肺皮疽奴卡菌重症肺炎1例并25例病例文献复习

奴卡菌是革兰染色阳性、弱抗酸性、需氧丝状放线菌,主要感染免疫功能低下者。本文通过总结某院成功救治的1例皮疽奴卡菌所致重症肺炎患者的诊治经过,并结合2006年1月—2016年7月国内外具有完整资料的25例奴卡菌合并重症肺炎的病案报道进行文献复习,以提高临床工作者对肺奴卡菌所致重症肺炎临床表现、影像学特点、病原学特征以及诊疗方案的认识。     

A simultaneous outbreak of Serratia marcescens and Klebsiella pneumoniae in a neonatal intensive care unit

We describe two concurrent outbreaks of Serratia marcescens and Klebsiella pneumoniae in a neonatal intensive care unit (NICU). Over a 16-month period, a total of 27 infants were either colonized (N=14) or infected (N=13). There were 15 cases of S. marcescens and 11 cases of K. pneumoniae. Both micro-organisms were involved in one fatal case. Seven preterm babies developed septicaemia, two had bacteraemia, three had respiratory infections and one had purulent conjunctivitis. The S. marcescens and K. pneumoniae isolates were investigated by three molecular methods: enterobacterial repetitive intergenic consensus polymerase chain reaction (PCR), arbitrary primed PCR with M13 primer, and random amplification of polymorphic DNA. Different patterns were found in the 16 S. marcescens epidemic isolates from 16 newborn infants. The major epidemic-involved genotype was linked to the first nine cases and this was subsequently replaced by different patterns. Eight different typing profiles were also determined for the 13 K. pneumoniae isolates from 12 newborn infants. Four K. pneumoniae bacteraemic strains proved to be identical. In conclusion, the typing results revealed that two different micro-organisms (S. marcescens and K. pneumoniae) were simultaneously involved in invasive nosocomial infections in preterm newborns. Two simultaneous clusters of cases were documented. Heterogeneous genotypes among both species were also demonstrated to be present in the NICU at the same time. A focal source for both micro-organisms was not identified but cross-transmission through handling was probably an important route in this outbreak. Strict adherence to handwashing policies, cohorting, isolation of colonized and infected patients, and rigorous environmental hygiene were crucial measures in the containment of the epidemic.     

Improvement of Clostridium difficile isolation by heat-shock and typing of the isolated strains by SDS-page

Clostridium difficile plays an essential role in causing pseudomembranous colitis. We looked for the presence of these bacteria in the stools of 169 hospitalized patients and 38 nurses from wards with cases of diarrhea (207 subjects). The study was divided into three parts. In the first part, we compared three methods for isolating Clostridium difficile from stool samples: pre-selection with heat-shock, direct plating on Cycloserine-Cefotaxime-Fructose Agar (CCFA) and culturing in a selective broth medium. Final identification of Clostridium difficile was achieved by gas-chromatography and ApiZym. From the 207 consecutively obtained stool specimens, Clostridium difficile was isolated in 108 (52%) when pre-treated by heat-shock compared to only 26 (13%) when plated on modified CCFA and 23 (11%) when cultured in selective broth medium. Pre-selection significantly increases the isolation rate for Clostridium difflicile and should be used in further epidemiological research. In the second part of our study, a retrospective review of subjects' records showed that the heat-shock method detected Clostridium difficile in all age groups at a higher rate than the other methods. In the third part of our study, we typed the 157 isolates of Clostridium difficile strains by protein patterns using SDS-PAGE, and 16 distinct groups were identified. In 19 cases different Clostridium difficile strains were found in the same subject by SDS-PAGE. Finally, the isolated strains were compared with strains from Brussels and Freiburg. Matching patterns were noted in only three cases.This paper is dedicated to the memory of Professor Antonio Sanna, MD.     

Pityriasis rosea gibert: Detection ofLegionella micdadei antibodies in patients

Some epidemiological and clinical characteristics ofPityriasis rosea Gibert has led us to hypothesize that this disease may be the clinical manifestation of an infection caused by legionellas. We have thus tested the sera of 36 patients ill withPityriasis rosea and 19 controls forLegionella pneumophila serogroup 1–6 andLegionella micdadei antibodies. These, who had the same age and sex distribution as study patients, were receiving treatment for other diseases in the same ward. Also tested were 200 sera from the voluntary blood donors from the same region as study patients.Legionella micdadei antibodies were detected in 12 (33.3%)Pityriasis rosea cases and in one (5.2%) control. They were significantly more common in Pityriasis rosea cases than in either controls or voluntary blood donor population. The findings to date encourage continued research into the causative relationship between theLegionella micddadei infection and the onset ofPityriasis rosea Gibert.     

