急性白血病患者茄病镰刀菌感染的诊断与治疗措施

目的探讨茄病镰刀菌引起急性髓性白血病患者感染的诊断和治疗措施。方法对临床连续送检的脓液和坏死组织标本行真菌培养,根据真菌培养的菌落特点和镜下形态鉴定致病真菌,采用MIC方法进行真菌体外药敏试验。结果从造血干细胞移植术后患者全身出现的多发性皮下包块中采取标本,连续两次行真菌培养,均检测出茄病镰刀菌,体外药敏试验显示该菌对伏立康唑和两性霉素B有较低的MIC值,分别为2.0、4.0μg/ml。结论茄病镰刀菌对造血干细胞移植术后的感染少见,且难治疗,及时进行分离、培养、鉴定和药物敏感试验,正确选用抗菌药物、促进造血功能恢复,尤其是中性粒细胞、增强免疫功能,是治疗成功与否的关键。     

急性白血病患者尖端赛多孢子菌与细菌多重感染的实验诊断及治疗

目的 探讨尖端赛多孢子菌及细菌引起急性髓性白血病患者多重感染的诊断方法 和治疗措施.方法 连续采集患者左侧腹股沟分泌物或坏死组织行真菌和细菌培养,同时对阴茎冠状沟和包皮做病原菌检查;采用法国生物梅里埃公司VITEK-2全自动微生物分析仪对细菌进行鉴定和药敏试验;根据真菌培养的菌落特点和镜下形态鉴定致病真菌,采用MIC方法 进行真菌体外药敏试验.结果 抗真菌治疗前患者左侧腹股沟分泌物连续4次行真菌培养,均检测出尖端赛多孢子菌,体外药敏试验显示对伏立康唑有较低的MIC值,而对两性霉素B高度耐药;左侧腹股沟分泌物细菌培养结果 分别为产ESBLs肺炎克雷伯菌和产ESBLs大肠埃希菌;阴茎冠状沟和阴茎包皮处细菌培养结果 均为产ESBLs肺炎克雷伯菌和耐氨基糖苷类高水平粪肠球菌;产ESBLs大肠埃希菌和产ESBLs肺炎克雷伯菌对亚胺培南、哌拉西林/他唑巴坦、阿米卡星等抗菌药物敏感;耐氨基糖苷类高水平粪肠球菌敏感抗菌药物有:万古霉素、替考拉宁、亚胺培南.结论 尖端赛多孢子菌的感染少见,且难治疗,极易感染免疫低下的患者合并细菌引起多重感染;及时进行分离、培养、鉴定和药物敏感性试验,及早进行病原学诊断,正确选用抗菌药物是治疗成功与否的关键.     

急性白血病患者裂褶菌感染的实验室诊断研究

目的探讨裂褶菌及细菌引起急性髓性白血病造血干细胞移植患者多重感染的试验诊断和治疗方法,为临床诊断该菌感染及经验治疗提供科学依据。方法 2014年12月连续采集两次1例急性髓性白血病行造血肝细胞移植患者副鼻窦分泌物和副鼻窦清创术后坏死组织,进行真菌和细菌培养;采用法国生物梅里埃公司VITEK-2全自动微生物分析仪对细菌进行鉴定和药敏试验;采用肉汤稀释法(CLSI M38-A2)进行真菌体外药敏试验,数据采用SPSS 17.0软件进行统计分析。结果该例患者副鼻窦清创术后组织块真菌培养结果为裂褶菌,其对伏立康唑有较低的MIC值;连续两次副鼻窦分泌物和术中留取的组织块细菌培养结果均为大肠埃希菌和嗜麦芽寡养单胞菌;产ESBLs大肠埃希菌对亚胺培南、美罗培南、阿米卡星、头孢他啶等均为敏感,嗜麦芽寡养单胞菌敏感抗菌药物只有磺胺甲噁唑/甲氧苄啶。结论裂褶菌的感染少见,且难诊断,极易感染免疫低下的患者,及早进行病原学诊断,正确选用抗菌药物,是抗感染治疗成功与否的关键。     

