上海市闵行区腹泻患者粪便中5种细菌性病原的监测

目的 了解、分析上海市闵行区腹泻患者粪便中细菌性食源性疾病的比例与构成.方法 对2006年4～10月闵行区监测点肠道门诊细菌性食源性疾病病例采用流行病学方法进行回顾性描述与分析,使用SPSS 10.0等软件进行数据处理.结果 4～10月闵行区腹泻患者粪便中细菌性食源性疾病总阳性率14.08%,阳性率最高的月份是8月.结论 上海市闵行区细菌性食源性疾病在腹泻人群中占重要比重,7～9月是细菌性食源性疾病的发病高峰期,副溶血性弧菌是闵行区最主要的食源性病原菌.     

从腹泻患者粪便中分离出霍乱弧菌

从腹泻患者粪便中分离出霍乱弧菌建美，罗兰，陈冬梅，钟发，陈景文，陈求刚，陈菊香我院１９９４年７～９月从某地急性腹泻患者粪便中分离出霍乱弧菌７株，其中６株为Ｏ１群霍乱弧菌小川型，均属埃尔托生物型；另１株为非Ｏ１群Ｏ１３９霍乱弧菌。与广州市防疫站复查结果...     

腹泻患者粪便中检出沙鱼弧菌

沙鱼弧菌（Ｖ．ｃａｒｃｈａｒｉａｅ）属于弧菌属，是临床罕见的条件致病菌。我们于１９９７年８月从患者粪便中分离出１株，现报道如下。１病例摘要患者男，５６岁。腹泻１０余天，曾用头孢唑啉治疗一周无效。来我院就诊，粪便常规：稀粥样便，ＷＢＣ：５～１０／Ｈｐ，...     

血液透析患者血源性致病因子感染的调查

目的了解血液透析患者血源性致病因子感染情况,为对其进行有效防控提供参考。方法通过血液筛检方式,对某医院912例血液透析患者进行常规血清学指标检测。结果从该医院912例血液透析患者血液中检出携带血液传播性致病因子109例,总感染率为11.95%。分别检出HBsAg阳性81例,阳性率8.88%;检出抗-HCV阳性13例,阳性率1.43%;梅毒TPHA阳性15例,阳性率1.64%;未检出抗-HIV阳性患者。结论该医院血液透析患者中主要血源性致病因子总感染率达到11.95%,以乙型肝炎病毒感染为主,应加强血液透析室消毒隔离和预防措施。     

重症腹泻患者粪便中检出嗜水气单胞菌

重症腹泻患者粪便中检出嗜水气单胞菌徐志愿（江苏省中医药研究所附属医院，南京２１００２８）１９９３年７月，我们从患有重症腹泻的７岁男孩稀水便中检出一株嗜水气单胞菌，现报道如下。１细菌学检查标本接种于血平皿和ＳＳ平皿，于３７℃培养１８～２４小时后观察。血...     

腹泻患者粪便中病原体的检出与耐药分析

目的　研究腹泻患者病原体分布及耐药率。方法　采用SS琼脂、麦康凯琼脂、10 g/LNaCl碱性蛋白胨水、真菌快速显色培养基同时分离腹泻致病菌 ;药敏试验采用K B纸片法。结果　 872例腹泻患者致病菌分离率为 5 3.9%,其中肠杆菌科细菌、致病性弧菌、气单胞菌、真菌分别为 2 6 %、13.5 %、11.9%、2 .4%;肠杆菌科细菌在急性腹泻组和慢性腹泻组的分离率分别为 2 7.4%、12 .9%,其致病性大肠埃希菌、志贺菌、沙门菌构成比分别为 46 .8%和 45 .5 %、35 .2 %和 18.2 %、8.3%和 2 7.3%;致病性弧菌、气单胞菌、真菌在急、慢性腹泻组的分离率分别为 13.8%和 10 .6 %、12 .4%和 7.1%、0 .38%和 2 1.2 %。肠杆菌科细菌对氨苄西林、头孢噻吩、庆大霉素的耐药率分别为 73.1%、2 2 %、18.5 %;弧菌科细菌对氨苄西林、复方磺胺甲唑耐药率分别为 86 .9%、5 9%。结论　急性腹泻组肠杆菌科细菌、气单胞菌感染明显高于慢性腹泻组 ,真菌感染率慢性腹泻组明显高于急性腹泻组 ;肠杆菌科细菌中急性腹泻组志贺菌比率明显高于慢性腹泻组 ,而沙门菌分离率则明显低于慢性腹泻组。肠杆菌科细菌对氨苄西林耐药率较高 ;弧菌科对氨苄西林、复方磺胺甲唑耐药率较高 ;2类细菌对环丙沙星、头孢他啶均较敏感。     

