重症联合免疫缺陷病15例

目的分析单中心临床诊断的重症联合免疫缺陷病(SCID)15例的临床特点,提高临床儿科医师的警惕性。方法2000年1月-2007年4月根据临床表现,2岁以内静脉血CD3 T细胞<20%,绝对淋巴细胞计数<3×109 L-1,诊断为SCID15例,分析其临床特点,总结规律。采用描述性统计学分析方法进行统计学处理。结果本组男12例,女3例。平均发病年龄4.4个月,平均诊断年龄6.2个月。主要症状为发热15例,咳嗽12例,口腔黏膜白斑、皮疹、腹泻各3例,淋巴结大1例。主要诊断为重症肺炎12例,败血症7例,口腔念珠菌、肝脾脓肿各4例,腹泻3例,营养不良及发育落后2例,脓毒血症1例。血培养主要以革兰阳性菌、真菌为主,痰培养除常见呼吸道病原如金黄色葡萄球菌、肺炎克雷伯菌外,还包括真菌、大肠埃希菌、嗜麦芽寡养单胞菌等机会菌,未发现胞内菌和寄生虫。体格检查发现15例中8例有皮疹。15例中7例血IgG>2g/L,余8例IgG<2g/L。结论小于6个月患儿,出现长期发热、呼吸系统感染和败血症表现并有生长发育落后、腹泻、口腔念珠菌等情况,应考虑到SCID的可能,机会性病原感染更有提示意义,尤其有皮疹表现者,血IgG无明显降低不能除外SCID。     

Pathogenomics: An updated European Research Agenda

The emerging genomic technologies and bioinformatics provide novel opportunities for studying life-threatening human pathogens and to develop new applications for the improvement of human and animal health and the prevention, treatment, and diagnosis of infections. Based on the ecology and population biology of pathogens and related organisms and their connection to epidemiology, more accurate typing technologies and approaches will lead to better means of disease control. The analysis of the genome plasticity and gene pools of pathogenic bacteria including antigenic diversity and antigenic variation results in more effective vaccines and vaccine implementation programs. The study of newly identified and uncultivated microorganisms enables the identification of new threats. The scrutiny of the metabolism of the pathogen in the host allows the identification of new targets for anti-infectives and therapeutic approaches. The development of modulators of host responses and mediators of host damage will be facilitated by the research on interactions of microbes and hosts, including mechanisms of host damage, acute and chronic relationships as well as commensalisms. The study of multiple pathogenic and non-pathogenic microbes interacting in the host will improve the management of multiple infections and will allow probiotic and prebiotic interventions. Needless to iterate, the application of the results of improved prevention and treatment of infections into clinical tests will have a positive impact on the management of human and animal disease.The Pathogenomics Research Agenda draws on discussions with experts of the Network of Excellence “EuroPathoGenomics” at the management board meeting of the project held during 18–21 April 2007, in the Villa Vigoni, Menaggio, Italy. Based on a proposed European Research Agenda in the field of pathogenomics by the ERA-NET PathoGenoMics the meeting's participants updated the established list of topics as the research agenda for the future.     

服务行业从业人员肠道致病菌检测结果分析

目的:了解和分析三门县2004~2007年26318份饮食和公共场所从业人员肠道致病菌携带情况及菌型分布。方法:对从业人员粪便及肛拭标本进行肠道菌增菌、分离、生化及血清分型鉴定。结果:合计检测标本26318份,共检出阳性菌72株,总检出率0.27%;其中沙门菌69株,检出率0.26%;志贺菌2株,检出率0.008%;霍乱弧菌1株,检出率0.004%。69株沙门菌经生化和血清学鉴定分为9个血清群12个血清型,另有5株菌型未定,其中B群德尔卑沙门菌共检出37株,占沙门菌检出率53.6%,排在第一位;其次为D3群吉韦沙门菌检出6株,占沙门菌检出率8.7%;第三位的E1群纽兰沙门菌检出5株,占沙门菌检出率7.3%。结论:三门县饮食和公共场所从业人员沙门菌检出率最高,应加强健康体检,及时调离沙门氏菌带菌者。     

