布鲁氏菌104M液体气溶胶免疫BALB/c小鼠的有效性评价和安全性研究

目的 评价布鲁氏菌104M液体气溶胶肺递送途径免疫BALB/c小鼠有效性和安全性。方法 随机选取6～8周龄BALB/c雌鼠,分别经肺递送、滴鼻和皮下注射3种途径免疫接种布鲁氏菌104M,于免疫后第4、8、16、24周观察并记录小鼠的症状、检测小鼠体重、脾重、脾脏载菌量及肺匀浆、血清的抗体和细胞因子。待鼠脾脏载菌完全清除,用布鲁氏菌A19液体气溶胶肺递送途径攻毒。结果 各组实验小鼠均未见异常症状;体重无显著下降;攻毒前,脾重没有明显变化;攻毒后,免疫组小鼠脾重显著低于空白对照组（P<0.05）：液体气溶胶肺递送：实验组（0.26±0.16）g<空白对照组（0.40±0.19）g,滴鼻：实验组（0.21±0.11）g<空白对照组（0.28±0.19）g,皮下注射：实验组（0.14±0.02）g<空白对照组（0.30±0.18）g。随着免疫时间的增长,免疫组小鼠脾脏载菌量呈下降趋势,第20周完全清除。攻毒后2周（免疫24周）,所有小鼠脾脏载菌均显著增加,各免疫组脾载菌量均显著低于空白对照组（P<0.05）：脾载菌量以log₁₀菌落形成单位（colony-forming units,CFU）/g计数并统计分析,液体气溶胶肺递送：实验组（4.49±0.13）<空白对照组（6.90±0.46）;滴鼻：实验组（3.59±1.06）<空白对照组（7.08±0.14）;皮下注射：实验组（3.00±2.03）<空白对照组（6.81±0.34）。布鲁氏菌104M激发了BALB/c小鼠细胞免疫和体液免疫反应。在免疫后第4周,检测到104M特异性抗体IgG、IgM、IgA,第8周达到高峰,攻毒后再次显著上升。各免疫组血清和肺匀浆中IFN-γ和IL-18浓度在攻毒前,均显著高于空白对照组（P<0.05）,攻毒后,各免疫组血清IFN-γ和IL-18浓度均低于空白对照组（P<0.05）,而肺匀浆细胞因子浓度在攻毒前后均持续高于空白对照组（P<0.05）。结论 液体气溶胶肺递送途径是一种有效的免疫途径,表现出有效的保护作用;104M未引起小鼠体重减轻,相对安全,但在小鼠体内存活时间较长,引起小鼠轻度脾脏肿大,有一定的残余毒力。     

Role of TLRs in Brucella mediated murine DC activation in vitro and clearance of pulmonary infection in vivo

Brucellosis is worldwide zoonoses affecting 500,000 people annually with no approved human vaccines available. Live attenuated Brucella abortus vaccine strain RB51 protects cattle through CD4 and CD8 T-cell mediated responses. However, limited information is known regarding how Brucella stimulate innate immunity. Although the most critical toll like receptors (TLRs) involved in the recognition of Brucella are TLR2, TLR4 and TLR9, it is important to identify the essential TLRs that induce DC activation/function in response to Brucella, to be able to upregulate both vaccine strain RB51-mediated protection, and clearance of pathogenic strain 2308. Furthermore, in spite of the importance of aerosol transmission of Brucella, no published studies have addressed the role of TLRs in the clearance of strain 2308 or strain RB51 from intranasally infected mice. Therefore, we used a (a) bone marrow derived dendritic cell model in TLRKO and control mice to assess the differential role of pathogenic and vaccine strains to induce DC activation and function in vitro, and (b) respiratory model in TLRKO and control mice to assess the critical roles for TLRs in clearance of strains in vivo. In support of the essential TLRs in clearance and protection, we performed challenge experiments to identify if these critical TLRs (as agonists) could enhance vaccine induced protection against pathogenic strain 2308 in a respiratory model. We determined: vaccine strain RB51 induced significant (p≤0.05) DC activation vs. strain 2308 which was not dependent on a specific TLR; strain RB51 induced TNF-α production was TLR2 and TLR9 dependent, and IL-12 production was TLR2 and TLR4 dependent; TLR4 and TLR2 were critical for clearance of vaccine and pathogenic Brucella strains respectively; and TLR2 (p<0.05), TLR4 (p<0.05) and TLR9 (p=0.075) agonists enhanced vaccine strain RB51-mediated protection against respiratory challenge with strain 2308 in the lung.     