糖尿病湿性坏疽感染菌谱及耐药菌谱分析

目的 了解糖尿病湿性坏疽感染菌谱和耐药菌谱特点,使临床选择抗菌药物治疗更有针对性.方法 取糖尿病湿性坏疽分泌物进行需氧菌、真菌培养和药敏试验以及厌氧菌培养.结果 357例患者中,细菌培养结果阳性率为100％,共培养出469株细菌,其中感染率革兰阳性菌(G+)45.4％、革兰阴性菌(G-) 26.0％、厌氧菌23.7％、真菌4.9％,细菌混合感染率为29.9％. G+菌中葡萄菌属有5种药物的耐药菌株大于50％、肠球菌属有11种药物的耐药菌株大于50％,G-菌中肠杆菌科有3种药物的耐药菌株大于50％、不动杆菌属和假单胞菌属有8种药物的耐药菌株大于50％,真菌中光滑念珠菌有3种药物的耐药菌株大于50％,其余菌属药物的耐药菌株均小于50％.结论 糖尿病湿性坏疽感染菌谱特点是革兰阳性菌＞革兰阴性菌、厌氧菌＞真菌,混合感染较为突出.G+菌感染中的肠球菌属、G-菌感染中的不动杆菌属和假单胞菌属、真菌感染中的光滑念珠菌耐药性较高.     

真菌性角膜炎病原学及药敏结果分析

目的探讨真菌性角膜炎病原学分布特点及药敏结果。方法选择2006年1月-2016年12月医院眼科真菌性角膜炎200例作为研究对象,对200例患者眼角膜刮片标本进行真菌培养,行药敏检测。结果 200例真菌性角膜炎患者培养出221株病原真菌,以茄病镰刀菌、烟曲霉和光滑假丝酵母为主,分别为75株、23株和20株,分别占33.9%、10.4%、9.0%;75株茄病镰刀菌对伊曲康唑均不敏感,对伏立康唑敏感率为89.3%,对两性霉素B的敏感率为74.7%,对纳他霉素的敏感率为100.0%;23株烟曲霉对伊曲康唑、伏立康唑和纳他霉素的敏感率为100.0%,对两性霉素B的敏感率为52.2%;20株光滑假丝酵母对伊曲康唑、伏立康唑和纳他霉素的敏感率为100.0%,对两性霉素B的敏感率为85.0%。结论真菌性角膜炎的主要病原菌为茄病镰刀菌、烟曲霉和光滑假丝酵母,临床应选择敏感抗菌药物加以治疗。     

老年尘肺病人呼吸道感染病原菌分析

目的通过对合并呼吸道感染尘肺病人痰液的细菌培养资料分析,了解常见感染病原菌的类型及分布,以指导临床抗菌药物的应用和控制院内感染发生率。方法对我院自2006年3～5月收治的67例尘肺患者行痰液细菌培养,并结合病人临床病案资料进行综合分析。结果67例患者分离出感染病源菌36例,病源菌菌株数以白色念珠菌(44.4%)、肺炎克雷伯杆菌(25.0%)和铜绿假单胞菌(19.4%)为主。结论由于细菌合并真菌的二重感染病例明显增多,使真菌菌株数量超过革兰阴性杆菌升至第一位,须引起重视,进一步规范抗菌药物的合理应用。     

多重耐药铜绿假单胞菌感染相关因素分析

目的了解多重耐药铜绿假单胞菌感染的危险因素、治疗及预后情况。方法对我院2000年1月~2004年12月,经标本送检证实为多重耐药铜绿假单胞菌感染的病例进行回顾性调查。结果34例为多重耐药铜绿假单胞菌感染,29例为医院感染,34例MDRP感染者病死率67.7%,有30例合并有1~5种基础疾病,≥2种细菌混合感染者26例。结论多重耐药铜绿假单胞菌感染多发生于年老、合并基础疾病及混合细菌感染者。     

铜绿假单胞菌50例分析

铜绿假单胞菌是引起院内感染的主要细菌，在脓汁、呼吸道及分泌物中所占比例较高，及时准确地检出对临床治疗用药有着重要的意义。是临床分离假单胞菌属中荧光假单胞菌DNA同源群中的一种。该菌在普通琼脂和SS琼脂平板上生长良好，在临床标本中，培养出现多种形态菌落。笔者所在医院2008年检测患者分泌物细菌巾，铜绿假单胞菌占有很大比例，下面将笔者所在医院常见铜绿假单胞菌50例报告分析如下。     

