Species distribution and antibiotic resistance of shigella isolates in an urban community in Malaysia

There is an increasing trend for Shigella isolates worldwide to be resistant to commonly prescribed antibiotics. The species distribution and antibiotic resistance of Shigella species isolated from children in Kuala Lumpur, Malaysia from 1978 to 1997 was reviewed. Three hundred and eighty six isolates were positive for Shigella species, representing 1.4% (95% CI: 1.3%-1.6%) of the 26320 total stool specimens and 13% (95% CI: 11.8%-14.2%) of 2986 isolates positive for bacterial pathogens. Shigella flexneri, constituting 74% of all isolates in the first five years of the study, decreased by 40% during the last five years (95% CI of decrease: 22.1%-57.9%), p-value < 0.0001) to 34%. There was a significant reduction (chi2 for linear trend = 77.6, p-value < 0.001) in the number of Shigella isolates as a percentage of total stool isolates obtained. 58% of the 241 isolates tested for antibiotic sensitivity were resistant to at least one antibiotic, and 42% wEre multi-resistant to three or more antibiotics. Shigella species was not a common pathogen among children admitted with diarrhoea in Kuala Lumpur, and was more likely to be resistant to commonly prescribed antibiotics.     

闽东农村婴幼儿腹泻病原学调查

对闽东农村５８２例婴幼儿腹泻患者进行细菌性病原调查，在２０８例腹泻患儿粪便中检出致泻菌２４６株，检出率为４２．２６％，其中ＥＴＥＣ７７株（１３．２３％），ＥＩＥＣ１９株（３．２６％），空肠弯曲菌１７株（２．９２％），沙门氏茵６株（１．０３％），亲水性气单胞菌２株（０．３４％）。表明致泻大肠杆菌（ＥＴＥＣ，ＥＰＥＣ，ＥＩＥＣ）是我区婴幼儿致泻主导菌群，占检出菌的６６．３％。混合感染率在农村腹泻患儿中高达１７．３％，值得临床工作者重视。     

Orphan airlift. Enteric pathogens isolated from Vietnamese children immigrating to the United States.

Isolation studies for bacterial and parasitic agents were carried out on stool specimens from Vietnamese infants at the time of their mass airlift to the United States. One or more bacterial pathogens were found in 49% of the 367 stool specimens cultured. The isolates included enteropathogenic Escherichia coli (161), Shigella (16), Salmonella (15), but no Salmonella typhi or Vibrio cholerae. Parasites identified in 88 stool specimens included Giardia lamblia (10), Ascaris lumbricoides (7), and Entamoeba histolytica (1). Transmission of agents to volunteers probably occurred, because 48% of 272 adults questioned had diarrhea shortly after caring for the children, and stool cultures from these adults resulted in the isolation of E coli (105), Salmonella (1), and Shigella (3).     

Value of stool examination in patients with diarrhoea

Findings of stool examinations in 1593 patients with diarrhoea due to a single enteric pathogen--enterotoxigenic Escherichia coli rotavirus, Shigella, Campylobacter jejuni, Vibrio cholerae 0:1, Entamoeba histolytica, or Giardia lamblia--were reviewed to determine how well they predicted the agent associated with the diarrhoea. Specimens were examined visually for blood and mucus, tested for pH, and examined under a microscope for the presence of red and white blood cells, parasites, and stool fat. Although visible blood was more common in specimens from patients infected with Shigella (51%) and Ent histolytica (39%) than in those from patients infected with other agents (6%; p less than 0.01), patients infected with Shigella were most likely to have numerous faecal leucocytes (greater than 50/high power field: 39% v 8% of all patients and 7% of patients infected with Ent histolytica, p less than 0.01 in both cases). Patients infected with enterotoxigenic E coli, rotavirus, V cholerae 0:1, or C jejuni had loose stools with fewer red or white cells. Patients infected with rotavirus and C jejuni were more likely to have acid stools with 3 to 4+ fat, but these findings were related to young age and breast feeding. Stool examination is most useful in establishing a diagnosis of dysentery and in helping to distinguish between patients infected with Shigella and Ent histolytica; it is of limited usefulness in discriminating between pathogens causing watery diarrhoea.     