Chronic cryptococcal meningitis in an intravenous drug addict without evidence of infection by HIV-1,2 in southern Italy

Before the emergence of AIDS, extra-pulmonary cryptococcosis was very rare. By contrast, meningeal cryptococcosis is a very common opportunistic infection in AIDS patients. We report an intravenous drug addict with cryptococcal meningitis, who was not infected with HIV and had no apparent predisposing conditions. This case, as those elsewhere described, supports the potential existence of viral agents, other than HIV-1,2, capable of encouraging the occurrence of unusual infections as have emerged during the AIDS pandemic.     

14例布鲁氏菌病性胸锁关节炎患者临床特点

目的 总结布鲁氏菌病性胸锁关节炎患者临床症状、影像学表现、实验室检查特点, 为诊断及治疗提供参考。 方法 采用回顾性分析方法收集2013年8月—2023年2月呼伦贝尔市某医院布鲁氏菌科入院患者, 整理分析流行病学特点、首诊情况、临床表现、临床体征、实验室检查、影像学检查、治疗及预后情况。 结果 14例布鲁氏菌病性胸锁关节炎患者, 其中男性11例, 女性3例, 14例均有明确流行病学史。临床表现为关节疼痛(14例)、发热(10例)、乏力(10例)、多汗(6例)、寒战(5例)。临床体征以关节红肿痛(14例)、脾大(4例)、淋巴结肿大(3例)为主。实验检查异常以炎性指标升高为主, 其中C反应蛋白升高14例, 红细胞沉降率升高10例, 另伴有血液系统损伤、肝损伤。14例患者均给予12周及以上足疗程联合抗感染治疗, 其中治愈13例, 手术治疗1例, 有效率100%。 结论 布鲁氏菌病性胸锁关节炎发病率较低, 易出现误诊漏诊, 临床应注意鉴别, 若早发现、早诊断、早治疗, 临床预后较好。     

Gastrointestinal infection due to Anisakis simplex in southern Italy

The authors present four cases of infection due to Anisakis in an area where people are prone to infectious diseases transmitted by raw fish, but in which the presence of this parasite has never been reported. Three of four cases were discovered accidently during surgical procedures for co-existing abdominal pathologies. Raw fish was apparently not involved in all patients. Characteristics of the patients are discussed.     

Human infection with M- strain of Brucella canis

The less mucoid strain of Brucella canis or M- strain is used for the serologic diagnosis of canine brucellosis. While this strain is avirulent in dogs, we report the case of clinical brucellosis that developed in a laboratory worker a few days after handling live M- cells for antigen production.     

海南省布鲁氏菌病疫情特征研究

目的 分析海南省布鲁氏菌病（布病）流行病学特征。方法 对2012-2017年海南省收集的16株布鲁氏菌采用Vitek 2 compact进行布鲁氏菌初步鉴定,再用传统生物学分型方法进行确证,结合饲养家畜血清学和病原学检测结果分析患者的流行病学特征。结果 Vitek 2 compact鉴定12株为羊种布鲁氏菌,4株为人苍白杆菌。传统生物学分型方法鉴定11株为羊种布鲁氏菌3型,5株为猪种布鲁氏菌3型。菌株对应的16例病例中2012年1例,2013年2例,2014年4例,2015年1例,2016年2例,2017年6例,分布在东方市、临高县、海口市、万宁市、乐东县、定安县等地。同时对疫区东方市745份羊血清进行布鲁氏菌血清抗体检测,阳性47例（6.3%）,从东方市病羊采集的标本中分离到羊种布鲁氏菌3型。结论 Vitek 2 compact是一种简单、方便的布鲁氏菌鉴定方法,但不能替代传统生物学分型方法;海南地区布病主要流行的菌种为羊种3型及猪种3型,通过东方市2017年布病疫情,说明海南省有布病疫畜传染人的疫情,布病防控形势严峻。     

