四川省一起伴中毒性休克综合征的人感染猪链球菌2型暴发

目的 调查2005年7月中旬四川省资阳市一家医院报告5例以败血症休克为主要临床表现的聚集性病例的病因。方法 建立了病例主动发现、报告的加强监测系统，根据病例的流行病学暴露史和临床表现进行临床诊断；采集患者标本进行细菌分离培养和生化反应鉴定，应用PCR方法对猪链球菌2型的种属和毒力基因进行检测和序列测定；与当地往年报告的流行性脑脊髓膜炎发病数进行比较。结果 2005年6月10日至8月21日，四川省共报告了68例实验室确诊人感染猪链球菌病例，发病前都有屠宰、洗切、加工等病（死）猪的直接暴露史。其中26例（38％）表现为中毒性休克综合征，15例（58％）死亡。其他病例临床表现为轻型败血症或脑膜炎。分离菌株应用PCR方法检测猪链球菌2型的种属和毒力基因（tuf、16S rRNA、cps2J、mrp、sly、ef）均为阳性。同期还报告了136例有相似暴露史，但缺乏实验室确诊依据的临床诊断病例。结论 证实该起发生在四川省部分农村地区直接暴露于病（死）猪后的疾病为猪链球菌2型感染暴发。推测这种罕见的、表现为高病死率的中毒性休克综合征可能是由于感染某种高致病性菌株循环所致。     

Septic shock caused by Streptococcus suis: case report and investigation of a risk group

A case of septic shock caused by Streptococcus suis type 2 occurred in a 36-year-old truck driver who transported pigs. Here, as well as in nearly all other cases of S. suis infections reported to date, close occupational contact with pork or pigs preceded the incident. This epidemiological link may be explained by the frequent occurrence of S. suis as a commensal and opportunistic germ in pigs. In order to assess the potential risk for an infection with S. suis, 132 workers in pig slaughtering, pork dissecting and processing industries were examined in a cross sectional study for the occurrence of S. suis in their pharynx, and compared with an age and sex matched control group. The evaluation of the pharyngeal swabs showed an atypical colonisation by a variety of microorganisms in some of the employees who were so far healthy, but potentially at risk. The colonisation of the case group with S. suis amounted to 5.3%.     

Notes from the field: multistate outbreak of Salmonella Altona and Johannesburg infections linked to chicks and ducklings from a mail-order hatchery - United States, February-October 2011

Salmonella infections from contact with live poultry (chickens, ducks, turkeys, and geese) continue to be a public health problem. In summer 2011, two clusters of human Salmonella infections were identified through PulseNet, a molecular subtyping network for foodborne disease surveillance. Standard outbreak and traceback investigations were conducted.?From February 25 to October 10, 2011, a cluster of 68 cases caused by Salmonella serotype Altona and a cluster of 28 cases caused by Salmonella Johannesburg were identified in 24 states. Among persons infected, 32% of those with Salmonella Altona and 75% of those with Salmonella Johannesburg were aged ≤5 years. Forty-two of 57 (74%) Salmonella Altona patients and 17 of 24 (71%) of Salmonella Johannesburg patients had contact with live poultry in the week preceding illness. Most patients or their parents reported purchasing chicks or ducklings from multiple locations of an agricultural feed store chain that was supplied by a single mail-order hatchery. Live poultry were purchased for either backyard flocks or as pets.     

Streptococcus suis sequence type 7 outbreak, Sichuan, China

An outbreak of Streptococcus suis serotype 2 emerged in the summer of 2005 in Sichuan Province, and sporadic infections occurred in 4 additional provinces of China. In total, 99 S. suis strains were isolated and analyzed in this study: 88 isolates from human patients and 11 from diseased pigs. We defined 98 of 99 isolates as pulse type I by using pulsed-field gel electrophoresis analysis of SmaI-digested chromosomal DNA. Furthermore, multilocus sequence typing classified 97 of 98 members of the pulse type I in the same sequence type (ST), ST-7. Isolates of ST-7 were more toxic to peripheral blood mononuclear cells than ST-1 strains. S. suis ST-7, the causative agent, was a single-locus variant of ST-1 with increased virulence. These findings strongly suggest that ST-7 is an emerging, highly virulent S. suis clone that caused the largest S. suis outbreak ever described.     

