PCR-SSCP法检测结核分枝杆菌耐药性

目的：探讨耐多药结核分枝杆菌耐药基因突变与耐药性的关系以及聚合酶链反应-单链构象多态性分析(poly merase chain reaction-single strand cinfomlation polymorphism，PCR-SSCP)方法的临床应用价值。方法：用PCR-SSCP方法检测58株结核分枝杆菌临床分离株katG，rpoB，rpsL基因突变并与常规药敏试验检测结果进行对比。结果：经常规药敏试验检测，58株结核分枝杆菌临床分离株中共有41株耐药，其中，耐异烟肼(INH)为35株，高耐药株27株；耐利福平(RFP)为31株，高耐药株24株；耐链霉素(SM)有31株，高耐药株26株。同时耐3种药物的有21株(51．2％)，耐2种药物的14株(34．1％)，单耐药株6株(14．6％)．PCR-SSCP方法对58株临床分离株katG，rpoB，rpsL基因突变的检测率为40％(23／58)，45％(26／58)，38％(22／58)，其中检出3个基因同时突变的有13株(32％)，2种基因突变的12株(29％)，1种基因突变的有10株(23．8％)．常规药敏试验与PCR-SSCP法检出结核分枝杆菌同时耐3种药物的符合率为61．9％(13／21)，检出耐2种药物的符合率为85．70k，(12／14)，检出耐1种药物的符合率为50％(3／6)．高耐药株中突变率为80．5％(62／77)，低耐药株中突变率为60％(12／20)．结论：PCR-SS-CP方法对耐2种以上药物的结核杆菌检出率较高，且耐药基因突变率随着耐药浓度增高而增高。将PCR-SSCP法与药敏试验联合应用可互相弥补，已成为临床指导用药的好方法。     

Professor Ahmed Shafik (1933–2007)

Most cases of anal abscess are caused by anal fistula and invasion of the surrounding tissues by a mixed colonic flora. Treatment consists of excision of the abscess and, in case of fistula, fistulectomy. Primary anorectal and perianal forms of actinomycosis are very rare and caused by actinomyces, as ubiquitous anaerobics bacterium. We report a case of perianal actinomycosis. The patient had a short history of painless perineal induration without fever and leukocytosis with normal results at routine blood examination. After excision, sulfur granules drained from the cavity and pathological investigations indicated perianal actinomycosis. Appropriate surgery and antibiotic treatment healed the perianal infection. After exclusion of possible diagnoses such as Crohn’s disease, tuberculosis and malignant growths, the rare case of perianal actinomycosis should be considered in the differential diagnosis of painless perianal masses.     

结核分枝杆菌Rv1009基因蛋白的克隆和表达

目的 克隆表达结核分枝杆菌促Rv1009基因,序列测定正确后进行融合、表达.方法 采用热启动聚合酶链反应（Polymerase Chain Reaction,PCR）从结核分枝杆菌H37Rv基因组中扩增出Rv1009编码基因,用限制性内切酶消化后插入pGEX 4T-2载体中,将重组质粒转化大肠杆菌BL21（DE3）,目的基因经IPTG诱导,表达Rv1009基因蛋白.结果 经PCR扩增在1300bp处发现一条目的片段,获得了结核分枝杆菌H37Rv株Rv1009基因蛋白,经诱导后高效表达分子量为64KD的外源蛋白,与预期分子量大小一致,凝胶自动扫描分析,在A600值为0.6,IPTG终浓度为0.3 mmol/L,诱导表达3 h时融合蛋白表达量即达峰值,占菌体总蛋白的22.8%.结论 构建了结核分枝杆菌Rv1009基因重组表达载体,获得了RPF样融合蛋白的高效表达,为今后深入研究奠定了基础.     

牙源性脓肿标本中的产黑色素类杆菌群菌株分离鉴定

本文对４４例牙源性脓肿（尖周脓肿２４例，牙周脓肿１２例，冠周脓肿８例）脓液标本中的产黑色素类杆菌群菌株进行分离、培养、鉴定。其中３８例存在产黑菌群，以中间型类杆菌阳性率最高。牙龈类杆菌在牙周脓肿中检出率最高。２４例尖周脓肿可分离出６株牙髓类杆菌而其它两种牙源性脓肿则无牙髓类杆菌，推测该菌与牙髓尖周感染的病理过程有关。     

HBV、TB合并感染时抗TB治疗对肝功能的影响

目的:探讨乙型肝炎病毒(HBV)、结核(TB)杆菌合并感染时抗TB药物所致肝损伤的临床及组织学特点。方法:单纯TB感染者45例,TB合并HBV感染者35例,前4月均服用异烟肼、利福平、吡嗪酰胺、乙胺丁醇,后2月服用异烟肼、利福平。每2～4周复查肝功能、HBV标记物、T细胞亚群等指标,部分患者进行了肝穿刺病理检查。结果:TB HBV组肝功能异常发生率为34.3%,较单纯TB组高,发生时间较单纯TB组早半月,发生平均年龄小8岁;谷丙转氨酶水平、肝组织学炎症积分均较TB组高(P<0.05);肝功能异常者中80%为HBeAb阳性,T细胞免疫功能紊乱较重,CD4 细胞明显减少(P<0.05)。结论:HBV、TB合并感染时,抗TB药物的肝毒性增强,治疗过程中应及时复查肝功能。     

脑脓肿的诊断及治疗

目的：进一步探讨脑脓肿发病情况，影像学表现，选择最佳治疗方法，提高治疗效果。方法：回顾分析１４７裂离脓肿的发病，病因，影像学表现，治疗方法及死亡率下降因素，结果：脑脓肿发病年龄较年青，血源性及隐源性脑脓肿发病率升高，ＣＴ结合ＭＲＩ可明确诊断，选择最佳手术方法。ＣＴ应用后死亡率由２３．８％下降到７．５％，结论：ＣＴ为脑脓肿最主要的诊断方法，ＣＴ定位下穿刺排脓可治愈大部分脑脓肿。     

Epidural abscess following epidural steroid and local anaesthetic injection

Epidural abscess is a well-recognised but rare complication of epidural catheter placement. We have found only five previous reports of epidural abscess from noncatheter-related administration of steroids and/or local anaesthetic. We describe a further case which led to critical illness and emphasise the association between diabetes mellitus and epidural infection.     

Giant infectious intracavernous carotid artery aneurysm presenting as intractable epistaxis

Infectious intracavernous carotid artery aneurysms usually present with ophthalmoplegia and/or signs of cavernous sinus thrombosis. We report an unusual case in which a patient with AIDS presented with intractable epistaxis secondary to rupture of a giant infectious intra-cavernous carotid artery aneurysm. Culture of the aneurysm grew mycobacterium avium intracellulare (MAI). The patient was treated successfully by excision of the aneurysm and reconstruction of the internal carotid artery with a saphenous vein interposition graft.