Increased Risk for Group B Streptococcus Sepsis in Young Infants Exposed to HIV,Soweto, South Africa, 2004–2008

Although group B Streptococcus (GBS) is a leading cause of severe invasive disease in young infants worldwide, epidemiologic data and knowledge about risk factors for the disease are lacking from low- to middle-income countries. To determine the epidemiology of invasive GBS disease among young infants in a setting with high maternal HIV infection, we conducted hospital-based surveillance during 2004–2008 in Soweto, South Africa. Overall GBS incidence was 2.72 cases/1,000 live births (1.50 and 1.22, respectively, among infants with early-onset disease [EOD] and late-onset [LOD] disease). Risk for EOD and LOD was higher for HIV-exposed than HIV-unexposed infants. GBS serotypes Ia and III accounted for 84.0% of cases, and 16.9% of infected infants died. We estimate that use of trivalent GBS vaccine (serotypes Ia, Ib, and III) could prevent 2,105 invasive GBS cases and 278 deaths annually among infants in South Africa; therefore, vaccination of all pregnant women in this country should be explored.     

Streptococcus oralis Meningitis with Gingival Bleeding in a Patient: A Case Report and Review of the Literature

An 81-year-old man with a history of gingival bleeding presented with a fever, headache, and drowsiness. His mouth and full dentures were unsanitary. Laboratory tests revealed Streptococcus oralis meningitis caused by odontogenic bacteremia. We reviewed eight reported cases, including the present case, because S. oralis meningitis is rare. Our review indicated that S. oralis meningitis needs to be considered when encountering cases of a fever, disturbance of consciousness, and headache with episodes of possible odontogenic bacteremia.     

24株停乳链球菌似马亚种的分子鉴定和基因分型

目的 探讨停乳链球菌似马亚种(Streptococcus dysgalactiae subspecies equisimilis,SDSE)感染的临床分布特点及分子特征。方法 收集SDSE感染患者的临床资料及相应分离菌株,分离株经全自动微生物分析系统、基质辅助激光解析电离飞行时间质谱技术(MALDI-TOF-MS)及PCR扩增16S rRNA和链激酶前体基因等3种方-法进行鉴定。对SDSE菌株进行M蛋白基因(emm)分型和多位点序列分型(Multilocus sequence typing, MLST),并通过BioNumerics 6.6软件进行聚类分析。结果 24株停乳链球菌似马亚种主要分离自咽拭子、皮肤、血液,分别占58.33%、20.83%、8.33%;24株SDSE被分为5种emm类型,以stCNSRT2.0(n=16,66.7%)占优势,其次是stG840.0(n=3,12.5%)。通过MLST分型,共有6种ST型别,以ST44(n=17,70.8%)为主,ST605为新定义的ST型。结论 本研究中SDSE分离株具有分子多样性,ST605为首次报告的MLST型别。     

非疫苗血清型肺炎链球菌发生机制及疫苗新策略

肺炎链球菌(Streptococcus pneumoniae,Sp)是社区获得性肺炎以及侵袭性疾病如脑膜炎和败血症的主要致病菌之一,到目前为止,关于肺炎链球菌感染性疾病的预防仍以肺炎链球菌多糖疫苗(pneumococcal polysaccharide vaccine,PPV)和肺炎链球菌多糖蛋白结合疫苗(pneumococcal conjugate vaccine,PCV)为主。然而靶向特定荚膜多糖的肺炎链球菌疫苗的选择性压力在一定程度上诱导了肺炎链球菌荚膜转换,导致了不同荚膜抗原突变体的产生,进而造成非疫苗血清型(non-vaccine type,NVT)及无荚膜肺炎链球菌(nonencapsulated streptococcus pneumoniae,NESp)的增加,使现有的疫苗不能有效预防肺炎链球菌的感染。本文重点介绍了肺炎链球菌非疫苗血清型的发生机制,为制备新型肺炎链球菌疫苗提供思路与策略。     

Pneumococcemia as the presenting feature of multiple myeloma

Multiple myeloma is associated with a susceptibility to bacterial infections, specifically for encapsulated organisms such as Streptococcus pneumoniae. However, severe bacterial infection as the initial presentation of this disease has been rarely reported. The most common presenting features are anemia, lytic lesions, hypercalcemia, and renal failure. We report two cases of pneumococcal bacteremia as the initial manifestation of an underlying multiple myeloma. The first case is of a 68-year-old woman with pneumococcal pneumonia and bacteremia, presenting with a white blood cell count of 900/microL and mild anemia. Further work-up disclosed monoclonal IgG kappa and 50% plasma cells in bone marrow. Her course was complicated by acute renal failure requiring hemodialysis. The second patient is a 57-year-old man presenting with acute pneumococcal meningitis and bacteremia. Due to prior bacterial epiglottitis, further work-up disclosed IgG lambda monoclonal spike and 40% plasma cells in bone marrow. Both cases responded to antibiotic therapy without complications. These two cases add to the few patients described in the literature with pneumococcemia as the first sign of multiple myeloma. Features that were common in most of these cases, and that should lead to a suspicion of myeloma in an otherwise asymptomatic patient, are S. pneumoniae bacteremia, leukopenia, mild anemia, history of prior bacterial infections, and indirect evidence of a paraproteinemia, such as increased total protein levels with low albumin.     