A severe and explosive outbreak of hepatitis B in a rural population in Sirsa district, Haryana, India: unnecessary therapeutic injections were a major risk factor

Most outbreaks of viral hepatitis in India are caused by hepatitis E. This report describes an outbreak of hepatitis B in a rural population in Haryana state in 1997. At least 54 cases of jaundice occurred in Dhottar village (population 3096) during a period of 8 months; 18 (33.3%) of them died. Virtually all fatal cases were adults and tested positive for HBsAg (other markers not done). About 88% (21/24) of surviving cases had acute or persistent HBV/HCV infections; 54% (13/24) had acute hepatitis B. Many other villages reported sporadic cases and deaths. Data were pooled from these villages for analysis of risk factors. Acute hepatitis B cases had received injections before illness more frequently (11/19) than those found negative for acute or persistent HBV/HCV infections (3/17) (P = 0.01). Although a few cases had other risk factors, these were equally prevalent in two groups. The results linked the outbreak to the use of unnecessary therapeutic injections.     

Serratia marcescens-contaminated baby shampoo causing an outbreak among newborns at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

During November 2008 to January 2009, 11 babies in the neonatal intensive care (NICU) and three babies in the nursery were infected with Serratia marcescens at King Abdulaziz University Hospital in Saudi Arabia. Overall, fifteen infections were identified among 11 newborns in the NICU: septicaemia (five cases), purulent conjunctivitis (three), urinary tract infection (two), meningitis (two) and cellulitis (one). Three newborns in the nursery had three infections: purulent conjunctivitis (two cases) and omphalitis (one). Thirteen of 14 babies recovered fully but one died from S. marcescens meningitis and septicaemia. All infections were traced to intrinsically contaminated baby shampoo introduced to the units five days before the first reported case. The outbreak terminated following withdrawal of the shampoo product.     

Occupational exposure to Streptococcus suis type 2

Antibody titres to Streptococcus suis type 2 were measured with an enzyme linked immunosorbent assay (ELISA) in four occupational groups in New Zealand. No veterinary students, 9% of dairy farmers, 10% of meat inspectors and 21% of pig farmers were seropositive to S. suis type 2. The development of antibody to S. suis type 2 was associated with occupational contact with pigs or their meat products. Subclinical infection with S. suis type 2 appears to occur in humans and the antibody produced is of only short duration. The annual incidence of subclinical infection and seroconversion in pig farmers may approach 28%. Thus S. suis type 2 may be one of the most infectious potentially zoonotic agents present in New Zealand, although very rarely resulting in clinical disease.     

Community Outbreak of Adenovirus,Taiwan, 2011

In 2011, a large community outbreak of human adenovirus (HAdV) in Taiwan was detected by a nationwide surveillance system. The epidemic lasted from week 11 through week 41 of 2011 (March 14–October 16, 2011). Although HAdV-3 was the predominant strain detected (74%), an abrupt increase in the percentage of infections caused by HAdV-7 occurred, from 0.3% in 2008–2010 to 10% in 2011. Clinical information was collected for 202 inpatients infected with HAdV; 31 (15.2%) had severe infection that required intensive care, and 7 of those patients died. HAdV-7 accounted for 10%, 12%, and 41% of infections among outpatients, inpatients with nonsevere infection, and inpatients with severe infection, respectively (p<0.01). The HAdV-7 strain detected in this outbreak is identical to a strain recently reported in the People’s Republic of China (HAdV7-HZ/SHX/CHN/2009). Absence of circulating HAdV-7 in previous years and introduction of an emerging strain are 2 factors that caused this outbreak.     

猪链球菌分泌蛋白的免疫蛋白质组学研究

目的 寻找猪链球菌(S.suis)SC84菌株分泌蛋白中具有抗原活性的蛋白,为S.suis特异诊断抗原和新的疫苗候选抗原的筛选提供线索.方法 采用免疫蛋白质组学和介质辅助激光解吸电离飞行时问质谱(MALDI-TOF MS)技术,分析和鉴定S.suisSC84菌株分泌蛋白中能与感染病例恢复期血清发生免疫杂交的蛋白点.结果 在S.suis SC84菌株分泌蛋白的免疫杂交膜上,共发现14个具有抗原活性的蛋白点,其中11个点可以在考马斯蓝染色胶上找到匹配点.11个蛋白点经质谱鉴定,分属于8种蛋白,全部定位于胞壁或胞外.其中溶菌酶释放蛋白、溶血素、细胞外因子为S.suis 已知的抗原蛋白;5'-核苷酸酶、ribonucleases G和E、金属内肽酶等为新发现的具有抗原活性的蛋白;所有的蛋白均能在测序菌株S.suis 05ZYH33基因组中找到相应的编码基因.结论 在S.suis 分泌蛋白中发现了新的具有抗原活性的蛋白,可能作为S.suis特异诊断抗原和疫苗候选抗原,用于诊断试剂和疫苗的研究.     