Nocardial Infections in Japan from 1992 to 2001, Including the First Report of Infection by Nocardia transvalensis

In the period from 1992 to 2001, 303 cases of nocardioses were diagnosed in Japan, with the corresponding etiological agents isolated and characterized. Taxonomic analyses of these 303 strains showed that most nocardial infections were caused by members of the Nocardia asteroides group (72.3%). Speciation showed that 72 strains were N. asteroides, 31 strains were N. cyriacigeorgica, 2 strains were N. beijingensis, 81 strains were N. farcinica, and 33 strains were N. nova. Sixty-six strains of N. brasiliensis were the next most prevalent species of the total Nocardia isolates, followed by 14 strains of N. otitidiscaviarum. Infections by N. transvalensis (3 strains) and N. pseudobrasiliensis (1 strain) were also confirmed. The infections due to N. transvalensis, N. cyriacigeorgica, and N. beijingensis were the first reported in Japan. The most common factor that predisposed individuals to nocardial infection in Japan was therapy by immunosuppressive agents (22.4%), including SLE therapy (3.6%), followed by cancer (6.6%), diabetes (3.6%) and AIDS (2.0%). Nocardial infections occurred more commonly in the elderly, with most of the patients between the ages of 61 and 80 years of age. No significant difference regarding infectivity levels between the sexes was observed.     

Investigation of an outbreak of Salmonella typhi in a public school in Madrid

A typhoid fever outbreak affecting 54 school students occurred in a Public School of Móstoles, Madrid. The date of onset was 11 June 1991 and the last detected case was 8 July 1991. Salmonella typhi was cultured from blood and/or stool samples corresponding to 54 patients and one food-handler. There were no secondary cases detected. Epidemiological investigation suggested a salad or a custard as the common source. Patients and the food-handler were treated with ampicillin/amoxicillin for up to three weeks. There were seven relapses that were also treated with the same antibiotics with success. None were found to be excreting the organisms when tested after four months. All the Salmonella ryphi isolated strains were phagetype 34, biotype Xylose +, Tetrationate Reductase + and harboured a similar 22 Mdal plasmid, they were also susceptible to the antibiotics tested.     

Prevalence of Borrelia burgdorferi (sensu lato) in Ixodes ricinus (L.) populations in France, according to a phytoecological zoning of the territory

Ixodes ricinus is considered as the main vector of Lyme Borreliosis in France. The aim of our investigations was to obtain a comprehensive view of the spatial risk linked to the distribution of the species in our country. Previous studies [1] have provided strong evidence that the species populations are widely distributed, so the objective of the present work was to ascertain the bacteriological infection of the tick by the agent of the zoonosis (Borrelia burgdorferi, sensu lato), over the French territory, whatever the ecological conditions may be. For this purpose, we kept the same framework as that used in our acarological investigation, a phytoecological zoning of the territory into 54 geographically separate and ecologically distinct units distributed into three climatic zones. Batches of ticks, picked up in these different phytoecological units (only two thirds of which were sampled), were submitted for bacteriological investigation. A total of 4,673 ticks were examined, individually, for the presence of Borellia burgdorferi, by immunofluorescence. Percentages of infection according to the various stages of Ixodes ricinus free stages, collected by flagging, were as follows: 4.95% in 3,247 nymphs, 11.2% in 699 males, 12.5% in 727 females. Larvae were ignored. Practically all the tested units harboured the bacterium. The percentage of tick samples (25 ticks or more) absolutely free of Borrelia, wherever they came from, is very low (not exceeding 10 percent of the sampled forests). Our study confirms the assessment of a widespread distribution of the zoonosis in France which was, until now, exclusively based on an approximate distribution of limited human cases observed in the country.     

鼠伤寒沙门菌生物学分型方法在流行病学调查和监测中的应用

为探索用简便有效的手段对鼠伤寒沙门菌感染进行调查监测，采用英国学者Ｄｕｇｕｉｄ的鼠伤寒沙门菌生物学分型方法，应用于医院天津监测、病例追踪、食物中毒调查。结果：从医院感染患儿分离菌株的主要生物型与医院环境污染、医务人员携带菌株的生物型分布相似；截瘫患者尿中菌株与从其家庭环境和妻子手上分离菌株生物型别一致；从食物中毒者和乘彩中分离菌株的生物型别与鸭子携带菌株主要生物型别一致。结论：患儿医院感染是由于病     

Short- and long-term responses of Daphnia spp. to propanil exposures in distinct food supply scenarios

