多位点序列分型和脉冲场凝胶电泳技术辅助鉴定肠炎沙门菌

伤寒沙门菌和甲、乙、丙型副伤寒沙门菌引起肠热型感染,而肠炎沙门菌、鼠伤寒沙门菌、鸭沙门菌等则多引起急性胃肠炎型感染.准确的沙门菌菌株鉴定对于传染病的预防控制有重要意义.笔者应用肠杆菌科细菌鉴定系统ATB ID32E和API 20E对一起食源性疾病暴发事件中分离到的2株沙门属菌株及1株分离自住院患者的沙门属菌株进行生化鉴定,同时进行血清凝集试验.     

综合医院非伤寒沙门菌感染腹泻患者病原学分析

目的了解综合医院腹泻患者非伤寒沙门菌感染情况,分析非伤寒沙门菌的血清分型、耐药性和分子特征。方法对2009年9月-2011年6月腹泻病患者送检的767份粪便标本进行非伤寒沙门菌检测,对分离到的菌株进行血清分型、药物敏感性试验和脉冲场凝胶电泳(PFGE)分型。结果从767份腹泻粪便标本中分离到36株非伤寒沙门菌,阳性检出率为4.56%;以儿童为主,占65.71%;共分为10种血清型,主要以鼠伤寒沙门菌和肠炎沙门菌为主,分别占37.14%和28.57%;10个血清型非伤寒沙门菌对头孢类和环丙沙星的敏感率>84.00%,除斯坦利沙门菌和山夫登宝沙门菌外,其他血清型均对多种抗菌药物产生不同程度的耐药或交叉耐药;将13株鼠伤寒沙门菌和10株肠炎沙门菌共分离出19个PFGE分型,其中2株肠炎沙门菌PFGE同型,3株鼠伤寒沙门菌PFGE同型,存在不同耐药谱。结论综合医院引起感染性腹泻的非伤寒沙门菌主要为鼠伤寒沙门菌和肠炎沙门菌,儿童多见;非伤寒沙门菌多药耐药严重,临床在应用氟喹诺酮类治疗非肠外沙门菌属感染时,应根据药敏结果慎重选择。     

实用儿科诊疗规范——儿科：感染性疾病（五）——第二节 细菌感染 非伤寒沙门菌感染

1概述 非伤寒沙门菌感染是指伤寒、副伤寒以外的沙门菌引起的急性感染性疾病，简称沙门菌感染。近10余年来，沙门菌感染明显增加，多见于婴幼儿。本病主要通过粪-口途径传播，任何年龄均可患病。细菌内毒素为主要的致病因素，有些沙门菌可产生肠毒素。临床表现分为胃肠炎型、败血症型和伤寒型三型。     

实用儿科诊疗规范——儿科:感染性疾病(五)

(接上期) 第二节细菌感染 非伤寒沙门菌感染 1 概述 非伤寒沙门菌感染是指伤寒、副伤寒以外的沙门菌引起的急性感染性疾病,简称沙门菌感染.近10余年来,沙门菌感染明显增加,多见于婴幼儿.本病主要通过粪-口途径传播,任何年龄均可患病.细菌内毒素为主要的致病因素,有些沙门菌可产生肠毒素.     

伤寒、副伤寒30例误诊分析

伤寒、副伤寒是由沙门属伤寒杆菌和甲、乙、丙型副伤寒沙门菌所引起的急性传染病,其典型临床表现有稽留热、玫瑰疹、相对缓脉、肝脾大、粒细胞减少等,少数病例有肠出血或肠穿孔。但近年来出现伤寒和副伤寒的临床表现多不典型,再加上抗菌药物及预防接种的广泛应用,典型病例已较少见,     