四种儿童常见肠道致病菌的多重PCR检测

目的 对儿童感染性腹泻能进行四种常见病原菌如肠致病性大肠埃希菌（enteropathogenic Escherichia coli,EPEC）、沙门菌属（Salmonella spp.）、志贺菌属(Shigella spp.)、空场弯曲菌(Campylobacter Jejuni)的快速检测。方法 建立多重PCR检测体系。结果 该方法用一次PCR即可检测四种肠道致病菌,灵敏度达10~100CFU/ml;同时利用16S rRNA基因的保守区域作为内参照,有利于对粪便标本的扩增进行质量控制;对粪便标本,整个检测过程约5 h。结论 通过检测编码细菌的毒力因子或特异性生化反应相关的酶的基因,多重PCR体系能特异、灵敏、快速地检测四种肠道致病菌;icsA基因可以作为志贺菌属检测的特异性靶基因;该方法可进一步完善成体外基因诊断试剂盒。     

240例小儿细菌性腹泻病原学检测与临床用药效果研究

目的 :了解小儿细菌性腹泻的主要病原菌及不同药物的治疗效果,用以指导临床上合理用药.方法 :对2014年12月~2015年12月在我院儿科就医的细菌感染性腹泻的240例小儿大便标本进行病原学检验,并分别应用头孢曲松钠和氨苄青霉素对患儿分组进行治疗,观察疗效.结果 :①小儿细菌性腹泻好发于夏、秋季节,粪检病原菌阳性率37.50%,主要病原菌为志贺菌、大肠埃希菌和克雷伯菌,病原菌检出率在不同年龄组间差异有统计学意义;②应用头孢曲松钠治疗的总有效率为96.67%,优于氨苄青霉素(86.67%),两组疗效的比较差异有统计学意义,典型临床症状改善的时间均为头孢曲松钠组少于氨苄青霉素组.结论 :用药前进行细菌分离鉴定,有助于对症用药,应用头孢曲松钠治疗小儿细菌性腹泻疗效可观.     

Yersinia enterocolitica infection in children

The role of Yersinia enterocolitica as a human pathogen has been documented in publications from over 30 countries, and Y. enterocolitica has been recognized increasingly to cause gastrointestinal disease in children. In 1979, an Australian survey yielded only three isolates of Y. enterocolitica from 3298 faecal specimens obtained from adults. We screened all stool specimens received during a 22-month period for Yersinia by means of a recently developed selective agar medium. Y. enterocolitica was isolated from 32 of 4136 (0.7%) specimens. Most isolates were of serotype O:3, biotype 4. During the study, 154 Salmonella spp. (3.7%), 196 Campylobacter spp. (47%), seven Shigella spp. (0.2%) and 27 Aeromonas spp. (0.9% of 2779) were recovered. Children infected with Y. enterocolitica presented with acute diarrhoea associated with fever and pharyngitis; chronic or recurrent diarrhoea; or pain in the right iliac fossa associated with mesenteric adenitis. Gastrointestinal symptoms usually resolved spontaneously within two weeks. However, some children were treated successfully with cotrimoxazole.     

Surveillance study on bacteriological etiology of 8371 children with diarrhea]

The results of stool cultures from 8371 children of 0-13 years old with diarrhea during the years of January 1981 to December 1989 in Shanghai area are reported. 2906 strains of enteropathogenic bacteria were isolated, with total detection rate of 34.72%. Shigella were still the most common pathogens in 1981-1984, and Campylobacter jejuni took second place, whereas from 1985 on Campylobacter exceeded Shigella as the first pathogenic bacteria of children's diarrhea. Except in 1987 and 1988 Shigella sounei predominated over Shigella flexneri in detection rate within the past nine years, the detection rates of EPEC and Salmonella were lower. It was significant that Salmonella typhimurium was about half the number for Salmonella non typhi. During 1986 and 1987 we specially isolated and identified Vibrionaceae bacteria with 130 strains of Vibironaceae detected, occupying third place among pathogens of children's diarrhea in these two years, and among which aeromonas were the most common. This article analyses in detail the distribution of enteropathogenic bacteria with respect to their species, genus and serum type.     