The widespread increase of pesticides application in crops frequently leads to the contamination of vicinal freshwater lentic ecosystems. Herbicides such as propanil may impair cladoceran fitness, which is per se strongly influenced by the food availability and/or its acquisition efficiency. This work intended to evaluate the responses of Daphnia magna and three clonal lineages belonging to the Daphnia longispina complex to acute and chronic exposures of the herbicide propanil, as well as to assess whether food availability features these responses. Results showed that the agrochemical was acutely and chronically toxic to both D. magna and the D. cf. longispina clones at the same range of low concentrations, while relevant differences were depicted between the three distinct genotypes belonging to the D. longispina complex. Food-level conditioned the general fitness of the daphnids in the tests but evidences suggest that it does not interfere specifically with the toxicant mode of action.     

Individual and combined effect of anthracene, cadmium, and chloridazone on growth and activity of SOD izoformes in three Scenedesmus species

Short-term (12-48 h) experiments were carried out to examine the effect of anthracene (three-ring aromatic hydrocarbon), cadmium (CdCl(2)), and chloridazone (triazine herbicide), individually and in combination, on growth and SOD activity of three green algae Scenedesmus: S. subspicatus, S. obliquus, and S. microspina, grown in a batch-culture system. The relative toxicity of chemicals to algae was anthracene > chloridazone > cadmium. The species revealed similar growth sensitivity to individual chemicals after 24 h of exposure but there were differences between them when exposed to their combinations. Two methods were used to determine the modes of interaction effects of the chemical combinations; both led to the same results, with two exceptions of all 36 variants examined. In general, mixtures of two and three chemicals behaved toward algal growth mainly in an antagonistic manner (20 cases), whereas additive and synergistic interaction occurred 13 and 3 times, respectively. Antagonism was the most frequently observed to growth of S. obliquus; antagonistic interaction and additive effect was noted in relation to S. subspicatus, while response of S. microspina depended markedly on applied combination. There is a relationship between SOD activity and growth response to stress. The markedly higher level of SOD isoforms activities was noticed in cells (especially S. microspina and S. obliquus) exposed to 12 h to combined chemicals, as compared to individually treated and control cells. SOD activities in cells of three Scenedesmus grown 24 h were similar in all experimental variants and after 48 h of exposure significantly decreased in almost all cases (especially in S. subspicatus). There were no differences observed between SOD profiles obtained for all variants examined. Chloroplasts seems to be the main target site of interaction effects of dissimilarly acting chemicals.     

Use of DNA fingerprinting in an epidemiologic study of outbreak-specific and non-specific strains of group C Neisseria meningitidis

DNA fingerprints of nine group C isolates of Neisseria meningitidis were obtained by digestion with three restriction endonucleases, BamHI, EcoRI, and HindIII. Identical restriction profiles were displayed by five strains isolated from two patients and three contacts during a localized outbreak of meningococcal disease in the area served by our laboratory. A slight difference, appreciable only in the fingerprints obtained with EcoRI, was observed between these isolates and a sixth one isolated from a clinical case occurring in the same area one year later. In contrast, three additional strains, recently isolated from patients in separate areas in Italy, gave restriction profiles differing strikingly from one another and from those produced by the strains isolated in our area.Corresponding author.     

Relationships between the Rhipicephalus sanguineus complex ecology and mediterranean spotted fever epidemiology in France

The authors examine the epidemiologic features of Meditteranean spotted fever in France in light of the bioecological pecularities of each of the three known member of the Rhipicephalus sanguineus tick group (R. sanguineus, R. turanicus, R. pusillus). The results show that R. sanguineus is the main vector. Certain aspects of this tick species are of interest: affinity for man, close contact with humans for a long periods, peak of tick population (preimaginal stages) at the same time as the peak of the disease. The largest populations of R. sanguineus are noted in the endemic zone of human rickettsiosis. The fact that immature stages are more prevalent during the hot season and these forms' ability to bite humans is important and may suggest a role for them in the epidemiology of the disease. The sporadic isolation of this species outside the endemic zone may explain the occurrence of isolated cases of the disease in these areas. We cannot currently exclude vector roles for the two other species, which can parasitize humans, though none of our data supports this hypothesis.     