重症监护病房患者耳念珠菌感染的调查与防控

目的 调查某院重症医学科(ICU)耳念珠菌患者感染/定植及环境污染情况,评价医院感染防控措施的效果。方法 2022年6月某院ICU 1例长期住院患者血培养检出耳念珠菌,立即对该科住院患者不同体表部位及病区环境进行多次采样和细菌培养(频率为每间隔一周采样一次),并采用基质辅助激光解吸电离飞行时间质谱技术进行分析。对检出耳念珠菌的患者采取单间隔离、温水冲浴、洗必泰擦洗等措施,对病区环境采取擦洗、消毒等措施,采取主动筛查的方法评估防控措施效果。结果 第一次主动筛查ICU 14例在院患者,其中8例患者检出耳念珠菌9株;首次检出耳念珠菌前一周内转出ICU的3例患者,均未检出耳念珠菌。第二次主动筛查ICU 13例在院患者,其中2例患者检出耳念珠菌2株;第三次主动筛查ICU 8例在院患者,仅在1例患者的腹股沟和腋下检出耳念珠菌,余患者筛查均为阴性;第四、五次主动筛查均未再检出耳念珠菌。环境监测结果显示,第一次主动筛查采集80份环境标本,分别在地面、医疗设备检出耳念珠菌6株,第二、三次筛查均未检出耳念珠菌。经采取综合防控措施,14例在院患者仅1例发生耳念珠菌败血症医院感染,其余患者均确定为耳念珠菌定植...     

国外非结核分枝杆菌医院感染暴发的研究现状: 1985—2023年

非结核分枝杆菌在环境中广泛存在, 可因医疗用水、器械污染等引起血流、皮肤和软组织感染, 并导致感染暴发。本文通过在PubMed检索非结核分枝杆菌暴发事件相关的文献, 总结分析1985—2023年国外非结核分枝杆菌医院感染暴发情况, 以期为今后非结核分枝杆菌感染防控措施的制定和监管提供参考。     

Outbreak of Nocardia farcinica infection with the same pattern in randomly amplified polymorphic DNA analysis

We experienced three cases of nocardiosis by Nocardia farcinica in the same ward within a six-month period. The result of gene analysis by randomly amplified polymorphic DNA gave the same pattern. Thus, these three cases were considered to be caused by the same strain of N. farcinica, implying the presence of nosocomial infection.     

The impact of needle-exchange programs on the spread of HIV among injection drug users: A simulation study

Objective. To determine the impact of the implementation of a needle-exchange program (NEP) on the spread of human immunodeficiency virus (HIV) in an injection drug user (IDU) community. We conducted a Monte Carlo simulation study of a theoretical population of 10,000 IDUs. The population was followed monthly from 1984 to 2000. HIV was assumed to be transmitted only by needle sharing. The NEP was introduced in 1989 and evaluated over a period of 11 years. The impacts of the proportion of the population attending the NEP, the risk level of IDUs attending the NEP, the reduction in needle-sharing frequency, and the number of new needle-sharing partners acquired at the NEP on prevalence and incidence of HIV were determined. Increasing the proportion of the population who always attend the NEP and eliminating needle-sharing incidents among IDUs who always attended the NEP were the most effective ways of reducing the spread of HIV. Attracting high-risk users instead of lower risk users to the NEP also reduced the spread of HIV, but to a lesser extent. NEPs are effective at reducing the spread of HIV; even under the worst case scenario of low risk users more likely to attend the NEP, one additional partner per month as a result of attending the NEP, and poor NEP attendance, the estimated prevalence was still less than that from the scenario without an NEP. Under our model, NEPs were shown to reduce the spread of HIV significantly. Efforts should be focused on getting as many IDUs as possible to become regular NEP attenders and stop sharing needles rather than partially reducing the frequency of sharing by a larger number of IDUs.     

Risk factors associated with the conversion of meticillin-resistant Staphylococcus aureus colonisation to healthcare-associated infection