腹泻患者粪便中病原体的检出与耐药分析

目的研究腹泻患者病原体分布及耐药率.方法采用SS琼脂、麦康凯琼脂、10 g/L NaCl碱性蛋白胨水、真菌快速显色培养基同时分离腹泻致病菌;药敏试验采用K-B纸片法.结果 872例腹泻患者致病菌分离率为53.9%,其中肠杆菌科细菌、致病性弧菌、气单胞菌、真菌分别为26%、13.5%、11.9%、2.4%;肠杆菌科细菌在急性腹泻组和慢性腹泻组的分离率分别为27.4%、12.9%,其致病性大肠埃希菌、志贺菌、沙门菌构成比分别为46.8%和45.5%、35.2%和18.2%、8.3%和27.3%;致病性弧菌、气单胞菌、真菌在急、慢性腹泻组的分离率分别为13.8%和10.6%、12.4%和7.1%、0.38%和21.2%.肠杆菌科细菌对氨苄西林、头孢噻吩、庆大霉素的耐药率分别为73.1%、22%、18.5%;弧菌科细菌对氨苄西林、复方磺胺甲NFDA9唑耐药率分别为86.9%、59%.结论急性腹泻组肠杆菌科细菌、气单胞菌感染明显高于慢性腹泻组,真菌感染率慢性腹泻组明显高于急性腹泻组;肠杆菌科细菌中急性腹泻组志贺菌比率明显高于慢性腹泻组,而沙门菌分离率则明显低于慢性腹泻组.肠杆菌科细菌对氨苄西林耐药率较高;弧菌科对氨苄西林、复方磺胺甲NFDA9唑耐药率较高;2类细菌对环丙沙星、头孢他啶均较敏感.     

从腹泻患者粪便分离出霍乱弧菌

3年来,从某地644份急性腹泻患者粪便中,分离出霍乱弧菌15株,除2株稻叶型外,余为小川型,其中1994年13株,1995及1996年各1株.对胺卡那霉素、氯霉素、四环素100%敏感,对氨苄青霉素66.7%敏感,对头孢唑啉20.0%敏感.     

从腹泻患者粪便中分离出三株沙门菌

从腹泻患者粪便中分离出三株沙门菌道彩梅，杨莉，梁文瑛我们从３例急性腹泻患者的粪便中，分离鉴定出３株沙门菌。报道如下。例１女，４岁。腹泻入院。体温３９．６℃，粪便常规检验：黄色稀便，白细胞３～５个／ＨＰ，未见红细胞，细菌鉴定为哈达尔沙门菌。例２女，４岁...     

急性感染性腹泻病原菌的分布及耐药性分析

目的：监测肠道感染患者病原菌的分布及耐药状况，为临床合理用药提供依据。方法：以我院肠道门诊急性腹泻患者为研究对象：通过对粪便标本培养出致病菌后，进一步鉴定种、群及血清型；对所鉴定细菌进行药敏试验。结果：在506例急性腹泻患者粪便标本中，共检测出178株致病菌，总分离率为35．2％。其中弧菌属56株(31．5％)，变形杆菌36株(20．2％)；志贺菌23株(4．6％)。药敏试验结果表明，弧菌属及变形杆菌对药物最敏感，而气单胞菌属和大肠埃希菌耐药率较高。细菌对青霉素类和磺胺类药物耐药率较高，喹诺酮类、第三代头孢菌素以及亚胺培南等药物抗菌活性较强。结论：致病性弧菌在肠道门诊急性腹泻患者检出率已超过志贺菌属，成为第1位病原菌，应根据肠道病菌菌型变迁的耐药性监测结果合理应用抗菌药物。     