肿瘤患者铜绿假单胞菌医院感染的临床特点与耐药性

目的探讨肿瘤患者铜绿假单胞菌医院感染的临床特征及对抗菌药物的耐药性特点,为临床医师预防与治疗医院感染提供实验室参考依据。方法调查2009年1月-2012年12月288例肿瘤患者发生铜绿假单胞菌感染临床资料,所有试验操作严格遵循《全国临床检验操作规程》中的临床微生物学检验有关规定进行,无菌手法采集感染性标本进行细菌培养和菌种鉴定;抗菌药物的耐药性检测采用K-B法操作,药敏数据采用WHONET最新软件进行统计分析。结果肿瘤患者各种感染性标本中培养获得288株铜绿假单胞菌,对阿米卡星、亚胺培南、美罗培南、头孢哌酮/舒巴坦和哌拉西林/他唑巴坦等抗菌药物的耐药率<15.0%;对头孢噻肟、哌拉西林的耐药率>40.0%;对其他抗菌药物耐药率均在20.0%³5.0%,检出耐亚胺培南铜绿假单胞菌21株,检出率7.3%,未发现泛耐药铜绿假单胞菌。结论县级基层医院肿瘤患者医院感染铜绿假单胞菌的耐药率比较严重,尽管耐药率低于大城市综合医院铜绿假单胞菌耐药率,但仍然应该提高防范意识,贯彻落实卫生部颁发的《抗菌药物临床应用管理办法》,控制细菌耐药性快速增长的危险倾向。     

运用Cox-Staurt趋势检验分析医院感染铜绿假单胞菌耐药趋势

目的研究医院感染铜绿假单胞菌流行病学特征和耐药趋势。方法采用VITEK-2Compact自动化微生物分析系统对2008-2010年医院感染患者送检标本进行细菌鉴定和耐药性检测,并用Cox-Staurt趋势检验分析耐药趋势。结果 2008-2010年医院感染铜绿假单胞菌分离率为18.78%,为检出细菌首位,且呈上升趋势,其主要分布在干部保健特诊科、重症医学科、血液科;铜绿假单胞菌对头孢曲松、磺胺甲噁唑/甲氧苄啶、头孢唑林、头孢替坦、氨苄西林的总耐药率>70.0%,对妥布霉素、庆大霉素、哌拉西林、哌拉西林/他唑巴坦、左氧氟沙星、环丙沙星、头孢他啶、头孢吡肟、亚胺培南、氨曲南的总耐药率<30.0%;Cox-Staurt趋势检验分析,铜绿假单胞菌对氨苄西林、头孢曲松、头孢唑林、头孢替坦、亚胺培南的耐药率呈上升趋势,而对哌拉西林、哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、氨曲南、庆大霉素、妥布霉素、环丙沙星、左氧氟沙星和磺胺甲噁唑/甲氧苄啶的耐药率无上升趋势。结论铜绿假单胞菌引起的医院感染越来越严重,应定期进行细菌耐药性监测,以指导临床合理使用抗菌药物,预防控制耐药菌株的产生和流行。     

Allergens from Fusarium solani identified by immunoblotting in asthma patients In Iran

We extracted Fusarium solani antigens to evaluate specific anti-F. solani IgE in fifty-one patients with asthma (33 men and 18 women) and in 22 non-atopic healthy subjects (15 men and 7 women). F. solani strains were cultured in Sabouraud glucose agar and subjected to cell disruption using the freeze-and-thaw method. The obtained cytoplasmic extracts were analysed using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Sensitisation to F. solani antigens has been evaluated in asthmatic patients using the immunoblotting assay. The SDS-PAGE identified 29 protein bands in the cytoplasmic extracts of F. solani isolates, with molecular weights ranging from 24 kDa to 112 kDa. Immunoblotting detected specific anti-F. solani IgE antibody in all asthma patients, but not in the control group. The predominant reactive allergens in patients corresponded to the bands with molecular weights of 24 kDa, 58.5 kDa, 64.5 kDa, 69 kDa, 72 kDa, and 97 kDa. Our results suggest that various allergenic components of F. solani may produce symptoms of asthma in susceptible individuals and they call for further research.     

三种药用植物内生真菌抗菌活性菌株的筛选

目的 筛选具有抗多种植物病原真菌活性的药用植物内生真菌菌株.方法 以常见的植物病原真菌包括灰葡萄孢( Botrytis cinerea)、尖孢镰孢(Fusarium oxysporum)、终极腐霉(Pythium ultimum)与立枯丝核菌(Rhizoctonia solani)菌株为指示菌,对分离自天南星、多花黄精、银杏三种药用植物的73株内生真菌菌株进行抗菌活性筛选.结果 共有20株菌株对至少一种指示菌有抑制活性,占总菌株数的27.4％;其中天南星内生真菌ZJCWF006茎点霉Phoma sp.、多花黄精内生真菌ZJCY610变灰青霉Penicillium canescens与银杏内生真菌TMSFI69团青霉Penicillium commune对四种指示菌均有较强抑制活性.结论 药用植物内生真菌对植物病原菌有较高抑制活性.     