The objective of the study was to identify risk factors for healthcare-associated meticillin-resistant Staphylococcus aureus (HA-MRSA) infections in patients with MRSA colonisation over an extended time period. This was a case–control study conducted at a community teaching hospital. Patients included 41 cases and 82 controls, aged ≥18 years, who were nares colonisation culture positive for MRSA and either did or did not develop an HA-MRSA infection within 60 days after index colonisation, respectively. Potential risk factors evaluated included: patient demographics, comorbid conditions, medication use, presence of invasive devices, presence of wounds or other infections, nutritional status, number of hospitalisations and time to infection development. In the univariate analysis, the presence of peripheral vascular disease, three or more comorbidities, a central venous catheter, a Foley catheter, or two or more hospitalisations were significantly associated with increased risk for HA-MRSA infection. Multivariate analysis yielded a model that included presence of a central venous catheter (OR: 8.00; 95% CI: 3.13–20.4) or two or more hospitalisations (OR: 3.37; 95% CI: 1.37–8.26) as independent risk factors for MRSA infection in those with MRSA colonisation. In conclusion, risk factors independently associated with the conversion of MRSA colonisation to HA-MRSA infection include the presence of a central venous catheter or two or more hospitalisations. Strategies involving risk factor minimisation may be helpful in reducing HA-MRSA infections in this patient population.     

唾液富组蛋白5——治疗白念珠菌感染的一种新策略

白念珠菌是一种机会性病原体,可引起不同部位的真菌感染。目前,白念珠菌治疗药物单一,且随着临床药物的不合理使用,白念珠菌耐药问题日益加剧。富组蛋白5(Hst-5)是口腔唾液中分泌最丰富的抗菌肽,作为宿主第一道防御线,对白念珠菌具有很强的抗菌活性。其作用机制与传统抗真菌药物和其他抗菌肽不同,其中涉及白念珠菌表面的多种转运蛋白、MAPK途径、体外多种金属离子等,且随着对Hst-5的深入研究,发现Hst-5的多种衍生肽(K11R-K17R、P-113Tri等),在抗菌效力上能发挥更大杀伤力。因此,对Hst-5及其衍生肽在白念珠菌中的抗菌机制进行研究尤为重要,将为目前临床治疗真菌感染提供新策略。     

Diffusion of thermophilicCampylobacter in the Pesaro-Urbino area (Italy) from 1985 to 1992

The results of research on the spreading of campylobacter in the Pesaro-Urbino area carried out from 1985 to 1992 are presented. Materials of different origin were examined: 822 samples of human faeces, 533 animal rectal swabs, 192 samples of domestic sewage, 48 of river water, 96 of sea water and 632 of various types of food. Two hundred and nine strains of campylobacter were isolated (9%), most of which wereCampylobacter jejuni (80%), with particular frequency in food products (chicken carcass 45.7%, ground meat and sausage 18.1%) and in river water (31.3%). In contrast, the samples of sea water and dairy cheese products were always negative. It may be concluded that the spreading of campylobacter in the Pesaro-Urbino area is mainly associated with food products of animal origin. Therefore, better controls in the processing of these products may be necessary.     

普雷沃菌血流感染: 一项为期10年的单中心回顾性研究

目的 提高临床医生对普雷沃菌血流感染的认识,减少误诊和漏诊率,拓宽诊疗思路。 方法 收集2013年5月-2023年5月南京大学医学院附属某医院普雷沃菌血流感染患者的临床资料,回顾性分析普雷沃菌血流感染患者的危险因素、感染来源、感染菌种、临床表现、实验室检查结果、治疗及转归。 结果 共纳入23例确诊为普雷沃菌血流感染的患者,共中男性15例（65.2%）,女性8例（34.8%）。大部分患者血流感染前有相关诱发因素,如手术操作（11例,47.8%）、恶性肿瘤（10例,43.5%）、糖尿病（9例,39.1%）、导尿管置入（10例,43.5%）等。感染菌种共9类,主要为颊普雷沃菌（6例,26.1%）、二路普雷沃菌（5例,21.7%）和中间普雷沃菌（4例,17.4%）。感染来源主要为肝胆系统（6例,26.1%）、腹腔及胸腔（4例,17.4%）和泌尿生殖道（4例,17.4%）。所有患者均有畏寒、发热表现,血液炎症指标明显升高,4例（17.4%）并发感染性休克,18例（78.3%）患者经恰当的抗感染治疗后预后良好。 结论 当怀疑不典型病原菌普雷沃菌血流感染时,应尽早去除诱发因素,积极留取血液送培养,依据药敏试验合理应用抗菌药物,有利于迅速控制感染,改善预后。     

MALDI-TOF-MS鉴定成人颅内感染人型支原体1例

人型支原体是一类没有细胞壁、具有多形性、可通过滤菌器的已知最小原核型微生物。在人体中,其主要引起泌尿生殖系统感染,而在成人颅内感染中极为少见,且引起的颅内感染在诊断、治疗、预后管理等方面尚缺乏统一的共识。本文报告1例成人因车祸伤行神经外科手术后出现人型支原体颅内感染的病例,旨在为临床此类疾病诊治提供参考。     