儿童社区获得性腹泻病原菌菌谱及药敏分析

目的 了解儿童社区获得性腹泻病原菌分布及耐药情况.方法 本研究对598例在2008～2010年度本院门诊的急性腹泻患儿进行志贺菌、沙门菌、致泻性大肠埃希菌、变形杆菌、肠球菌、金黄色葡萄球菌培养分离、鉴定及药敏.结果 在分离的病原菌中,致泻性大肠埃希菌、肠球菌属和金黄色葡萄球菌为前三位的病原菌,分别占27.5％、26.9％和23.4％;金黄色葡萄球菌对万古霉素均敏感,对红霉素、青霉素的耐药率均＞50％;肠球菌对万古霉素敏感,环丙沙星、高浓度庆大霉素和红霉素均有较高的耐药率;大肠埃希菌对亚胺培南均敏感,而对哌拉西林、环丙沙星、庆大霉素耐药率较高;亚胺培南、头孢噻肟、氨曲南、阿米卡星、环丙沙星对志贺菌有较好的抗菌作用.结论 肠球菌是主要的儿童社区获得性腹泻的病原菌;细菌性腹泻在小儿社区获得性腹泻中占一定的比例,应重视病原菌的分离.     

Mixed infections in childhood diarrhoea: results of a community study in Kiambu District, Kenya

One thousand four hundred and twenty diarrhoea specimens from 846 children aged 0 to 60 months were collected and analysed for bacteria, parasites and rotavirus over a 16 month period, from June 1985 to September 1986 inclusive. The study was conducted in 4 villages situated in Kiambu District, Kenya. All the specimens were analysed for rotavirus and parasites, including Cryptosporidium. The majority of the specimens were analysed for enteropathogenic Escherichia coli (EPEC), Shigella, Salmonella, Campylobacter and Aeromonas. Only 387 specimens were analysed for enterotoxigenic E. coli (ETEC). However, of this proportion analysed for ETEC, 33% were positive. A total of 344 specimens were negative for any organisms while a further 140 were only positive for parasites which have been implicated as being pathogenic, including Ascaris lumbricoides, Hymenolepis nana, Trichomonas hominis and Blastocysts hominis were considered to be at least potentially pathogenic and capable of causing diarrhoea. An average of only 29.4% of these organisms occurred as single isolates. The remaining infections were mixed, with a maximum of 7 potentially pathogenic organisms occurring together in a single specimen. The associations of certain organisms were significant, notably Campylobacter with Giardia lamblia. Campylobacter with EPEC, EPEC with Ascaris, and G. lamblia with rotavirus. The latter was a negative association.     

携带毒力岛大肠杆菌性小儿腹泻

目的：探讨携带毒力岛大肠杆菌（HPIEC）在小儿腹泻中的病原学地位。方法：采用PCR扩增和菌落原位杂交检测HPIEC－irp2毒力岛基因,并用血清学分型和聚合酶链反应（PCR）法检测各类致泻大肠杆菌。结果：从1032例腹泻患者粪便中分离出652株大肠杆菌,经血清学和PCR毒力基因分型,检出各类致泻大肠杆菌225株,其中肠致病性大肠杆菌（EPEC）20株,ETEC81株,产志贺样毒素大肠杆菌（SLTEC）47株,产志贺样毒素侵袭性大肠杆菌（ESIEC）74株,产毒素大肠杆菌（EIEC）3株。所有致泻大肠杆菌和未能分型的普通大肠杆菌株,再用HPIEC－irp2探针作菌落原位杂交,共检出携带毒力岛大肠杆菌（HPIEC－irp2)112株,总阳性率为17．2％。其中41例是从致泻大肠杆菌ESIEC（24／74）和SLTEC（17／47）中检出。携带毒力岛大肠杆菌性小儿腹泻的主要临床表现为食欲不振（87．5％）,腹痛（58．0％）,腹泻（＞6次／d,75．9）,发热（50．9％）,以粘液便为主（69．6％）。结论：携带毒力岛大肠杆菌是引起小儿腹泻的重要病原菌之一。     

合肥市新生儿感染性腹泻病原的调查

1988年3～5月对合肥市两所医院(甲、乙医院)婴儿室新生儿感染腹泻病原菌进行调查,336名新生儿中RV感染率14%,EPEC感染率2.1%,其余细菌未检出。乙医院感染率高于甲医院。发现同时感染RV和EPEC但不发病。提示新生儿可以携带RV和EPEC,其意义有待进一步研究。     

Reliable and easy identification of bacterial acute respiratory infections of childhood.