Costs of nosocomial Clostridium difficile-associated diarrhoea

Nosocomial Clostridium difficile-associated disease (CDAD) is a common infection in hospitals. A matched case-control study was carried out to determine hospital-wide excess costs due to CDAD. Cases were assessed by prospective hospital-wide surveillance in a tertiary care university hospital in 2006. Nosocomial cases of CDAD (>72h after admission) were matched to control patients without CDAD in a ratio 1:3 using the same diagnosis-related group in the same year, for a hospital stay at least as long as the time of risk of the CDAD cases before infection and a Charlson comorbidity index +/-1. Data on overall costs per case were provided by the finance department. Matching was possible for 45 nosocomial CDAD cases. The difference in the length of stay showed that CDAD cases stayed significantly longer (median 7 days; P=0.006) than their matched controls. The average cost per CDAD patient was euro33,840. The difference in the cost per patient showed that the cost for CDAD patients was significantly more than for their matched controls (median euro7,147; 95% confidence interval: 4,067-9,276). Nosocomial CDAD is associated with high costs for healthcare systems. Clinicians should be aware of the financial impact of this disease and the application of appropriate infection control measures is recommended to reduce spread.     

Outcome of late-onset hospital-acquired pneumonia related to causative organism

Pneumonia caused by Pseudomonas spp. has been associated with an increase in mortality in critical care patients. Previous assessments, however, have failed to compare outcome solely with other pathogens associated with hospital-acquired pneumonia (HAP). We have performed a retrospective review of all critical care patients with late-onset HAP (hospital inpatient stay >72 h at time of diagnosis) due to pure respiratory cultures of Pseudomonas spp., meticillin-resistant Staphylococcus aureus (MRSA) or non-pseudomonal Gram-negative (NPGN) organisms from 1998 to 2007. Casenote review involved assessments of illness severity, clinical pulmonary infection scoring (CPIS), critical care and hospital survival, and critical care length of stay. Out of 252 casenotes, 204 were reviewed. There were 186 treated cases of pneumonia. Ten patients had both pseudomonal and NPGN pneumonias during the same admission and two patients presented with community-acquired infections due to these organisms. These 12 patients were excluded from further analysis. Of the remaining 174 patients, 80 were infected with pseudomonas, 40 with MRSA and 54 had NPGN organisms. The three groups of patients were well-matched, with similar age, sex, CPIS scores, incidence of bacteraemia and Acute Physiology and Chronic Health Evaluation II scores at diagnosis. There were no outcome differences between the groups with respect to hospital and critical care survival and critical care length of stay. In this series, there appears to be no survival disadvantage associated with pseudomonal pneumonia when compared with other hospital-acquired organisms associated with HAP, where disease severity between the groups is similar.     

Carriers of Neisseria meningitidis in household contacts of meningococcal disease cases in Catalonia (Spain)

A population-based study was carried out in Catalonia (Spain) from May 1998 to April 1999 to determine the prevalence of Neisseria meningitidis strains in meningococcal disease (MD) cases and their contacts, as well as the prevalence of meningococci in close contacts of patients with MD, and risk factors for its carriage. A total of 364 close contacts of 87 patients with MD were studied. Throat samples were collected by hospital staff before rifampicin chemoprophylaxis was begun. For each contact, a questionnaire was completed for sociodemographic and epidemiological data. A total of 61 contacts (an overall prevalence of 16.8%) were carriers of meningococcal strains (40 B, 10 C, 1 Z and 10 non-groupable isolates). This prevalence is two to three times higher than in the general population (5-10%). In 33/61 microbiologically confirmed cases (54%) and in 9/26 probable cases (35%), contacts carrying N. meningitidis were found. In 22/33 confirmed cases with carrier contacts, it was possible to study the phenotype of the carrier and patient strains (sero-group, serotype and serosubtype). In 14 cases (64%), both strains were identical, in four cases, only a minor change was observed, in three cases, some strain (from the case or from his contact) was non-serotypable and non-serosubtypable, and in one case, both isolates were completely different. Bivariate analysis identified five statistically significant risk factors for meningococcal carriage: age (5-9 years old), meningococcal A+C vaccination, severe household overcrowding, social class and heavy active smoking (>20 cigarettes a day). Multivariate analysis revealed that of these five variables, only heavy active smoking remained statistically significant when the other factors were controlled.     