152例非伤寒沙门菌肠炎临床及耐药情况分析

目的:研究近年来本地区非伤寒沙门菌感染肠炎患者的临床特征、流行病学特征及其耐药情况,为本地区的流行病学研究及临床合理用药提供依据。方法:用SS琼脂及伊红美兰琼脂培养基培养阳性的沙门菌,采用血清凝集法鉴定分型,同时采用K-B纸片法检测药物敏感性,采用NCCLS质控标准。结果:沙门菌肠炎主要是由肠炎血清型和鼠伤寒沙门菌所引起,任何年龄均可患病,幼儿发病率比较高,与不洁饮食有一定关系,春、秋季为该病新的发病高峰。该病以发热,腹痛,腹泻为主要临床表现,152株非伤寒沙门菌药敏结果显示该菌对喹喏酮类药物耐药率较高。结论:非伤寒沙门菌肠炎是临床常见的腹泻性疾病,近年该菌在流行病学方面表现出新的特征,且对临床常用抗菌药耐药率逐渐增加,患者临床表现仍以发热、腹痛、腹泻为主,加强其对喹喏酮类药物的监测是非常必要的。     

广东省2007年度非伤寒沙门菌监测及病原学特征分析

目的 了解广东省腹泻病患者中非伤寒沙门菌感染情况和菌株的血清型别、分布、耐药性变化.方法 对纳入研究的腹泻病患者进行非伤寒沙门菌检测,对分离到的菌株进行血清分型、药物敏感性试验和脉冲场凝胶电泳(PFGE)分型.结果 2007年度共检测1128份腹泻粪便标本,分离到71株沙门菌,阳性检出率为6.29%;共分得29种血清型,肠炎和鼠伤寒沙门菌居多;大多数沙门菌对常用的头孢类和喹诺酮类抗生素敏感,鼠伤寒沙门菌的耐药率普遍较肠炎和斯坦利沙门菌高;除肠炎沙门菌外,其余的血清型没有同一PFGE型别的菌株;用Xba Ⅰ酶切17株肠炎沙门菌可分为PFGE-XbaⅠ 1～8型,其中PFGE-XbaⅠ 4型为优势型别.用Sfi Ⅰ和Not Ⅰ酶对12株肠炎沙门菌进行再分型,综合用Xba Ⅰ/Sfi Ⅰ/Not Ⅰ三种酶的结果 发现仍有三组菌的PFGE图谱是完全一致的.结论 2007年度广东省非伤寒沙门菌的感染多数为散发病例,头孢类和喹诺酮类抗生素是治疗非伤寒沙门菌感染的首选药物.     

16例妊娠合并伤寒沙门菌感染患者的临床分析及护理对策

目的 分析妊娠合并伤寒沙门菌感染的临床特点及护理对策,为临床治疗提供参考.方法 选取16例妊娠合并伤寒沙门菌感染患者16例为观察组,另选取10例妊娠妇女为妊娠组及10例单纯伤寒女性患者为单纯伤寒组进行对照,比较3组患者的肝功能、电解质、血常规和血沉变化.结果 观察组中肝功能异常和电解质异常比例均高于单纯伤寒组(P＜0.05)；观察组白细胞下降、嗜酸性粒细胞下降和血沉升高的比例分别为75.00％、68.75％和87.50％,均高于单纯伤寒组,两组差异有统计学意义(P＜0.05).结论 妊娠合并伤寒沙门菌感染常导致孕妇肝功能损害,应有针对性地进行护理,帮助患者早日康复.     

在1例患者血液中检出典型伤寒沙门菌的报告

伤寒沙门菌引起的肠道传染病是我国法定的乙类传染病之一,此类病人伴有弛张性高热,其传染性较强,在所有肠道病原感染中,伤寒沙门菌(Salmonella typhi)感染是最严重的。近年来,由伤寒沙门菌引起的感染在发达城市越来越少,上海市     

2012年-2013年深圳市罗湖区腹泻患者沙门菌流行特征及耐药情况分析

目的分析2012年-2013年本辖区腹泻患者中沙门菌的感染情况及耐药特征,为防治沙门菌感染和临床治疗提供依据。方法采用GB 4789.4—2010沙门菌检测方法,对从腹泻患者中分离的49株沙门菌进行分离鉴定,阳性菌株用全自动细菌鉴定仪做生化鉴定及药敏分析。结果沙门菌感染主要以幼年组(0岁~5岁)儿童为主,分离高峰集中在春季、夏季;鼠伤寒沙门菌的分离率最高,菌株对青霉素类及磺胺类药物耐药率较高,存在多重耐药菌株。结论鼠伤寒沙门菌是本辖区感染性腹泻的优势菌型,感染患者的年龄呈现低龄化,沙门菌耐药率呈逐年升高趋势,菌株多重耐药形势严峻。     