Serotypes,antibiotic resistance,and virulence genes of Salmonella in children with diarrhea

Background Salmonella is an important foodborne pathogen that causes acute diarrhea in humans worldwide. This study analyzed the relationships of serotypes and antibiotic resistance with virulence genes of Salmonella isolated from children with salmonellosis.MethodsSerological typing was performed using the slide‐agglutination method. The Kirby‐Bauer disk diffusion method was used to test antibiotic susceptibility. Twenty virulence genes were detected by PCR.Results Salmonella Typhimurium (21 isolates, 34.43%) and S Enteritidis (12 isolates, 19.67%) were the predominant species among the 61 isolates. Ampicillin resistance was most common (63.93%), and among the cephalosporins, resistance was most often found to cefotaxime, a third‐generation cephalosporin (19.67%). Among the 20 virulence genes, prgH, ssrB, and pagC were detected in all Salmonella isolates. In S Typhimurium, the detection rates of hilA, sipB, marT, mgtC, sopB, pagN, nlpI, bapA, oafA, and tolC were high. In S Enteritidis, the detection rates of icmF, spvB, spvR, and pefA were high. Nitrofurantoin resistance was negatively correlated with the virulence gene bapA (P = .005) and was positively correlated with icmF, spvB, spvR, and pefA (P = .012, .008, .002, and .005, respectively), The P values between all other virulence genes and antibiotic resistance were >.05.Conclusion Salmonella Typhimurium and S Enteritidis were the main serotypes in children with diarrhea in Hangzhou, China. Salmonella exhibited a high level of resistance to common antibiotics, and a high rate of bacteria carrying virulence genes was observed. However, no significant correlation was found between virulence genes and resistance to common antibiotics.     

Study of the absorption of cefcapene pivoxil in patients with infectious disease and soft stool or diarrhea

 Cefcapene pivoxil hydrochloride (CFPN-PI), an ester cephem antibiotic, was orally given at a dose of 100 mg three times daily in patients with infection and soft stool or diarrhea, and its absorption was determined using the recovery ratio of 12-h urine pooled after the initial administration as an index. The primary endpoint, the recovery ratio of 12-h urine pooled after oral administration, could be evaluated in six of the eight patients finally gathered, and the mean value was 30.1 ± 5.8%, which was not considered to differ from the mean value of 34.4 ± 5.5% obtained in six healthy adult volunteers in the previous phase I study. Clinical efficacy in the eight patients was rated as very effective, effective, and ineffective in two, five, and one patients, respectively, with an effective ratio of 87.5% (7/8). Neither adverse drug reactions nor abnormal laboratory data were observed in any patient. These results indicate that CFPN-PI, at the routine oral dose, does not cause any problems in terms of absorption, efficacy, and safety when it is used in patients with infection and soft stool or diarrhea. Received: April 17, 2002 / Accepted: November 18, 2002     

Predictors of positive stool culture in adult patients with acute infectious diarrhea

Stool cultures for bacterial pathogens are often requested for investigation of patients with infectious diarrhea, but the literature reports low yield for this diagnostic test. The identification of clinical predictors of positive stool culture will help the physician in determining the necessity for stool requests. A retrospective study was performed in the setting of an Emergency Department (ED) in Hong Kong, to compare presenting features of adult patients with positive stool culture against those with negative culture. We compared 130 consecutive cases with positive stool culture, over a 12-month period, against 119 control cases obtained from a random sampling of 524 consecutive negative cases over the same period. In multivariate analysis, the independent variables found to be associated with positive stool culture were: the month of presentation (summer season), fever, duration of abdominal pain, and requirement of IV fluid therapy. Neither bloody diarrhea nor persistent diarrhea was associated with positive stool culture.     

