类鼻疽伯克菌——生物武器中的定时炸弹

病菌特点 类鼻疽伯克菌作为生物战剂有下面这些特点： 1．病死率高，为30％～60％。 2．不易诊断，感染者-临床上的表现“似百样病”，急性的像败血症，有些出现肺炎、肺脓肿、心包炎、肾炎、肝脓肿等症状，还有的慢性发病，很像空洞性肺结核，极易误诊。     

我院儿科2016年1-6月支气管肺炎病原学及用药合理性分析

目的:分析我院儿科支气管肺炎感染细菌的分布及耐药情况,为临床合理用药提供参考。方法:选取我院儿科2016年1-6月收治的支气管肺炎患儿1 172例,采集深部痰液标本1 001份,即送检验科检验,根据检验报告统计分析细菌的分布及耐药情况,并对临床用药进行合理性评价。结果:1 001份痰液标本分离菌株221株,阳性率为22.08%。221株病原菌中,革兰阳性菌64株(28.96%),革兰阴性菌147株(66.52%),真菌10株(4.52%);排名前5位的病原菌依次是肺炎链球菌、流感嗜血杆菌、肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌,共163株(73.76%)。肺炎链球菌对万古霉素、氯霉素、头孢曲松、头孢噻肟、氧氟沙星、左氧氟沙星、莫西沙星、利奈唑胺、泰利霉素的耐药率均为0;流感嗜血杆菌对环丙沙星、头孢曲松、左氧氟沙星、头孢他啶、头孢呋辛、氨曲南、阿奇霉素、氯霉素的耐药率均为0;铜绿假单胞菌、肺炎克雷伯菌及大肠埃希菌对碳青霉烯类、氨基糖苷类及喹诺酮类抗菌药物的耐药率较低。我院儿科治疗支气管肺炎的初始经验性用药主要为茁鄄内酰胺酶抑制剂复合制剂,占 92.06%。结论:我院儿科支气管肺炎病原菌主要有肺炎链球菌、流感嗜血杆菌、肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌,不同菌种对抗菌药物的耐药率差别明显,我院儿科治疗支气管肺炎存在过度使用抗菌药物的问题。临床医师应根据细菌药敏试验结果合理选用抗菌药物,以减少细菌耐药性的产生。     

PCT早期鉴别诊断细菌和病毒感染及其在疾病控制中的应用

目的:分析早期细菌和病毒感染血清降钙素原(PCT)水平的差别,探讨血清PCT检测鉴别诊断早期细菌和病毒感染的价值,为PCT在传染病预防控制中的应用提供实验依据。方法:采用半定量固相免疫测定法测定28例细菌感染者、42例病毒感染者以及20例正常对照血清中的PCT,将检测结果分成4个水平,PCT<0.5 ng/ml,0.5 ng/ml≤PCT<2.0 ng/ml,2.0 ng/ml≤PCT<10.0 ng/ml和PCT≥10.0 ng/ml,分析PCT水平与细菌病毒感染之间的关系。以PCT≥0.5 ng/ml为阳性诊断标准,计算诊断试验的灵敏度和特异度。统计学处理采用SPSS14.0中的χ2检验。结果:细菌感染、病毒感染和健康组的PCT水平分布存在显著性差异(χ2=42.6,P=0.00);细菌感染组显著高于病毒感染组(χ2=26.1,P=0.00)和健康组(χ2=28.3,P=0.00),但病毒感染组与健康组之间没有显著性差异(χ2=4.8,P=0.09)。PCT试验的灵敏度为82.1%,特异度为95.0%。结论:血清PCT半定量检测是一个较好鉴别早期细菌与病毒感染的指标,建议在疫情调查中作为早期细菌与病毒感染的筛查指标。     