A review of vaccine research and development: human enteric infections

Worldwide, enteric infections rank third among all causes of disease burden, being responsible for some 1.7-2.5 million deaths per year, mostly in young children and infants in developing countries. The main infectious agents responsible for human enteric infections include several viruses (enteric adenoviruses, astroviruses, human caliciviruses (HuCV), rotaviruses (RV)) and several bacterial agents, such as Campylobacter jejuni, a variety of pathogenic Escherichia coli strains including enterotoxigenic E. coli (ETEC), several Shigella species, various Salmonella strains including S. typhi and S. paratyphi, the agents of typhoid fever, and Vibrio cholerae, the agent of cholera. While effective vaccines are available at present against typhoid fever and cholera, no vaccine is available against illnesses caused by HuCV, Campylobacter, ETEC or the Shigellae. Rotavirus vaccines have had more success, although RV disease prevention suffered a major setback in 1999 with the withdrawal of a live simian-human reassortant RV vaccine less than a year after its introduction. New live oral RV vaccines have now been developed and are or should presently be ready for licensure. This article reviews the state of the art in vaccine R&D against human viral and bacterial enteric infections of public health importance.     

Postpartum infections

The unexpected occurrence of a fever higher than 38 degrees Celsius at least twice in 48 hours after childbirth is a common problem. A well-executed clinical examination of a patient with a high fever is necessary to determine the origin of the infection. It is necessary to remain vigilant because it could be a sign of severe infection threatening a mother's life. The fever can sometimes remain moderate while the infection progresses at lightning speed. This is especially the case in weak patients (e.g., those with tuberculosis, AIDS, or malnutrition); thus it will be necessary to keep an attentive eye on them. Major causes to be familiar with and to recognize include malaria (always to be considered), uterine infection (the most common postpartum infection), kidney infection, tender breasts, pneumonia, meningitis, or appendicitis. Things health workers should consider if they suspect uterine infection are birth history, endometritis, and the fact that, in the absence of treatment, the infection can spread to the Fallopian tubes and eventually to the general circulation (septicemia). Special cases include uterine infections accompanied by retention of placental debris or membranes, fever after abortion, and fever after cesarean section. Health workers must consider all cases of retention, even those without a fever, as a potential infection. They must administer antibiotic treatment within 5 days after emptying the uterus. The treatment of choice for fever following an abortion is 3 g ampicillin for 7 days. In cases of infection after an abortion, health workers should consider uterine perforation and retention. Fever usually occurs 4-5 days after a cesarean section. Antibiotic treatment is usually necessary.     

Age-related clinical and microbiological characteristics of enteric fever in India

A retrospective, hospital-based study at Safdarjang Hospital, India, was undertaken between January 1999 and December 2003 to estimate age-related epidemiological, clinical and microbiological characteristics in enteric fever cases. A total of 750 blood-culture-proven cases of enteric fever were studied. The majority of cases occurred in children aged 5-12 years and 24.8% of cases were in children up to 5 years of age. Salmonella serotypes showed an age-related predilection, with paratyphoid fever more common in adults. Classically-described clinical features of the disease were comparable among patients under and above 5 years of age. Hepatomegaly, anaemia and complications in general were more frequent in children up to 5 years of age. The antimicrobial resistance pattern, irrespective of Salmonella serotype, did not reveal a statistically significant difference across age groups for the different antibiotics tested. Multidrug resistance was seen only in Salmonella enterica serotype Typhi but not in S. Paratyphi A isolates. However, resistance to nalidixic acid was comparable in both serotypes. Age-related differences of serotype isolation rates, clinical presentation and associated complications are noteworthy for better case management and policy planning. More epidemiological studies regarding reasons for age-related differential serotype patterns would enable and guide public health strategies to contain enteric fever in endemic locations.     