Surveillance of bacterial pathogens of diarrhea disease in Indonesia

Emerging or reemerging infections due to bacterial disease may be a local, regional or global problem. Bacterial acute gastroenteritis is a potential cause of substantial morbidity in travelers and deployed U.S. military personnel. A surveillance study was conducted over a two-year period in Indonesia among 6760 patients with debilitating diarrheal diseases. Of the 6,760 patients, 587 (9%) of the patient stools were positive for bacteria. The proportions of bacteria isolated from the 587 patients were: Shigella flexneri (39%), Salmonella spp. (26%), Vibrio spp. (17%), S. sonnei (7%), Campylobacter jejuni (4.4%), Salmonella typhi (3%) and S. dysenteriae (2.3%). Shigella flexneri was the most prevalent pathogen isolated, over Vibrio spp. No V. cholerae was isolated in the cities of Pontianak, Padang or Batam in Indonesia. Shigella dysenteriae reemergence was noted in Bali, Kalimantan, Batam and Jakarta after an absence of 15 years. Isolation of a high proportion of S. flexneri, and Vibrio spp. occurred during the rainy months. All bacterial isolates were susceptible to quinolones, with the exception of C. jejuni and Salmonella spp., which were resistant to ciprofloxacin, norfloxacin and nalidixic acid. Our findings highlight the decline of V. cholerae, the rise of S. flexneri and the reemergence of S. dysenteriae in Indonesia. The study also documents the emergence of quinolone-resistant Campylobacter spp. in the Indonesia archipelago.     

不同临床类型慢性乙肝患者乙肝病毒基因型检测

目的探讨本院慢性乙型肝炎患者乙肝病毒基因型分布特征及与临床类型的关系。方法利用线性探针分析法进行乙肝病毒基因分型。结果52例慢性乙肝患者检出乙肝病毒基因型B型24例（46．2％）,C型26例（50％）,A、B混合型2例（3．8％）,B、C两型均以男性多见,两型间性别比例差异无统计学意义（X2=0．65,P〉0．05）;在慢性肝炎轻度、中度、重度、肝硬化及肝癌中,B和C基因型的分布差异无统计学意义（P〉0．05）;A、B混合型2例分别为慢性乙型肝炎轻度和慢性乙型肝炎中度。C型HBeAg阳性率高于B型,差异有统计学意义（P〈0．05）,HBVDNA载量两组间差异无统计学意义（P〉0．05）。结论本组慢性乙肝患者的乙肝病毒基因型以B、C为主要亚型,且C型稍多,C型HBeAg阳性率高于B型。     

Correlation of oxidative stress in patients with HBV-induced liver disease with HBV genotypes and drug resistance mutations

ObjectiveThis study aims to explore the correlation of oxidative stress (OxS) in patients with chronic hepatitis B (CHB) and the disease severity with HBV genotypes and drug resistance mutations.MethodsA total of 296 patients with CHB were enrolled into the study. PCR-reverse dot-blot hybridization was used to detect the HBV genotypes (B, C, and D) and the drug resistance-causing HBV mutant genes. In addition, the total oxidative stress (TOS) and total antioxidant status (TAS) were determined, and oxidative stress index (OSI) was calculated and compared.ResultsSerum levels of TOS and OSI, the B/C ratio, and drug resistance mutation rate were increased along with the elevated disease severity degree (CHB<HBC<HCC) (P < 0.05), while the serum TAS level showed the opposite trend (though there was no statistical difference between patients at the CHB and HBC stages). Moreover, patients with drug resistance-causing HBV mutation had higher serum TOS and OSI levels, while lower serum TAS levels (P < 0.05), compared with patients without mutations. Furthermore, mutation site numbers were positively correlated with the disease severity degree (γ = 0.614, P < 0.001).ConclusionThere is oxidative damage in patients with HBV-induced liver disease, and the damage degree is correlated with the HBV genotype and drug resistance mutation. Oxidative stress might be a useful indicator of the progression of HBV-induced liver disease in patients.     