Epidemiological findings and medical, legal, and public health challenges of an investigation of severe soft tissue infections and deaths among injecting drug users -- Ireland, 2000

In May 2000, public health authorities in Dublin, Ireland, identified a cluster of unexplained severe illness among injecting drug users (IDUs). Similar clusters were also reported in Scotland and England. Concurrent investigations were undertaken to identify the aetiology and source of the illnesses. In Dublin, 22 IDUs were identified with injection-site inflammation resulting in hospitalization or death; eight (36%) died. Common clinical findings among patients with severe systemic symptoms included leukaemoid reaction and cardiogenic shock. Seventeen (77%) patients reported injecting heroin intramuscularly in the 2 weeks before illness. Of 11 patients with adequate specimens available for testing, two (18%) were positive by 16S rDNA PCR for Clostridium novyi. Clinical and laboratory findings suggested that histotoxic Clostridia caused a subset of infections in these related clusters. Empiric treatment for infections among IDUs was optimized for anaerobic organisms, and outreach led to increased enrolment in methadone treatment in Dublin. Many unique legal, medical, and public health challenges were encountered during the investigation of this outbreak.     

High incidence of extra-intestinal infections in a Salmonella Havana outbreak associated with alfalfa sprouts

OBJECTIVE: To determine a vehicle and point source for an outbreak of Salmonella Havana. METHODS: The authors conducted a case-control study and traceback investigation of 14 residents of California and four from Arizona with onsets of illness from Apr 15, 1998, to June 15, 1998, and Salmonella Havana infections with identical PFGE patterns. RESULTS: Seventeen of 18 patients were women. Seventeen were adults 20-89 years of age. Nine (50%) had diarrheal illness, 6 (33%) had urinary tract infections, 2 (11%) had sepsis, and one had an infected surgical wound after appendectomy. Four patients were hospitalized, and one died. Eating alfalfa sprouts was associated with S. Havana infection (OR = 10.0; 95% confidence interval 1.2, 83.1; P = 0.01). CONCLUSIONS: This outbreak resulted in a high incidence of extra-intestinal infections, especially urinary tract infections, and high morbidity. Raw alfalfa sprouts, often considered a safe "heath food," can be a source of serious foodborne disease outbreaks.     

四川省人感染猪链球菌病危险因素的匹配病例对照研究

目的探讨人感染猪链球菌病的危险因素。方法采取1：M匹配的病例对照研究。对疫情早期发病的29例人感染猪链球菌患者及其家属、邻居和一起处理过病（死）猪的个体共147名匹配对照进行问卷调查。调查的危险因素重点是与病（死）猪及其制品的接触方式。统计分析采用条件logistic回归方法。结果多因素分析结果显示，病前一周内曾屠宰过（OR=11978，95％CI：3．355～42．756）和洗切加工过（OR=3008，95％CI：1．022～8．849）病（死）猪是发病的主要危险因素。估计屠宰和洗切加工暴露的归因危险度百分比分别为91．65％和66．76％。在研究人群中，喂养、销售、埋葬和食用等暴露因素不是发病的危险因素。结论屠宰和洗切加工病（死）猪是人感染猪链球菌病的重要危险因素。     