Enteric fever in patients admitted to a diarrhoeal disease hospital in Bangladesh

The hospital records of 62 patients with blood culture-proven enteric fever admitted to the Dacca Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, over a one-year period were reviewed. Older children and young adults had the highest age-specific rates of disease. The clinical, epidemiplogical and laboratory features of patients with enteric fever were compared with similar information from patients in hospital for cholera and shigellosis. Patients with enteric fever had a significantly longer prodrome of illness and were more likely to have fever than patients in the other groups. Our hospital cares primarily for patients with diarrhoeal diseases and while 94% of enteric fever patients had diarrhoea, only 5% had the recognized diarrhoeal pathogens Shigella or Vibrio cholerae identified, compared to 25% of the total hospital in-patient group, suggesting that Salmonella typhi itself may be a cause of diarrhoea. Antibiotic resistance patterns of S. typhi isolates were reviewed, and one isolate was found to be multiply antibiotic resistant. The advent of an effective oral typhoid vaccine makes further work on the epidemiology of enteric fever in endemic areas such as Bangladesh a high priority.     

Informing the public health management of typhoid and paratyphoid: the Australian context

Objective: To examine outcomes of public health management of notified enteric fever cases in South‐East Queensland over the past five years. Methods: Notification records of typhoid and paratyphoid infection in South‐East Queensland 2008–2012 (inclusive) were reviewed to determine likelihood of cases and contacts adhering to present or previous recommendations for faecal clearance/screening, duration of infectiousness of cases and extent of local transmission to contacts. Results: Sixty‐nine of 85 cases and 218 of 265 contacts submitted at least one faecal specimen. Cases were 2.7 (95%CI 1.2–6.0) and contacts were 4.4 (95%CI 3.0–6.4) times more likely to complete recommended faecal clearance/screening under previous compared to present guidelines (requiring more specimens). In ten cases with positive post‐treatment specimens, last recorded infectiousness was 19 days to six months after notification. The documented rate of local transmission of infection was 18/1,000 contacts submitting at least one faecal specimen (95%CI 6–48/1,000). Conclusions: Local transmission risk of enteric fever in South‐East Queensland is low, although small numbers of cases may have prolonged bacilli excretion post‐treatment. More complex clearance/screening regimens are associated with decreased compliance. Implications: Pursuing extensive faecal clearance/screening regimens is unlikely to be effective in terms of public health management of enteric fever in South‐East Queensland. We suggest a unified national approach focussing on cases/contacts at high risk of disease transmission.     

Salmonella paratyphi A rates, Asia

Little is known about the causes of enteric fever in Asia. Most cases are believed to be caused by Salmonella enterica serovar Typhi and the remainder by S. Paratyphi A. We compared their incidences by using standardized methods from population-based studies in China, Indonesia, India, and Pakistan.     

Salmonella infections associated with international travel: a Foodborne Diseases Active Surveillance Network (FoodNet) study

Salmonella species cause an estimated 1.2 million infections per year in the United States, making it one of the most commonly reported enteric pathogens. In addition, Salmonella is an important cause of travel-associated diarrhea and enteric fever, a systemic illness commonly associated with Salmonella serotypes Typhi and Paratyphi A. We reviewed cases of Salmonella infection reported to the Centers for Disease Control and Prevention's (CDC) Foodborne Diseases Active Surveillance Network (FoodNet), a sentinel surveillance network, from 2004 to 2008. We compared travelers with Salmonella infection to nontravelers with Salmonella infection with respect to demographics, clinical characteristics, and serotypes. Among 23,712 case-patients with known travel status, 11% had traveled internationally in the 7 days before illness. Travelers with Salmonella infection tended to be older (median age, 30 years) than nontravelers (median age, 24 years; p<0.0001), but were similar with respect to gender. The most common destinations reported were Mexico (38% of travel-associated infections), India (9%), Jamaica (7%), the Dominican Republic (4%), China (3%), and the Bahamas (2%). The proportions of travelers with Salmonella infection hospitalized and with invasive disease were inversely related to the income level of the destination (p<0.0001). The most commonly reported serotypes, regardless of travel status, were Enteritidis (19% of cases), Typhimurium (14%), Newport (9%), and Javiana (5%). Among infections caused by these four serotypes, 22%, 6%, 5%, and 4%, respectively, were associated with travel. A high index of clinical suspicion for Salmonella infection is appropriate when evaluating recent travelers, especially those who visited Africa, Asia, or Latin America.     