肺炎支原体肺炎患儿口咽部常见细菌及临床意义北大核心CSCD

目的:了解肺炎支原体肺炎(MPP)患儿口咽部常见细菌及临床意义。方法:回顾性分析。选取中国医科大学附属盛京医院小儿呼吸内科2016年12月至2017年6月住院治疗的134例MPP患儿为研究对象,选取同期同医院42例健康儿童为健康对照组。采用荧光定量聚合酶链反应Taqman探针法检测入组儿童口咽部常见细菌[肺炎链球菌(SP)、卡他莫拉杆菌(CTA)、流感嗜血杆菌(HI)]。首先比较MPP患儿及健康儿童口咽部细菌检出情况,再将134例MPP患儿根据年龄(<1岁、1~<3岁、3~<6岁及6~14岁)、有无细菌检出[肺炎支原体(MP)、MP+细菌]及检出菌种不同(MP+SP、MP+CTA及MP+HI)进行分组比较。采用秩和检验及 χ^(2)检验对相关临床资料进行分析。 结果:134例MPP患儿检出细菌79例(58.96%),42例健康儿童检出细菌17例(40.48%),差异有统计学意义( χ^(2)=4.404, P<0.05)。与MP组相比,MP+细菌组外周血中白细胞(WBC)水平[8.5(6.7,12.0)×10^(9)/L比7.8(5.8,9.3)×10^(9)/L, Z=-2.232]、C反应蛋白(CRP)水平[19.2(7.2,35.0) mg/L比8.4(3.4,24.6) mg/L, Z=-2.810]、乳酸脱氢酶(LDH)水平[286(244,365) U/L比250(210,302) U/L, Z=-2.474]及大叶性肺炎比例[40.51%(32/79例)比18.18%(10/55例), χ^(2)=7.510]、胸腔积液比例[13.92%(11/79例)比3.64%(2/55例), χ^(2)=3.917]、难治性肺炎支原体肺炎(RMPP)比例[34.18%(27/79例)比18.18%(10/55例), χ^(2)=4.151]均较高;总热程[10(7,12) d比8(6,10) d, Z=-2.706]及抗生素使用时间[16(13,19) d比12(9,16) d, Z=-3.747]均较长,差异均有统计学意义(均 P<0.05)。MP+SP组外周血中WBC高于MP+HI组[12.20(7.80,17.30)×10^(9)/L比6.75(5.37,9.44)×10^(9)/L],差异有统计学意义( Z=11.574, P<0.05);MP+SP组[56.67%(17/30例)]大叶性肺炎发生率高于MP+CTA组[0(0/3例)]和MP+HI组[18.75%(3/16例)],差异有统计学意义( χ^(2)=9.770, P<0.05)。 结论:MPP患儿口咽部更易发生细菌定植或感染,当WBC、CRP及LDH均明显升高,影像表现为大片实变影或有胸腔积液时,提示可能混合细菌感染,热程更长,难治性MPP比例增高,且常见的混合细菌为SP。     

呼吸道感染肺炎链球菌分离株的耐药性分析

目的研究呼吸道感染患者肺炎链球菌分离株的耐药情况。方法通过细菌培养获得肺炎链球菌，对获得的肺炎链球菌进行药敏实验。结果呼吸道分离肺炎链球菌中青霉素耐药(PRSP)占39．3％，对头孢哌酮／舒巴坦、头孢克洛、头孢呋辛、头孢噻肟、头孢曲松、环丙沙星、左氧氟沙星、红霉素、克林霉素、复方新诺明、万古霉素、利福霉素的耐药率分别为39．3％，13．8％，36．6％，17．2％，35．9％，16．6％，40．0％，36．6％．51．7％，38．6％，60．0％，0和17．2％。结论吉林省肺炎链球菌对青霉素的耐药率已经处于较高水平，耐青霉素菌株对其他抗生素普遍耐药．已经发现对三代头孢菌素耐药菌株，未发现万古霉素耐药菌株。     

Release of Teichoic and Lipoteichoic Acids from 30 Different Strains of Streptococcus pneumoniae during Exposure to Ceftriaxone, Meropenem, Quinupristin/Dalfopristin, Rifampicin and Trovafloxacin

Summary The release of teichoic acids (TA) and lipoteichoic acids (LTA) from 30 different strains of Streptococcus pneumoniae during exposure to ceftriaxone, meropenem, quinupristin/dalfopristin, rifampicin and trovafloxacin at concentrations of 10 μg/ml and of the respective MIC was determined by an enzyme immunoassay. At 10 μg/ml the most rapid and intense release was detected during treatment with the β-lactam antibiotics ceftriaxone and meropenem, the lowest release was seen with rifampicin and quinupristin/dalfopristin. Trovafloxacin delayed the release of TA/LTA. The maximum concentrations of TA/LTA, however, during trovafloxacin treatment were almost as high as those during exposure to ceftriaxone and meropenem. During exposure to the MIC, ceftriaxone, meropenem, rifampicin and trovafloxacin released significantly higher amounts of TA/LTA than during exposure to 10 μg/ml (p < 0.01). Only quinupristin/dalfopristin released small amounts of TA/LTA at the low and high concentration. In conclusion, at high concentrations antibiotics that do not affect the bacterial cell wall released less pro-inflammatory compounds from S. pneumoniae than ceftriaxone and meropenem. This may be of value in the treatment of meningitis and sepsis. Received: May 18, 1999 · Revision accepted: December 8, 1999     

Streptococcus pasteurianus septicemia

Streptococcus pasteurianus is part of the normal flora of the intestine. It has also been isolated from various infection sites. However, to date it has not been reported as a cause of fulminant septicemia and death. We report the post-mortem findings in a splenectomized hemophiliac patient with cirrhosis and concurrent human immunodeficiency virus (HIV), hepatitis B and hepatitis C infections.