Occupational hypersensitivity pneumonitis due to molds in an onion and potato sorter

A 42-year-old female non-smoking onion and potato sorter developed work-related shortness of breath, cough, fatigue and flu-like symptoms. The diagnosis of hypersensitivity pneumonitis was based on patchy infiltrates in both lungs on high resolution computed tomography and lymphocytosis of 71% in a bronchoalveolar lavage sample with a CD4/CD8 ratio of 0.4. Exposure cessation and initial corticosteroid therapy resulted in complete recovery. IgG antibodies to Penicillium species and Fusarium solani cultivated from samples from the patient's workplace were detected in the patient's serum and cross-reactivity was demonstrated within Penicillium species, but also between Penicillium species and Aspergillus fumigatus. We conclude that occupational hypersensitivity pneumonitis due to molds may develop in onion and potato sorters.     

眼部丝状真菌感染的诊断与致病菌分离鉴定

目的 分析眼部丝状真菌感染致病菌的种类和致病特征。方法 对13例眼部丝关真菌感染患者的临床资料进行分析和致病菌分离鉴定，对眼部丝状真菌感染的致病菌、发病原因、早期诊断方法、丝状真菌与酵母菌眼部感染特征进行分析。结果 13例患者中11例为真菌性角膜溃疡，2例为真菌性眼内炎；13例15眼标本真菌培养均为丝状真菌，其中痂病镰刀菌2例、烟曲霉2例、谢瓦曲霉1例、黄曲霉1例、链格孢霉1例、尖端单孢子菌1例、总关毛霉1例、链霉菌1例。结论 眼部丝状真菌感染仍以镨刀菌、曲霉为主，但有明显的多样化趋势；确定诊断须真菌检查，早期是预后良好的关键。     

Detection of microbial volatile organic compounds (MVOCs) produced by moulds on various materials.

Twelve fungal species were screened for microbial volatile organic compounds (MVOCs): Aspergillus fumigatus, A. versicolor, A. niger, A. ochraceus, Trichoderma harzianum, T. pseudokoningii, Penicillium brevicompactum, P. chrysogenum, P. claviforme, P. expansum, Fusarium solani and Mucor sp. More than 150 volatile substances derived from fungal cultures have been analysed by head-space solid-phase microextraction (HS-SPME). Each species had a defined MVOC profile which may be subjected to considerable modification in response to external factors such as cultivation on different substrata. The cultivation on different substrata changes the number and concentration of MVOCs. Species-specific volatiles may serve as marker compounds for the selective detection of fungal species in indoor environments. Examination of MVOCs from indoor air samples may become an important method in indoor air hygiene for the detection of type and intensity of masked contamination by moulds.     

Nutritive value, antioxidant and antimicrobial properties of Struchium sparganophora leaves

Struchium sparganophora leaf is a green leafy vegetable popularly used in soup preparations in processed and unprocessed forms in Nigeria. Fresh leaves of S. sparganophora were soaked overnight to remove its bitterness, before determination of the nutrient and antinutrient content, while sun-dried S. sparganophora leaves were extracted with rectified spirit. The antioxidant and antimicrobial properties of the extracts were subsequently determined. The result of the study revealed that the fresh leaf has high nutrient (protein, fat, crude fiber, and mineral) but low antinutrient (tannin and phytate) content. However, processing of the S. sparganophora leaf caused a significant decrease (P < .05) in both the nutrient and antinutrient contents. The ethanolic extract of the leaf contains alkaloids, tannin, saponins, phlobatannin, anthraquinone, and glycosides; furthermore, the extract has high antioxidant activity as typified by its high total phenol (5.4 g/100 g) content, reducing power (2.50 OD(700)), and free radical scavenging ability (65.2%). In addition, the extract (1.0 mg/mL) inhibited the growth of some pathogenic bacteria [Shigella dysenteriae (zone of inhibition 17.0 mm), Staphylococcus aureus (11.0 mm)] and fungi [Candida albicans (18.0 mm), Penicillium sp. (14.0 mm), Saccharomyces cerevisiae (15.0 mm)]. The inhibition of the bacterial and fungal growth was dose dependent. However, the same concentration of the extract did not inhibit the growth of Escherichia coli, Proteus sp., Pseudomonas aeruginosa, and Klebsiella sp., as well as the growth of the following fungi: Aspergillus fumigatus, Fusarium solani, and Aspergillus flavus. It could therefore be inferred that the leaf of S. sparganophora is promising both nutritionally and medicinally because of its high nutrient content, low antinutrient content, and arrays of pharmaceutically active phytochemicals with high levels of antioxidant and antimicrobial activity.     