OBJECTIVES: To identify the causative bacteria in childhood acute respiratory infections (ARI) and to determine the usefulness of pus cell counts in differentiating between pathogenic and commensal bacteria, cultured from nasopharyngeal aspirates. DESIGN: Case control prospective study. SETTING: Outpatients' department and the paediatric unit at General Hospital, Colombo South. SUBJECTS: 200 children under 5 years with cough and difficulty in breathing for less than one week who had no history of antibiotic therapy for the current illness, and 50 healthy controls matched for age and sex. RESULTS: 56.5% of cases had bacterial infections. Branhamella catarrhalis (25%), Haemophilus influenzae (12.5%) and Streptococcus pneumoniae (10.5%) were the major pathogens identified. Pus cell counts were found to be significantly higher in cases than in controls (X2 58.28 df = 1 p < 0.001), and the pathogens were more often associated with pus cell counts of more than 10/field. CONCLUSIONS: 56.5% of children with ARI had bacterial infections. B catarrhalis seems to play a major role in childhood ARI. Examination of nasopharyngeal aspirates is a useful way to identify pathogens, provided microscopic examination for pus cells is performed together with culture.     

感染性腹泻临床与病原学分布特点及耐药分析

目的探讨新疆地区感染性腹泻的临床及病原学分布特点,指导经验性治疗感染性腹泻,避免滥用抗菌药物。方法回顾性分析2009年8～10月及2010年5～10月新疆医科大学第二附属医院肠道门诊感染性腹泻患者的临床及病原学特点、药敏结果。结果以急性腹泻为首发症状就诊的183例患者中,26例(14.2%)粪便细菌培养阳性,其中志贺菌属感染14例(53.8%),大肠埃希菌属感染5例(19.2%),沙门菌属感染3例(11.5%),肺炎克雷伯杆菌、嗜水气单胞菌、摩氏摩根菌、雷氏普罗威登斯菌感染各1例(3.8%)。年龄≤60岁患者病原菌的检出率高于年龄﹥60岁者(P﹤0.05)。志贺菌属感染以黏液便、水样便为主,大肠埃希菌与沙门菌感染以稀便为主。志贺菌、大肠埃希菌及沙门菌普遍对氨苄西林耐药,对β-内酰胺酶类、头孢菌素类和喹诺酮类等抗菌药物产生不同程度的耐药性;尚未发现病原菌对碳青霉烯类抗菌药物产生耐药性。结论肠道门诊细菌感染性腹泻患者粪便细菌培养阳性率较低,仍以志贺菌属为主要病原菌。监测病原菌分布、药敏结果,合理选择抗菌药物对降低细菌耐药十分重要。     

云南战区腹泻病原菌监测及流行病学特征研究

目的对云南战区腹泻病原菌进行监测,掌握其腹泻病原谱的构成和流行病学特征,为军队和地方腹泻病的防控及诊治提供重要依据。方法采集监测点肠道门诊腹泻患者新鲜粪便标本,按统一制定的监测方案,操作规程检测志贺菌、沙门菌、致泻性大肠埃希菌（EIEC、ETEC、EPEC、EHEC、EAggEC）、小肠结肠炎耶尔森菌、空肠弯曲菌、霍乱弧菌、副溶血弧菌、气单胞菌、类志贺邻单胞菌以及其它肠道病原菌。结果从588例腹泻患者粪便标本中检出各类病原菌220株,检出率为37.41%。其中肺炎克雷伯菌居首位（6.80%）、费劳地枸橼酸菌次之（5.95%）、居第三位的是志贺菌（4.25%）、列第四位的是奇异变形菌和阴沟肠杆菌（3.23%）、排第五至第七位的分别是产酸克雷伯菌（2.89%）、侵袭性大肠杆菌（2.21%）和气单胞菌（1.53%）。不同年龄组检出率为29.11%～48.34%之间,其中36～45岁年龄组检出率最高,男女性别间差异无统计学意义（P〉0.05）。病原检出率5、8、9月份较高。结论通过对腹泻病原菌监测,了解腹泻病原菌的组成,建立病原谱,掌握其流行病学特征,为军队和地方腹泻病的研究、防控、流行病学调查等提供重要参考资料。     