广西21例人感染猪链球菌病例的流行病学分析

目的掌握人感染猪链球菌病疫情的流行病学特点,为制订防制对策提供科学依据。方法对广西报告的人感染猪链球菌病病例进行个案调查,采集标本进行细菌培养和基因检测,对所收集的资料进行数据录入和流行病学分析。结果病例呈散发性分布,发病时间集中在夏秋季,病例多为中老年男性,职业以农民和屠商为主,传播途径为直接接触病死猪肉及内脏,手上有伤口占76.19%。脑膜脑炎型、中毒休克型和普通型病例分别占52.38%、38.10%和9.52%。中毒休克型和脑膜脑炎型病人在克氏征阳性、皮肤瘀点瘀斑、休克和多脏器衰竭等症状体征方面有统计学差异。病死率33.33%,治愈率66.67%,后遗症发生率35.71%。平均潜伏期中位数为42小时;从发病至到县级以上医院就诊的时间间隔中位数为2天;病程在死亡病例中位数为3天、存活病例中位数为20天。结论没有发现人传人现象;直接接触病死猪肉及内脏是感染猪链球菌的重要途径,应告诫群众严禁剖杀食用病死猪;中毒休克型病例病情进展快、病程短、病死率高,脑膜脑炎型后遗症发生率高,应及早采取措施预防休克和致残。     

北京市密云县鸭养殖人群禽流感病毒感染情况调查

目的了解北京市密云县鸭养殖人群中H5、H7、H9病毒感染水平。方法采取随机抽样方法抽取6个乡镇作为监测点,调查对象分为个体规模化养鸭者、家庭养鸭者,按照标准选择调查对象,进行问卷调查和血清禽流感抗体检测。结果共调查221人,其中个体规模化养鸭者22人、家庭养鸭者199人,两类人群H5、H7抗体均为阴性,H9抗体阳性率规模化养鸭者组未检出,家庭养鸭者组为2.01%。结论目前密云县地区人群中尚无H5、H7亚型病毒感染情况,H9亚型禽流感病毒在家庭养鸭者人群中有不同程度的感染,应加强对家庭养鸭人群的监测和干预。     

四川省人感染猪链球菌病流行病学调查分析

目的查明人感染猪链球菌病感染来源和途径,流行范围,流行特征与特点,为制定预防控制措施提供依据。方法制订统一的临床诊断标准对病例进行诊断,制订统一的流行病学个案调查表进行流行病学调查,采集病例的早期血、脑脊液样和病死猪组织样进行病原分离和鉴定,收集患者的临床表现和检查结果,对死亡病例进行病理改变观察,综合以上信息进行分析。结果2005-07中旬以来,发生在四川省资阳市等地的不明原因疾病,经调查证实为猪链球菌2型引起的人感染猪链球菌病。截至2005-08-09,在四川省的12个地区共发现病原学确诊和临床诊断病例180例,疑似35例,死亡39例。病例主要分布在资阳、内江2市,感染途径为宰杀、洗切病死猪等家畜,病例散在发生,病例之间无接触史,无续发病例,无人传人的现象,病例以参与宰杀病死猪的农村男性为主。病例的临床分型主要为脑膜炎和休克型,潜伏期短,平均2.37d,病理改变主要表现为全身多器官受损,败血症伴弥漫性血管内凝血。结论2005-07中旬以来,发生在四川省资阳市等地的人感染猪链球菌病,病原菌为猪链球菌2型,感染途径为直接接触(宰杀、洗切)病死猪等家畜。病例主要表现为脑膜炎型和休克型。     

Antimicrobial resistance, serotypes, and virulence factors of Streptococcus suis isolates from diseased pigs

Streptococcus suis isolates from diseased pigs were examined for susceptibility to nine antimicrobials, possession of virulence-associated factors (VFs), and distribution of serotypes. The association between antimicrobial resistance (AMR) and serotypes as well as VFs was subsequently assessed. Among the isolates investigated, serotype 2 (66.04%) was mostly prevalent, followed by serotypes 1 (23.27%), 9 (1.26%), and 7 (0.63%), whereas 14 isolates were untypable by the polymerase chain reaction typing method used. Analysis with pulsed-field gel electrophoresis revealed the isolates had diverse DNA macrorestriction patterns. The frequency of antimicrobial resistance among the S. suis isolates was higher than that reported from other countries. It is notable that multiple antimicrobial resistance (three or more antimicrobials) was observed with 98.73% of the S. suis isolates, and the dominant resistance phenotype was erythromycin-tilmicosin-clindamycin-chloramphenicol-levofloxacin-ceftiofur-kanamycin-tetracycline-penicillin (35.85%). The most prevalent VFs were those encoded by muramidase-released protein (61.64%), followed by suilysin (56.60%) and extracellular factor (46.54%). Presence of VFs and the possession of certain AMR phenotypes were significantly associated as determined by statistical analysis. Together, these findings indicate that the clinical S. suis isolates obtained from diseased pigs in China are genetically diverse, are resistant to multiple antibiotics of clinical importance, and carry known virulence factors.     