Sporothrix schenckii var Luriei as the cause of sporotrichosis in Italy

The second known case of sporotrichosis caused by Sporothrix schenckii var. luriei in a patient living in Piacenza, Italy is described. In the absence of cultures, the diagnosis was based on histologic studies. Stained tissue sections (Hematoxylin and eosin, & Gomori methenamine silver) revealed hyaline, large, thick walled tissue form cells that had divided by septation or a budding process. These forms, along with the striking eyeglass configuration of incompletely separated cells that were also present, are the diagnostic features of this apparently rare variety. The use of a fluorescent antibody reagent, specific for S. schenckii, confirmed the identity of the etiologic agent.     

医院感染和社区感染患者分离肺炎克雷伯菌的耐药性差异及变迁

目的 了解某三甲综合医院连续3年分离医院感染和社区感染肺炎克雷伯菌（KP）的分布情况及耐药性差异,为临床抗菌药物合理应用提供依据。方法 回顾性分析2016年11月—2019年10月住院患者分离的社区感染和医院感染KP,比较两组KP在不同科室、不同标本来源的构成比及耐药性差异,分析耐药变化趋势。结果 共检出KP 1 104株,其中医院感染组410株,社区感染组694株。两组KP均主要来源于痰标本,主要来源科室均为重症监护病房（ICU）。两组KP除对替加环素的耐药率均为0外,对其他抗菌药物的耐药率医院感染组均高于社区感染组（均P<0.05）。社区感染组KP对抗菌药物的耐药率均<30%,医院感染组KP对头孢曲松、复方磺胺甲口恶唑的耐药率达50%以上,对亚胺培南的耐药率为18.54%。经趋势χ²检验,医院感染组检出KP对头孢曲松、头孢吡肟、头孢西丁、头孢哌酮/舒巴坦、亚胺培南、阿米卡星、妥布霉素、左氧氟沙星和环丙沙星的耐药率均呈上升趋势,差异有统计学意义（均P<0.05）;社区感染组检出KP对哌拉西林/他唑巴坦、头孢西丁、头孢哌酮/舒巴坦、亚胺培南和环丙沙星的耐药率呈上升趋势,差异有统计学意义（均P<0.05）,对庆大霉素的耐药率呈下降趋势,差异有统计学意义（P=0.004）。结论 医院感染KP耐药率高于社区感染,且医院感染组对多种抗菌药物的耐药率呈逐年上升趋势,对KP医院感染和社区感染应区别进行治疗。     

1例圣乔治教堂诺卡菌眼部感染病例及文献回顾

圣乔治教堂诺卡菌隶属于诺卡菌属,诺卡菌广泛分布于土壤和水中,不属于人体正常菌群,主要通过呼吸道吸入和破损皮肤侵入人体。诺卡菌病由诺卡菌感染所致,诺卡菌感染的常见部位以肺部和皮肤多见,眼部感染报道较少,圣乔治教堂诺卡菌所致眼部感染的报道更少。因此,报道某院1例圣乔治教堂诺卡菌眼部感染的病例,并结合国内外文献进行复习,旨在提高临床对诺卡菌病的诊治水平。     

Incompleteness of statutory notification of bacterial gastro-intestinal infection

A study was made of all potentially statutorily notifiable bacterial infections diagnosed in faecal samples submitted from symptomatic patients to a single microbiology laboratory during a six-month period. Salmonella spp, Campylobacter spp or Shigella spp were isolated from 167 patients and 51% of these were formally notified (54% of general practice patients and 47% of hospital patients). Forty-seven percent of cases of foodpoisoning (Salmonella spp. and Campylobacter spp) were notified as were 70% of cases of shigella infections. Notification was made on average 9.4 d after sending a specimen to the laboratory. A questionnaire used to ascertain the reasons for non-notification in 80 of 85 cases elicited replies in respect of 78 patients. Four patients infected with Salmonella spp or Campylobacter spp were said not to have been suffering from foodpoisoning. A variety of reasons was given for failing to notify the others, the most common were forgetfulness, not receiving the result of the specimen, or believing someone else had made the notification.