Drug-resistant Salmonella enterica serotype paratyphi A in India

The incidence of enteric fever caused by Salmonella enterica serotype Paratyphi A has been increasing in India since 1996. In 1998, the incidence of enteric fever caused by drug- resistant S. Paratyphi A abruptly increased in the New Delhi region. In the first 6 months of 1999, 32% of isolates were resistant to both chloramphenicol and cotrimoxazole and another 13% were resistant to more than two antibiotics.     

一起沙门氏菌食物中毒的溯源分析及药敏检测

目的对一起由沙门氏菌污染鸡爪引起的食物中毒进行脉冲场凝胶电泳(PFGE)分子分型溯源和耐药分析,为查明这起食物中毒的源头及临床治疗提供相关理论依据。方法对6例患者进行流行病学调查,采集可疑食品和患者粪便等标本,根据国家标准进行实验室检测,经增菌后挑取可疑菌落进行生化鉴定,对检出的7株沙门氏菌株采用标准诊断血清进行血清凝集试验,菌株DNA经限制性内切酶XbaⅠ酶切后进行PFGE分子分型,所得结果用BioNumerics软件进行聚类分析,最后利用微量肉汤稀释法对7株沙门氏菌株进行耐药性检测。结果6例患者均有不同程度的腹痛、腹泻和发热等症状;从鸡爪中检出沙门氏菌1株,患者粪便标本中检出沙门氏菌6株,通过生化仪鉴定和血清凝集试验显示7株沙门氏菌的血清型同为福尔斯布特尔血清型,PFGE显示7株沙门氏菌株同源性为100.0%,药敏结果显示这7株菌株均对四环素类药物(四环素、米诺环素)、大环内酯类药物(阿奇霉素)耐药。结论该起群体性腹泻、发热、腹痛事件为一起由沙门氏菌引起的食物中毒事件。有关部门应加大对食品安全知识的宣传普及,提高大众的食品安全意识;大众食用购买的熟食前应尽量加热处理后再食用,这是预防沙门氏菌食物中毒的重要措施;同时,建议监管部门加强对食品小作坊、饭店等生产经营场所的监管,预防类似事件的发生。     

Antibiogram pattern and seasonality of Salmonella serotypes in a North Indian tertiary care hospital

The antibiogram pattern and seasonal distribution of Salmonella serotypes were analysed retrospectively over a 6-year period from January 1999 to December 2004. Blood cultures received in the Bacteriology Laboratory were processed by standard procedures and the Salmonella spp. isolates were identified with specific antisera and standard biochemical tests. Antimicrobial susceptibility testing was carried out by a standard disc diffusion method and the minimum inhibitory concentration (MIC) of ciprofloxacin for 332 representative Salmonella isolates was determined by E test. Salmonella Typhi (75.7%) was the predominant serotype among 830 Salmonella spp. isolated during the study period followed by S. Paratyphi A (23.8%). The maximum number of enteric fever cases occurred during April-June (dry season) followed by July-September (monsoon season). There was a decrease in multidrug-resistant (MDR) S. Typhi, but MDR S. Paratyphi A isolates increased. There was also a dramatic increase in nalidixic acid-resistant isolates. All isolates were susceptible to third-generation cephalosporins and ciprofloxacin except one S. Typhi strain which demonstrated high-level ciprofloxacin resistance with a MIC of 16 mug/ml. A knowledge of the seasonal distribution and antibiotic resistance pattern of Salmonella in a particular geographical region is helpful in the delineation of appropriate control measures required for prevention of enteric fever.