2017年山西省婴幼儿流行性脑脊髓膜炎病例病原学分析

目的分析2017年山西省由B群脑膜炎奈瑟菌引起的3例婴幼儿流行性脑脊髓膜炎（流脑）病例病原学特征。方法收集3例婴幼儿流脑病例的临床流行病学资料,采集病例脑脊液和血液标本进行脑膜炎奈瑟菌培养、分离、鉴定和血清分群,采用多位点序列分型（MLST）方法进行分子分型,药敏E-test试纸条法检测抗生素敏感性。结果3例B群流脑病例发病月龄分别为12 d、5月龄和8月龄,符合化脓性脑膜炎症状,脑脊液标本均分离培养出3株B群脑膜炎奈瑟菌。 MLST序列分型分析显示,2株菌为ST-5664（CC4821）,1株为ST-5662。 3株B群菌株均对环丙沙星、左氧氟沙星和复方新诺明等药物耐药。结论山西省首次从病例标本中分离到B群脑膜炎奈瑟菌,3例B群流脑病例均为婴幼儿发病,且主要基因型属于CC4821。     

安徽省首例W135群流行性脑脊髓膜炎病例调查

目的 了解安徽省首例W135群流行性脑脊髓膜炎(流脑)病例的发病特点及流行病学特征,及时掌握安徽省流脑菌群变迁动向。 方法 查阅病例的病案资料;开展流行病学调查;采集病例血标本、密切接触者咽拭子标本进行病原培养和基因型别检测。 结果 患者临床表现为高热、剧烈头痛、呕吐、惊厥、皮肤瘀点瘀斑、休克等;无流脑疫苗免疫史,无流脑病例或疑似流脑病例接触史。从病例血液标本中检出1株W135群脑膜炎奈瑟菌(Nm),从病例密切接触者咽拭子标本中检出4株W135群Nm。对病例Nm和2株密接Nm进行MLST基因序列检测,结果均为ST-11型。 结论 该病例为安徽省首例W135群流脑病例,其MLST基因序列为ST-11型。     

广东省1例流行性脑脊髓膜炎死亡病例流行病学调查

2017年11月广东省汕头市报告1例疑似流行性脑脊髓膜炎死亡病例。患者表现为发热、呕吐,经抢救无效死亡。从病例脑脊液标本中检出b 型流感嗜血杆菌（Hib）,未检出脑膜炎奈瑟菌。确认该病例因感染Hib而死亡。     

2011年江苏省首例W135群流行性脑脊髓膜炎病例调查和应对

描述2011年江苏省首例W135群流行性脑脊髓膜炎病例的临床和流行病学特点及应对措施评估。该病例是江苏省2011年发现和报告的首例W135群流脑病例,病程进展迅速并死亡;疫情应对没有针对性,属无效措施。应加强W135群流脑监测,实施规范地防控措施,对高危人群的W135型疫苗接种进行评估。     

浙江省诸暨市健康人群流行性脑脊髓膜炎W135、Y群抗体水平分析

目的 通过检测健康人群W135、Y群脑膜炎奈瑟菌人群免疫抗体水平,了解自然感染情况,为流行性脑脊髓膜炎(流脑)预防提供参考依据。 方法 2011年10月至2012年3月按年龄分层随机抽样,采集浙江省诸暨市0~74岁人群血清1084份,用酶联免疫吸附试验检测流脑W135、Y群多糖抗体IgG含量。 结果 1084名调查对象流脑W135群抗体阳性率为25.65%,人群保护性抗体比例为11.81%,人群抗体几何平均浓度(GMC)为1.49 g/ml,各年龄组抗体阳性率差异有统计学意义(2=66.973,P0.01),阳性率以30~39岁组为最高(39.66%);流脑Y群抗体阳性率为10.98%,人群保护性抗体比例为6.55%,人群抗体GMC为1.32 g/ml,各年龄组抗体阳性率差异有统计学意义(2=27.832,P0.01),阳性率以20~29岁组为最高(17.21%)。 结论 人群对流脑W135、Y群普遍易感,应加强对脑膜炎奈瑟菌的监测,严防流脑W135、Y群的暴发流行。     