2例临床诊断粒细胞无形体病回顾性调查

[目的]通过对从事林区野外工作者人粒细胞无形体病血清学调查,发现2例被蜱叮咬后发病住院的病例,结合回顾性临床和流行病学调查结果,修正诊断为人粒细胞无形体感染。为进一步开展调查和制定防控措施提供依据。[方法]应用间接免疫荧光法（IFA）检测人粒细胞无形体IgG抗体,对阳性人群逐一进行蜱叮咬史等及临床资料调查,核对住院或门诊病历。[结果]2例住院患者均有明确被蜱叮咬史和较典型的临床症状体征,诊断为“昆虫咬伤伴感染和发热待查”。经抗生素治疗痊愈。目前血清学检测人粒细胞无形体IgG抗体滴度分别为1：64和1：128,其中1例莱姆病和恙虫病抗体均阳性,另1例恙虫病抗体阳性。修正诊断为“人粒细胞无形体感染合并莱姆病、恙虫病混合感染”。[结论]武夷山林区有嗜粒细胞无形体感染病例,应进一步在该区开展粒细胞无形体病病原和疫源地等调查。     

4种病原菌特异基因片段阳性蜱的16S rRNA基因克隆文库分析

Objective To develop the method of 16S rRNA gene clone library for tick bacterial flora analysis, and to analyze the detection effective of pathogens in tick and capacity of bacterial flora diversity. Methods Primers were designed according to the specific gene of Borrelia burgdorferi, Bartonella henselae, Anaplasma phagocytophilum, Ehrlichia chaffeensis and templates were choosen by positive PCR result to amplify the DNA extracted from the ticks. One set of primers targeting 16S rRNA gene conserved region were chosen to amplify certain fragments, DNA extraction, PCR reaction, cloning and sequencing. Nucleotide sequences were compared with GenBank database. Calculated Coverage values of clone library and Shannon-Wiener diversity index. Results Sixteen defined genus-or species-bacteria were detected in 103 valid sequences. Eight species were edge type (Clone No. > 5). Three kinds of pathogens were identified (Borrelia burgdorferi, Bartonella henselae and Rickettsia sp). Three kinds of pathogens were not edge type(Clone No. < 5). Coverage value was 96.11%, and Shannon-Wiener index was 2.40. Analysis results of cloning sequence showed that tick-parasitic bacteria mainly were α and γ deformation mycetes which accounted for 56.25% (9/16). Conclusions The 16S rRNA gene sequences technology could make relative quantitative of bacterial flora, and detect many kinds of pathogens in tick. It's a good method for detection of pathogens and bacterial flora analysis.     

4种病原菌特异基因片段阳性蜱的16S rRNA基因克隆文库分析

Objective To develop the method of 16S rRNA gene clone library for tick bacterial flora analysis, and to analyze the detection effective of pathogens in tick and capacity of bacterial flora diversity. Methods Primers were designed according to the specific gene of Borrelia burgdorferi, Bartonella henselae, Anaplasma phagocytophilum, Ehrlichia chaffeensis and templates were choosen by positive PCR result to amplify the DNA extracted from the ticks. One set of primers targeting 16S rRNA gene conserved region were chosen to amplify certain fragments, DNA extraction, PCR reaction, cloning and sequencing. Nucleotide sequences were compared with GenBank database. Calculated Coverage values of clone library and Shannon-Wiener diversity index. Results Sixteen defined genus-or species-bacteria were detected in 103 valid sequences. Eight species were edge type (Clone No. > 5). Three kinds of pathogens were identified (Borrelia burgdorferi, Bartonella henselae and Rickettsia sp). Three kinds of pathogens were not edge type(Clone No. < 5). Coverage value was 96.11%, and Shannon-Wiener index was 2.40. Analysis results of cloning sequence showed that tick-parasitic bacteria mainly were α and γ deformation mycetes which accounted for 56.25% (9/16). Conclusions The 16S rRNA gene sequences technology could make relative quantitative of bacterial flora, and detect many kinds of pathogens in tick. It's a good method for detection of pathogens and bacterial flora analysis.     