Comparative essential oil composition and antifungal effect of bitter fennel (Foeniculum vulgare ssp. piperitum) fruit oils obtained during different vegetation

The chemical composition of the flower and unripe and ripe fruits from fennel (bitter) (Foeniculum vulgare ssp. piperitum) has been examined by gas chromatography and gas chromatography-mass spectrometry. The main identified components of the flower and unripe and ripe fruit oils were estragole (53.08%, 56.11%, and 61.08%), fenchone (13.53%, 19.18%, and 23.46%), and alpha-phellandrene (5.77%, 3.30%, and 0.72%), respectively. Minor qualitative and major quantitative variations for some compounds of essential oils were determined with respect to the different parts of F. vulgare. The oils exerted varying levels of antifungal effects on the experimental mycelial growth of Alternaria alternata, Fusarium oxysporum, and Rhizoctonia solani. The 40 ppm concentrations of fennel oils showed inhibitory effect against mycelial growth of A. alternaria, whereas 10 ppm levels were ineffective. The analyses show that fennel oils exhibited different degrees of fungistatic activity depending on the doses.     

Epidemiology, molecular mycology, and environmental sources of Fusarium infection in patients with cancer.

OBJECTIVE: To investigate the epidemiology and environmental sources of Fusarium infections in patients with cancer. DESIGN: Retrospective case-control study conducted following surveillance environmental cultures and DNA analysis of isolated organisms. SETTING: A tertiary-care, university cancer center. METHODS: In 1996 and 1997, environmental cultures were performed on air samples and water systems. A retrospective chart review was performed for 70 patients with cancer identified with fusariosis between 1987 and 1997. Patients with fusariosis were compared with 49 uninfected control patients who occupied hospital rooms with positive environmental cultures for Fusarium. With the use of random amplification of polymorphic DNA, organisms isolated from infected patients were compared with environmental organisms. RESULTS: Most of the patients with Fusarium (40, 57%) were infected on or within 3 days of admission, indicating community rather than nosocomial acquisition. Patients were comparable in terms of underlying immunocompromised status to 49 uninfected control patients. However, the duration from admission to infection in the patients with fusariosis tended to be shorter than the duration from admission to discharge in the exposed control patients (P = .06). Water cultured from the hospital tanks and from sinks and water fountains was negative for Fusarium. With the use of polymerase chain reaction, environmental isolates did not match clinical ones. Quantitative air sampling showed that the quantitative outdoor Fusarium levels were eightfold higher than the indoor levels. During the rainy summer season, outdoor air concentrations of Fusarium were at their highest, coinciding with the peak incidence of fusariosis at our center. CONCLUSION: The most likely source of fusariosis was the external environment rather than nosocomial sources, such as water.     

串珠镰刀菌伏马菌素产毒基因及毒力的测定

目的研究我国串珠镰刀菌分离株伏马菌素产毒性与其生物合成酶基因fum5的关系。方法对不同省区、不同粮食样品中分离的29株串珠镰刀菌进行了产毒基因的测定,对其中18株产毒基因阳性株进行了伏马菌素生物合成,并用高效液相色谱法进行了毒素测定。结果26株为fum5基因阳性。除1株仅产生低水平的伏马菌素FB1外,其他菌株都产生不同水平的伏马菌素FB1、FB2和FB3,产毒量范围分别为0．41～140．20mg／kg、0．06～14．30mg／kg和0．30～58．00mg／kg。从芝麻中分离并鉴定了1株串珠镰刀菌伏马菌素强产毒株,分别产生高水平的伏马菌素FB1、FB2和FB3,产毒量分别达到128．84、11．80和14．88mg／kg。结论我国串珠镰刀菌分离株产生伏马菌素的能力与其生物合成酶基因rum5有密切关系。串珠镰刀菌可以污染芝麻并产生高水平的伏马菌素。