温州市流行性脑脊髓膜炎监测分析

目的 了解浙江省温州市流行性脑脊髓膜炎(流脑)带菌状况,菌群分布,耐药特性和免疫抗体水平等情况,从而为合理制定有效的预防措施提供依据.方法 按流脑监测方案,选择温州市鹿城区、瓯海区作为监测点,采集各年龄组健康人群咽拭子接种含双抗的巧克力色血琼脂进行脑膜炎奈瑟菌(Nm)分离培养,鉴定和药敏试验,同时采集血液分离血清用间接酶联免疫吸附试验(ELISA)法检测流脑A群和C群抗体.结果 检出C群流脑患者1例(男,20岁);健康人群Nm的带菌率为2.98%(10/336);健康人群流脑A群抗体的总阳性率47.09%(81/172),健康人群流脑C群抗体总阳性率35.47%(61/172).结论 流脑的发病率低和健康人群Nm的带菌率低,大部分人对A群流脑有免疫力有关,而对C群流脑的免疫力低,有必要加强A+C群流脑疫苗的接种,同时应密切注视流脑菌群的变迁,关注不同血清群菌株耐药性变化.     

1例症状不典型流行性脑脊髓膜炎病例报道

开滦医院急诊科于2009年3月30日收治了一位因高热入院的患者,初步诊断为急性上呼吸道感染,后根据病原学检测结果诊断为流行性脑脊髓膜炎. 一、病例 患者,女,21岁,于3 d前无明显诱因开始发热,体温最高时40.3 ℃,体温升高无明显规律性,伴轻度寒战,轻度咽痛,少量咳嗽,无咳痰、胸痛,无明显头痛、恶心及呕吐.检查神清语利,光反射敏感,咽充血,双肺未闻及干、湿性啰音,心率100次/min,未闻及早搏,各瓣膜区未及杂音.腹平软,无压痛,肝、脾未及,肠鸣音稍活跃.     

C群奈瑟菌引起的流行性脑脊髓膜炎抗生素使用及疗效分析

目的:探讨C群奈瑟菌引起的流行性脑脊髓膜炎抗生素的敏感性及临床疗效。方法:对10例C群奈瑟菌引起的流行性脑脊髓膜炎患者的临床资料进行分析。结果:药物敏感试验结果显示,对青毒素、头孢三嗪、磺胺嘧啶、氯霉素均为敏感;10例患者均治愈。结论:奈瑟菌菌群发生了变化,由A群变为C群,采用敏感抗生素联合用药可取得较好的疗效。     

广东省东莞市首例W135群流行性脑脊髓膜炎死亡病例调查和应对

2015年5月, 广东省东莞市出现首例W135群流行性脑脊髓膜炎死亡病例。患者表现为高热、皮肤瘀点、瘀斑、弥漫性血管内凝血, 经救治无效死亡。从血标本检出1株W135群脑膜炎奈瑟菌(Nm), 从密切接触者咽拭子标本中检出7株W135群Nm, 密切接触者带菌率为12.5%(7/56), 8株W135群Nm序列型同为ST-11型, 提示疫情在病例所在车间内造成局部传播。     

安徽省铜陵市首例W135群流行性脑膜炎病例调查

2012年2月25日,铜陵市人民医院报告了1例流行性脑脊髓膜炎(流脑)疑似病例。患者发病前无流脑病例接触史,表现为高热、恶心呕吐、全身瘀点瘀斑、颈项强直等典型的临床表现。对患者采集的血液标本和咽拭子标本进行实验室检测,确诊为W135群流行性脑膜炎感染。该病例为铜陵市首例实验室确诊的W135群流脑病例,为流脑流行菌群血清群变迁和疫苗免疫策略的修订提供了监测数据。     

Recent developments in vaccines to prevent meningococcal serogroup B infections

Meningococcal disease in most western countries is mainly caused by serogroup B. Despite the availability of successful meningococcal serogroup C conjugate vaccines, there is no effective vaccine against serogroup B. Efficacy trials with outer membrane vesicle (OMV) vaccines were ineffective and are complicated by the high variability of its main component, porin A. Several new approaches to either optimizing these OMV vaccines or searching for new, highly conserved antigens are therefore being investigated. The completion of the meningococcal genome sequence has provided new challenges. This review summarizes recent developments in the search for a broadly protective meningococcal serogroup B vaccine.     