4种病原菌特异基因片段阳性蜱的16S rRNA基因克隆文库分析

Objective To develop the method of 16S rRNA gene clone library for tick bacterial flora analysis, and to analyze the detection effective of pathogens in tick and capacity of bacterial flora diversity. Methods Primers were designed according to the specific gene of Borrelia burgdorferi, Bartonella henselae, Anaplasma phagocytophilum, Ehrlichia chaffeensis and templates were choosen by positive PCR result to amplify the DNA extracted from the ticks. One set of primers targeting 16S rRNA gene conserved region were chosen to amplify certain fragments, DNA extraction, PCR reaction, cloning and sequencing. Nucleotide sequences were compared with GenBank database. Calculated Coverage values of clone library and Shannon-Wiener diversity index. Results Sixteen defined genus-or species-bacteria were detected in 103 valid sequences. Eight species were edge type (Clone No. > 5). Three kinds of pathogens were identified (Borrelia burgdorferi, Bartonella henselae and Rickettsia sp). Three kinds of pathogens were not edge type(Clone No. < 5). Coverage value was 96.11%, and Shannon-Wiener index was 2.40. Analysis results of cloning sequence showed that tick-parasitic bacteria mainly were α and γ deformation mycetes which accounted for 56.25% (9/16). Conclusions The 16S rRNA gene sequences technology could make relative quantitative of bacterial flora, and detect many kinds of pathogens in tick. It's a good method for detection of pathogens and bacterial flora analysis.     

16例人粒细胞无形体病疑似病例临床观察

武汉协和医院感染科2009年3-5月收治了16例初诊为发热原因不明的患者,经医院及国家疾病预防控制中心专家会诊诊断为人类粒细胞无形体病(HGA).现将处理结果报道如下.     

猪链球菌四川资阳分离株特征分析

目的了解猪链球菌四川资阳分离株的生物学特征。方法以血平板分离培养获得分离株,用猪链球菌分型血清进行分型,用VITEK2compact微生物鉴定系统进行生化鉴定,PCR技术检测猪链球菌荚膜多糖基因(CPS2J)、溶菌酶释放蛋白基因(MRP)和溶血素基因(SLY),用K-B纸片法进行药物敏感性分析。结果从患者中分离到34株猪链球菌,从病死猪中分离到8株猪链球菌,血清分型均为血清2型,VITEK2compact微生物鉴定系统生化鉴定也为猪链球菌2型,均具有CPS2J、MRP、SLY毒力基因,42株菌对青霉素G、阿莫西林、奥恪门丁、头孢曲松、头孢他啶、氯霉素、氧氟沙星、环丙沙星、红霉素、克林霉素、万古霉素均敏感,对吡哌酸、四环素、庆大霉素、链霉素、阿米卡星、复方磺胺甲恶唑、氨曲南、呋喃唑酮、呋喃妥因均耐药。结论人源株和猪源株均为猪链球菌2型,血清鉴定与生化鉴定结果一致,致病力强,菌株耐药谱非常相似。     

陈旧性和近发性脊髓损伤幻觉痛的痛觉及心理的对比研究

采用莫克吉尔疼痛答卷、斯戴答卷和毕迪埃答卷等方式，对２２例“近发性”（Ｘ１）及２８例“陈旧性”（Ｘ２）脊髓损伤幻觉痛患者的疼痛、焦虑和抑郁等特点进行了观察和对比。结果发现：疼痛测定指数总分及疼痛强度的评分趋势，３０～３９岁组（Ａ组）及４０一４９岁组（Ｂ组）Ｘ１＞Ｘ２，５０一５９岁组（Ｃ组）为Ｘ１＜Ｘ２．而且疼痛对睡眠的影响与此趋势相一致；Ｘ１各年龄组幻觉痛的痛感觉成分均大于Ｘ２，Ｘ１各年龄组幻觉痛的痛情绪成分均小于Ｘ２；焦虑和抑郁对疼痛无直接影响。这一结果初步揭示了“近发性”与“陈旧性”脊髓损伤幻觉痛的规律，并可为采取有针对性的措施提供依据。