Prevalence of diabetes and incidence of angiopathy in patients with chronic viral liver disease

Patients with chronic liver disease (CLD) often develops glucose intolerance. We explored the prevalence of diabetes mellitus in viral CLD, and analyzed factors profoundly affecting the diabetic angiopathies. 229 CLD patients (124 chronic hepatitis and 105 liver cirrhosis) entered the study. The diagnosis of diabetes was made with the criteria by World Health Organization. Laboratory investigation included serum asparate aminotransferase, alanine aminotransferase, albumin, fasting blood sugar, hemoglobin A1c (HbA1c), fasting immunoreactive insulin, and HOMA-R (FBS*IRI/405). The incidence of macro- and microangiopathy were also examined. Forty (17.5%) CLD patients were diagnosed diabetes, giving a significantly higher incidence than that of general cohort (5.3%) (p<0.001). Among them, 12 (30%) had the triopathy, significantly lower than that in a matched group of diabetic patients without CLD (65%) (p<0.001). Significantly increased levels of HbA1c and HOMA-R were observed in diabetic CLD with angiopathy compared with diabetic CLD without. Incidence of diabetes was increased in viral CLD patients. The rate of diabetic angiopathies in CLD, however, was relatively low, this could be explained by low coagulability in these patients. Poor control of hyperglycemia, partly due to insulin resistance, might explain the onset of angiopathy in diabetic CLD.     

乙肝相关性肝病患者幽门螺杆菌感染的研究

目的研究慢性乙型肝炎(乙肝)、乙肝肝硬化、乙肝后肝癌等肝病患者幽门螺杆菌(Hp)感染情况。方法收集慢性乙肝、乙肝肝硬化、乙肝后肝癌等肝脏疾病患者273例,日期正常体检人群60例,采用免疫层析法检测患者血清中抗Hp抗体(Hp-IgG),定量PCR检测HBV DNA。结果乙肝相关性肝病患者Hp感染率73.3%,正常体检人群为40.0%,2组比较差异有统计学意义(P<0.01);慢性乙肝、乙肝肝硬化、乙肝后肝癌3组患者Hp感染率分别为62.7%、77.0%、79.7%,后二者Hp明显高于慢性乙肝患者(P<0.05);按病毒载量分级,HBV DNA阴性组Hp感染率低于HBV DNA阳性组,而阳性组按低、中、高分组,各组间Hp感染率分别为69.4%、65.0%、66.1%(P>0.05);乙肝肝硬化患者按Child-push分级后,A、B、C各级之间的Hp感染率分别为51.9%、63.4%、65.6%(P>0.05)。结论 Hp感染可能参与乙肝肝病患者肝脏损伤,显示Hp具有肝细胞毒性作用;肝硬化、肝癌感染率高于慢性乙型肝炎,提示Hp感染与慢性肝病疾病进展和肝癌的发生有一定相关性。     

Incidence of celiac disease in patients with chronic diarrhea

AIM: To study prevalence of celiac disease (CD) among patients with chronic diarrhea (ChD). MATERIAL AND METHODS: Serum levels of IgA-antibodies to gliadin, endomysium, reticulin and tissue transglutaminase were examined in 206 patients with CD. Biopsies were obtained from a distal portion of the duodenum or a proximal portion of the jejunum. RESULTS: CD was diagnosed in 35 (16.9%) of 206 patients with ChD. The disease was typical in 5 (2.4%) patients and was latent in 30 (14.5%) patients. Antibodies to gliadin, endomysium, reticulin and tissues transglutaminase in diagnostically significant titers were detected in the serum of all the examinees with CD. Formation of the antitissue antibodies occurred because of destructive-dystrophic alterations of the connective tissue of the lamina propria mucosae pointing to the autoimmune nature of a pathological process in celiac disease. CONCLUSION: To diagnose CD in ChD patients, it is necessary to supplement standard examination with duodenobiopsy, tests for antibodies to gliadin, tissue transglutaminase and to tissue structures--endomysium and reticulin.