苏州市首例输入性ST3789型B群流行性脑脊髓膜炎死亡病例的分子特征分析

了解1例输入性B群流行性脑脊髓膜炎死亡病例及密切接触者病原学分子流行病学特征。分离来源于患者瘀斑及密切接触者咽拭子中病原体,常规细菌试验及聚合酶链反应(polymerase chain reaction,PCR)鉴定,多位点序列分型(multilocus sequence typing, MLST)分析脑膜炎奈瑟菌(Neisseria meningitidis)的7个管家基因的序列,结果显示分离到的4株脑膜炎奈瑟菌均为B群,基因型为ST3789型,该菌对世界卫生组织推荐的大部分抗生素敏感,对青霉素、磺胺中度耐药;环丙沙星1株中度耐药,2株耐药;氨苄西林1株敏感,2株中度耐药。     

Fatal meningococcal meningitis in a 2-year-old child:A case report

BACKGROUND In fatal cases of meningococcal septicemia, bacteriological diagnosis may not be straightforward due to postmortem replication and relocation of endogenic microflora. In medicolegal practice, aside from routine autopsy and histopathology, also other diagnostic methods, such as microbiological tests,immunohistochemistry and polymerase chain reaction(PCR), are used to examine body fluids and tissues.CASE SUMMARY We present the case of sudden death in a 2-year-old child. The patient died approximately 30 min after hospital admission before any routine diagnostic procedures were undertaken. Presence of whole-body rash and fulminant course of the disease raised suspicion of meningococcal septicemia. An autopsy was performed seven days after death when the body showed the signs of late postmortem decomposition. No etiological factor of septicemia could be identified based on macro-and microscopic findings. However, PCR demonstrated the presence of genetic material of group W Neisseria meningitidis in patient's cerebrospinal fluid and blood.CONCLUSION Microbiological PCR should be conducted postmortem whenever a specific etiological factor could not be identified with conventional methods.     

Recombinant protein meningococcal serogroup B vaccine combined with outer membrane vesicles

INTRODUCTION: Meningococcal infection is a major cause of morbidity and mortality worldwide. Infection with Neisseria meningitidis is most common in young children, teenagers and people with certain medical conditions. Effective polysaccharide and glycoconjugate vaccines for serogroups A, C, W135 and Y have been developed. A similar capsular polysaccharide approach for serogroup B (MenB) has by most been judged as unsuitable, hence, no broad coverage vaccine has been licensed to date. The novel vaccine Bexsero (previously 4CMenB) has been developed and proven safe and immunogenic in clinical trials. AREAS COVERED: The authors outline the constituents of Bexsero and immunogenicity and safety data from preclinical and clinical trials published in peer-reviewed literature, meeting proceedings and publicly-available clinical trial websites from 2000 to 2010. EXPERT OPINION: Bexsero is well tolerated with a proven safety profile, and has demonstrated a robust immune response across different age groups against a range of diverse MenB strains. These data suggest that Bexsero has the ability to provide protection in infants, who are at the greatest risk of developing meningococcal disease.     

Recombinant protein meningococcal serogroup B vaccine combined with outer membrane vesicles

Introduction: Meningococcal infection is a major cause of morbidity and mortality worldwide. Infection with Neisseria meningitidis is most common in young children, teenagers and people with certain medical conditions. Effective polysaccharide and glycoconjugate vaccines for serogroups A, C, W135 and Y have been developed. A similar capsular polysaccharide approach for serogroup B (MenB) has by most been judged as unsuitable, hence, no broad coverage vaccine has been licensed to date. The novel vaccine Bexsero (previously 4CMenB) has been developed and proven safe and immunogenic in clinical trials.