Streptococcal infection in young pigs. IV. An outbreak of streptococcal meningitis in weaned pigs.

Twenty-eight pigs died in an outbreak of streptococcal meningitis in an East Anglian herd. Most were 10-14 weeks old. The outbreak lasted from January to April and was finally controlled by antibiotic therapy. A similar number of losses had occurred in the previous year though no diagnosis had then been made. The causal agent appeared to be a haemolytic streptococcus belonging to group D and provisionally designated Streptococcus suis type 2. It is probably identical with de Moor''s group R streptococcus which causes a similar disease in the Netherlands. It is serologically distinct from Streptococcus suis type 1 which causes meningitis in piglets. Type 2 infection in pigs appears to be widespread in England and Wales and to occur in animals up to the age of at least 14 weeks. A comparison is drawn between Str. suis meningitis in pigs and group B streptococcal meningitis in human infants.     

Community-acquired methicillin-resistant Staphylococcus aureus in institutionalized adults with developmental disabilities

Methicillin-resistant Staphylococcus aureus (MRSA) has recently been reported to emerge in the community setting. We describe the investigation and control of a community-acquired outbreak of MRSA skin infections in a closed community of institutionalized adults with developmental disabilities. In a 9-month period in 1997, 20 (71%) of 28 residents had 73 infectious episodes. Of the cultures, 60% and 32% obtained from residents and personnel, respectively, grew S. aureus; 96% and 27% were MRSA. All isolates were genetically related by pulsed-field gel electrophoresis and belonged to a phage type not previously described in the region. No known risk factors for MRSA acquisition were found. However, 58 antibiotic courses had been administered to 16 residents during the preceding 9 months. Infection control measures, antibiotic restriction, and appropriate therapy resulted in successful termination of this outbreak. Selective antibiotic pressure may result in the emergence, persistence, and dissemination of MRSA strains, causing prolonged disease.     

广州市2006—2021年人感染链球菌病流行特征分析

目的 分析广州市人感染猪链球菌病流行病学特征，为有针对性开展人感染猪链球菌病防控工作提供依据。方法 开展流行病学个案调查，采集病例的脑脊液或血液标本进行细菌培养与分离、生化鉴定、血清分型和PCR检测。结果 2006年至2021年，广州市共累计报告75例人感染猪链球菌病例，其中，本地病例46例，输入病例29例。报告了1例死亡病例，病死率为1.33%。以夏秋季多发，占比74.67%，病例年龄分布中位数为58（47，66）岁，患者以男性为主，男女比例为3.17[DK]∶1；发病人群的职业分布为来自屠宰场或从事猪肉零售相关工作、离退人员、家务及待业、农民、餐饮食品业、工人；职业和生活接触暴露占56.00%，暴露前手部有伤口病例占28.57%；猪链球菌的血清型以2型为主，占比76.60%。结论 广州市人感染猪链球菌的防控形势较为严峻，需完善联防联控机制，加强与动物防疫部门的交流与协作，提高疾病的监测预警能力。     

Cryptococcus gattii Infections in Multiple States Outside the US Pacific Northwest

Clonal VGII subtypes (outbreak strains) of Cryptococcus gattii have caused an outbreak in the US Pacific Northwest since 2004. Outbreak-associated infections occur equally in male and female patients (median age 56 years) and usually cause pulmonary disease in persons with underlying medical conditions. Since 2009, a total of 25 C. gattii infections, 23 (92%) caused by non–outbreak strain C. gattii, have been reported from 8 non–Pacific Northwest states. Sixteen (64%) patients were previously healthy, and 21 (84%) were male; median age was 43 years (range 15–83 years). Ten patients who provided information reported no past-year travel to areas where C. gattii is known to be endemic. Nineteen (76%) patients had central nervous system infections; 6 (24%) died. C. gattii infection in persons without exposure to known disease-endemic areas suggests possible endemicity in the United States outside the outbreak-affected region; these infections appear to differ in clinical and demographic characteristics from outbreak-associated C. gattii. Clinicians outside the outbreak-affected areas should be aware of locally acquired C. gattii infection and its varied signs and symptoms.