of cefoxitin-resistant Escherichia coli with an inducible phenotype were detected between November 2002 and July 2003 in a Korean hospital. Conjugations were tested by the filter mating method using azide-resistant E. coli J53 as the recipient. All isolates and their transconjugants were tested for broth microdilution minimum inhibitory concentrations, isoelectric focusing (IEF), polymerase chain reaction (PCR) for SHV, TEM, CTX-M and DHA-derived beta-lactamases, and DNA sequencing. XbaI-digested genomic DNA bands of the seven isolates were separated by pulsed-field gel electrophoresis (PFGE). IEF, PCR and sequence analysis revealed that all isolates possessed a blaTEM-1-like and a blaDHA-1 gene. Two isolates also carried the blaCTX-M-14 gene. Transfer of the resistance by conjugation experiments of all seven isolates was successful, suggesting that the blaDHA-1-containing plasmids in the E. coli isolates were self-transmissible. The isolates were recovered from patients in wards or an intensive care unit, all of which had been exposed to beta-lactams before isolation of the DHA-1 producers. Five patterns among the seven isolates were demonstrated by PFGE; sporadic infections with E. coli possessing an inducible beta-lactam resistance phenotype were found. DHA-1 encoded by conjugative plasmids conferred the resistance phenotype. The spread of the DHA-1 producers was due to both clonal spread and horizontal transfer of the resistance gene.     

上海市2016-2022年腹泻病例致泻性大肠埃希菌感染的流行特征与耐药分析

目的 掌握上海市腹泻病例致泻性大肠埃希菌（DEC）的感染情况、流行病学特征及耐药情况,为后续监测和防控提供数据支撑。方法 基于上海市腹泻病综合监测系统收集2016-2022年肠道腹泻门诊病例的流行病学资料,采集粪便标本,开展DEC检测。基于国家致病菌识别网系统收集2016-2022年药敏监测数据。统计学分析采用χ²检验或Fisher确切概率法。结果 在24 883例感染性腹泻患者中,DEC阳性率为9.13%（2 271/24 883）,其中单一致病型DEC阳性率为8.83%（2 197/24 883）,混合致病型DEC阳性率为0.30%（74/24 883）。DEC阳性主要型别为肠产毒性大肠埃希菌［4.33%（1 077/24 883）］,以≤5岁组人群的DEC阳性率最高［18.48%（22/119）］。2016-2022年DEC阳性率最高月份为7-9月［5.91%（1 470/24 883）］。2016-2022年市区和郊区的DEC阳性率分别为9.47%（554/5 847）和9.02%（1 717/19 036）,市区和郊区的DEC主要型别分别为肠黏附性大肠埃希菌［3.98%（233/5 847）］和肠产毒性大肠埃希菌［4.56%（868/19 036）］。2016-2019和2020-2022年DEC阳性率分别为9.42%（1 821/19 330）和8.10%（450/5 553）,主要型别分别为肠产毒性大肠埃希菌（4.87%,941/19 330）和肠黏附性大肠埃希菌（4.70%,261/5 553）。耐药菌株的多重耐药率为40.21%（618/1 537）。耐药率较高的前三位药物依次为氨苄西林［64.74%（995/1 537）］、萘啶酸［58.49%（899/1 537）］和四环素［45.09%（693/1 537）］。结论 相比于2016-2019年,2020-2022年DEC阳性率下降,主要型别由肠产毒性大肠埃希菌转变为肠黏附性大肠埃希菌。多重耐药现象较严重,建议应加强DEC的耐药性持续监测,同时规范临床抗生素的使用。