Areas covered: The authors outline the constituents of Bexsero and immunogenicity and safety data from preclinical and clinical trials published in peer-reviewed literature, meeting proceedings and publicly-available clinical trial websites from 2000 to 2010.

Expert opinion: Bexsero is well tolerated with a proven safety profile, and has demonstrated a robust immune response across different age groups against a range of diverse MenB strains. These data suggest that Bexsero has the ability to provide protection in infants, who are at the greatest risk of developing meningococcal disease.     

2019年浙江省台州市1例新生儿流行性脑脊髓膜炎病例病原学分析

目的对2019年1月浙江省台州市1例流行性脑脊髓膜炎（流脑）病例及密切接触者进行病原学特征分析,为流行病学调查提供分子溯源依据。方法对患者血液标本、脑脊液标本和10名密切接触者的咽拭子进行脑膜炎奈瑟菌分离,对分离菌进行生化、血清分群鉴定以及体外药敏试验,同时采用脉冲场凝胶电泳（PFGE）和多位点序列分型（MLST）进行分子分型分析。结果从患者血液标本和2名密切接触者咽拭子标本中分离到3株脑膜炎奈瑟菌,患者和1名密切接触者的菌株血清群均为B群,另1名密切接触者的菌株为不可分群。 药敏结果显示,3株菌株对头孢呋辛钠、头孢曲松、美洛培南等敏感,对米诺环素不敏感,对环丙沙星和复方新诺明耐药,对青霉素G和氯霉素中介。 PFGE分型显示,3株菌的相似度为100%,MLST均为ST-5664型,属于高致病性ST-4821克隆群。结论台州市人群中存在高致病性ST-4821克隆群B群脑膜炎奈瑟菌,并引起了感染病例,提示应当加强对本地区健康人群携带情况及菌株分子特征的监测,为流脑感染病原菌的溯源调查与控制提供实验室支持。     

湖南省首例W135群流行性脑脊髓膜炎病例流行病学及病原学分析

目的 了解湖南省首例W135群流行性脑脊髓膜炎(流脑)病例流行病学特征及W135群脑膜炎奈瑟菌的病原学特征。 方法 采集疑似病例的血液和脑脊液标本,采集健康人群咽拭子标本,进行脑膜炎奈瑟菌的培养、分离、鉴定,确定为脑膜炎奈瑟菌。对菌株进行血清学分群和药敏试验;采用多位点序列分型(multi locus sequence typing,MLST)以及脉冲场凝胶电泳(pulsed-field gel electrophoresis, PFGE)方法对菌株进行分子分型。 结果 疑似病例脑脊液及血液中分离培养出W135群脑膜炎奈瑟菌,健康携带者带菌调查咽拭子中分离培养出2株W135群脑膜炎奈瑟菌,均为ST-11型菌株,属于ST-11/ET-37 complex高致病克隆系。3株W135群脑膜炎奈瑟菌对复方磺胺甲恶唑全部耐药。 结论 湖南省首例W135群流脑病例是由ST-11型脑膜炎奈瑟菌引起,健康人群中也出现ST-11型W135型脑膜炎奈瑟菌的携带,W135群流脑在湖南省存在潜在流行的趋势。     

Atypical meningococcal meningitis with rashless presentation: A case report

Meningococcal disease is the major health problem in developing world. The clinical presentation is varied, ranging from transient fever and bacteraemia to fulminant disease with death ensuing within hours of the onset of clinical symptoms. The classical clinical manifestations of meningococcal disease have been well described, but atypical presentations if unrecognized, may lead to a delay in treatment and fatal outcome. We here report a case presented with atypical presentation of meningococcal meningitis without classical rash, which was diagnosed and managed successfully.