Prolonged hospital and community-based listeriosis outbreak caused by ready-to-eat scalded sausages

Listeria monocytogenes is a foodborne bacterial pathogen. Immunocompromised patients are at higher risk of developing invasive listeriosis with high fatality rates. After notification of two patients with Listeria that had stayed in the same hospital (hospital A) before the onset of infection, we began an investigation to ascertain the extent of the outbreak, identify its source and prevent further infections. We conducted active case finding by contacting hospital A, reviewing medical records and retrospectively investigating listeriosis notifications from the German surveillance system (SurvNet). The kitchen (hospital A) and its meat supplier (company X) were inspected and environmental and food samples were taken for microbiological testing. All isolates of L. monocytogenes, together with patient and food-related isolates from Baden-Württemberg 2006 to 2008, were characterised by pulsed-field gel electrophoresis (PFGE). Altogether, 16 cases of listeriosis were identified. Serotype 4b with the indistinguishable PFGE patterns (AscI 17a/ApaI 10) was detected from nine patients, five environmental and three ready-to-eat scalded sausage samples from company X, and two food samples from hospital A. All 11 patient cases linked to hospital A were immunosuppressed and were regularly served food during their hospital stay. Ten of these patients received corticosteroids and proton pump inhibitors (PPIs). Five cases were fatal. Our investigations indicate that ready-to-eat scalded sausages from company X caused this outbreak of listeriosis. Hospital food suppliers should guarantee the absence of L. monocytogenes in ready-to-eat meat products, controlled through optimised quality assurance.     

662例阴道镜下活检诊断宫颈癌和上皮内瘤变观察分析

目的:探讨阴道镜下活检诊断宫颈癌和上皮内瘤变(CIN)的价值。方法:回顾分析3年来阴道镜下活检诊断宫颈癌和CIN的阳性率及其阴道镜图像、与同期肉眼宫颈活检比较,并与阴道镜检查前3年宫颈癌和CIN的检出率比较。结果:662例阴道镜下活检诊断宫颈癌17例,CIN 67例,共84例,占12.7％。阴道镜下图像浸润癌主要是血管异常,原位癌(CIS)、醋白上皮、点状血管、镶嵌出现率均增高。CIN以醋白上皮出现率最高。阴道镜下活检与同期肉眼宫颈活检比较,CIN为67例比22例,诊断早期癌为6例比0。阴道镜检查的3年和以前3年比较CIN为89例比24例,宫颈癌为33例比7例。结论:阴道镜在筛查宫颈癌尤其是早期癌和CIN中有很大作用,阴道镜下宫颈异常图像和可疑病变部位活检与病理结合可提高诊断准确性和检出率。     

Identification of an epidemic strain ofAcinetobacter baumanii using electrophoretic typing methods

Nosocomial infections due toAcinetobacter baumannii dramatically increased in a Lebanese medical center following an outbreak of hostilities in Lebanon in 1984. The incidence of infection caused by this organism has remained high in this institution, thus requiring the implementation of a strain typing system to aid in infection control. Three methods were investigated for their utility in differentiating among a representative group of 36 nosocomialAcinetobacter baumannii isolates obtained over a 10 month period from specimens of hospitalized patients. Isolates were typed by antibiogram analyses, plasmid fingerprinting, and total cell protein profiles. Only three distinct total cell protein profiles were detected, with one pattern accounting for 26 (72.2%) of the isolates. However, eight different plasmid profiles were observed, with 20 (55.5%) isolates having the same profile. Eleven distinct antibiograms were seen with the most prevalent pattern occuring in 21 isolates. Twenty of the 21 (95%) isolates with the common antibiogram also had the same plasmid profile and total protein profile (44.4% of total isolates). The combination of these three typing methods was useful in tracing the spread of these organisms in the medical center. The data obtained suggest the distribution of a common strain among at least six wards of this hospital.     

The occurrence and sources of Campylobacter spp., Salmonella enterica and Escherichia coli O157:H7 in the Salmon River, British Columbia, Canada

In this study, we wished to assess the prevalence and determine the sources of three zoonotic bacterial pathogens (Salmonella, Campylobacter, and Escherichia coli O157:H7) in the Salmon River watershed in southwestern British Columbia. Surface water, sewage, and animal faecal samples were collected from the watershed. Selective bacterial culture and PCR techniques were used to isolate these three pathogens and indicator bacteria from these samples and characterize them. Campylobacter was the most prevalent pathogen in all samples, followed by Salmonella, and E. coli O157:H7. E. coli O157:H7 and Salmonella isolation rates from water, as well as faecal coliform densities correlated positively with precipitation, while Campylobacter isolation rates correlated negatively with precipitation. Analysis of DNA extracted from water samples for the presence of Bacteroides host-species markers, and comparisons of C. jejuni flaA-RFLP types and Salmonella serovars from faecal and water samples provided evidence that human sewage and specific domestic and wild animal species were sources of these pathogens; however, in most cases the source could not be determined or more than one source was possible. The frequent isolation of these zoonotic pathogens in the Salmon River highlights the risks to human health associated with intentional and unintentional consumption of untreated surface waters.     

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.