西南战区腹泻患者携带耶尔森菌HPI毒力岛大肠艾希菌调查

目的收集西南战区部队和地方医院腹泻患者粪便标本,做细菌分离与鉴定,分析病原菌组成。对分离的部分生化反应符合大肠艾希菌,但血清学证明不属于肠侵袭性大肠杆菌（EIEC）、肠产毒性大肠杆菌（ETEC）、肠致病性大肠杆菌（EPEC）和肠出血性大肠杆菌（EHEC）的菌株,做耶尔森菌HPI毒力岛irp-2基因检测,了解西南战区腹泻病人粪便中分离的大肠艾希菌携带耶尔森菌HPI毒力岛irp-2基因的存在情况。方法常规法分离,用肠杆菌科细菌生化鉴定编码系列（API-20E或GYZ-11e系统）和VITEK32全自动微生物生化分析仪以及弧菌科细菌生化鉴定编码系列（GYZ-9V系统）进行系统鉴定,PCR扩增法检测耶尔森菌HPI毒力岛。结果在1 352例腹泻病人中检出36个属种594株病原菌,检出率为43.93%,弗劳地枸橼酸杆菌检出率为6.14%、肺炎克雷伯菌为5.62%、变形杆菌4.66%、志贺菌4.07%,EIEC 1.85%,检出36株携带耶尔森菌HPI毒力岛irp-2基因大肠艾希菌,检出率为2.66%。结论从1352例腹泻患者粪便标本中分离到弗劳地枸橼酸杆菌占首位,肺炎克雷伯菌次之,变形杆菌、志贺菌分别居第三、第四位。西南战区存在携带耶尔森菌HPI毒力岛irp-2基因的大肠艾希菌。     

Multiplex Polymerase Chain Reaction for Rapid Identification of Diarrheagenic Escherichia coli

Despite the fact that diarrhaegenic Escherichia coli (DEC) has been identified as a major etiologic agent of childhood diarrhea which represent a major public health problem in developing countries, only a few studies have been performed in Bangladesh to identify these organisms. To detect DEC in patients with acute diarrhea, a total of 300 stool specimens were tested by multiplex polymerase chain reaction (PCR). The multiplex PCR was designed for the detection of target genes of "eae" for enteropathogenic E. coli (EPEC), "stx" for enterohemorrhagic E. coli (EHEC), "ipaH" for enteroinvasive E. coli (EIEC), "aspU", "CVD432" and "aggR" for enteroaggregative E. coli (EAEC) as well as "elt" and "est" for enterotoxigenic E. coli (ETEC). Out of 300 stool specimens collected from patients with acute diarrhea, the DEC was detected in 18% (54/300) cases. The dominating strain was ETEC (13%, 39/300), followed by EAEC (5%, 15/300) and no EHEC, EIEC and EPEC could be detected. Both heat-stable toxin (ST) and heat-labile toxin (LT) genes of ETEC were detected in 66.68% (26/39) strains and only ST or LT as single gene was detected in 23.07% (9/39) or 10.25% (4/39) strains respectively. The multiplex PCR assay could be used as a rapid as well as efficient diagnostic tool for identification of DEC in the clinical laboratory settings.     

Etiology of diarrhea among travelers and foreign residents in Nepal

A bacterial pathogen was isolated from 47% of 328 expatriate patients with diarrhea seen at two medical clinics in Nepal in 1986. Enterotoxigenic Escherichia coli (24%), Shigella (14%), and Campylobacter species (9%) were isolated most frequently. Enteroinvasive and adherence factor-positive E coli were isolated from 2% and 1% of patients, respectively. Giardia lamblia was detected in 12% of patients, rotavirus in 8%, and Cryptosporidium and Entamoeba histolytica each in 5%. Blastocystis hominis was present in 33% of patients but in only 9% of those who took trimethoprim-sulfamethoxazole. More than one enteropathogen was detected in 17% of patients. Patients with prolonged symptoms (longer than two weeks) were more likely to have Giardia (27%) and less likely to have Shigella (5%) than were patients with acute symptoms. The isolation rates of bacterial pathogens decreased with length of stay in Nepal. A wide variety of enteropathogens were detected in travelers to Nepal, and Shigella and protozoa were particularly important. Length of time abroad and duration of symptoms were important diagnostic considerations.     

2017年至2020年儿童感染性腹泻沙门菌和志贺菌分布及药敏结果

  目的  对昆明市儿童医院感染性腹泻沙门菌和志贺菌的分布和药敏结果进行分析，为临床合理用药提供参考依据。  方法  收集2017年1月至2020年12月门诊及住院腹泻患儿的粪便标本进行沙门菌和志贺菌培养，病原菌用全自动细菌分析仪VITEK COMPACT培养鉴定及药敏，并进行血清凝集分型，最后用WHONET 5.6软件对原始数据进行统计学处理。  结果  在检测的29674 份标本中，分离出志贺菌属和沙门菌属共 226株，志贺菌属 75株（33.2%），福氏志贺菌33株（14.6%），宋内志贺菌42株（18.6%），未检出痢疾志贺菌和鲍氏志贺菌。分离出沙门菌属 151株（66.8%），共检测出5种血清型，其中鼠伤寒沙门菌 106株（46.9%），伤寒沙门菌25株（11.1%）。腹泻患儿主要分布在4～10月，聚集分布在5～10月。2岁以下是沙门菌感染的易感人群，占72.8%（110/151）。沙门菌属感染引起的腹泻呈逐年上升趋势，沙门菌以鼠伤寒沙门菌为主。志贺菌在2017年、2018年以福氏志贺菌为主，而2019年以后转变为宋内志贺菌为主。另外，药敏结果显示沙门菌儿童感染性腹泻临床首选药物为阿莫西林/克拉维酸（敏感率82%），而宋内志贺菌首选药物为头孢他啶（敏感率97.6%）和阿莫西林/克拉维酸（敏感率92.8%），福氏志贺菌对头孢他啶、头孢吡肟敏感率仅为60%和40%，提示志贺菌属各血清群对抗菌药物敏感性不同，差异有统计学意义（P均 < 0.05）。沙门菌属和志贺菌属均为未发现亚胺培南耐药菌株。  结论  沙门菌和志贺菌引起的儿童感染性腹泻以沙门菌为主，呈逐年上升趋势，以2岁以下高发，鼠伤寒沙门菌为主要血清型，经验性用药首选阿莫西林/克拉维酸。各血清型志贺菌对抗菌药物的耐药性有所不同。需加强腹泻儿童粪便的病原菌和耐药监测，以便临床医生根据药敏结果给予针对性抗感染治疗。     

Cryptosporidiosis and childhood diarrhoea in a rural community in Kenya

Cryptosporidiosis has come to recent prominence as a cause of diarrhoea throughout the world in both adults and children, producing either an acute self-limiting diarrhoea or a protracted chronic diarrhoea which can be fatal in immunosuppressed patients. This study was therefore conducted to assess the prevalence of the infection among children less than five years of age in a rural community in Kiambu District, Kenya. 1420 diarrhoea specimens from children less than five years which were processed for bacteriology and parasitology were also examined for Cryptosporidium oocysts, using the modified Ziehl-Neelsen (ZN) acid-fast stain, 3.8% of all the diarrhoea samples were positive for oocysts. 320 non-diarrhoeic stools from children in the same age group were also examined and were all negative for Cryptosporidium oocysts. The results of this study would imply that infection with Cryptosporidium is associated with acute childhood diarrhoea in Kenya.