The French antibiotic resistance monitoring programs

Surveillance of antimicrobial resistance in bacteria from animal origin in France is organised by the French Agency for Food Safety (Agence Française de Sécurité Sanitaire des Aliments, AFSSA) through two types of networks. The first collects non-human zoonotic Salmonella strains in one centre (AFSSA, Paris) where they are tested for their antimicrobial susceptibility. The others, managed by AFSSA Lyon, deal with bovine pathogenic strains and are multicentric, that is they collecting antibiotic sensitivity and other data from the local public veterinary diagnostic laboratories. This requires standardisation of the methods used in each partner laboratory. Statistical analysis of any change in French resistance patterns can be monitored by these three networks either as a function of strain pathogenicity and/or of the ecological origin of the isolate. The system also encourages efficient collaboration between veterinarians and the laboratory. Such collaboration improves both the quality of routine antibiotic testing and understanding of the molecular mechanisms underlying resistance.     

Prevalence of intestinal pathogens in HIV patients with diarrhea: Implications for treatment

Patients infected with the human immunodeficiency virus (HIV) commonly exprience diarrhea at some time during their illness. A variety of enteric pathogens are identified in 50–80% of these patients, depending on the intensity of the diagnostic work-up that is done. In addition to the common enteric pathogens, several unusual enteric pathogens are recognized to cause diarrhea especially in HIV patients. These include protozoan parasites such asCryptosporidia, lsospora belli, Cyclospora cayatenensis andMicrosporidium species bacteria such as enteropathogenicEscherichia coli andMycobacterium avium-intracellulare, fungi includingCandida albicans andHistoplasma capsulatum, and viruses such as astroviruses and caliciviruses. Dlagnosis of these infections sometimes involves special procedures not readily available every where, and empiric therapy based on knowledge of the likely pathogens has been advocated for developing countries. This article reviews the currently available data on geographic variation of enteric pathogens in HIV patients with diarrhea and outlines a rational strategy for empiric therapy of these patients.     

Rapid identification of emerging pathogens: coronavirus

We describe a new approach for infectious disease surveillance that facilitates rapid identification of known and emerging pathogens. The process uses broad-range polymerase chain reaction (PCR) to amplify nucleic acid targets from large groupings of organisms, electrospray ionization mass spectrometry for accurate mass measurements of PCR products, and base composition signature analysis to identify organisms in a sample. We demonstrate this principle by using 14 isolates of 9 diverse Coronavirus spp., including the severe acute respiratory syndrome-associated coronavirus (SARS-CoV). We show that this method could identify and distinguish between SARS and other known CoV, including the human CoV 229E and OC43, individually and in a mixture of all 3 human viruses. The sensitivity of detection, measured by using titered SARS-CoV spiked into human serum, was approximate, equals1 PFU/mL. This approach, applicable to the surveillance of bacterial, viral, fungal, or protozoal pathogens, is capable of automated analysis of >900 PCR reactions per day.     

Heavy-metal and microbial depuration of the clam Ruditapes decussatus and its effect on bivalve behavior and physiology

The bivalve Ruditapes decussatus was evaluated as a possible biomonitor of heavy-metal contamination. Concentrations of copper (Cu), cobalt (Co), iron (Fe), nickel (Ni), and manganese (Mn) were measured in R. decussatus. Water and sediment samples were collected at two stations of Timsah Lake in Ismailia, Egypt, from October to November 2002, using atomic absorption spectrophotometry (AAS). Results from the heavy-metal and microbial analyses indicated that site II was less contaminated than site I. The bivalve showed accumulation of metals, with a bioaccumulation factor (BAF) greater than 4. The bioaccumulation of metals varied strongly according to the sampling site. After 48 h of depuration, Fe, Ni, Co, Cu, and Mn were reduced significantly, to 46.8% and 47.7%, 19.9% and 20.3%, 27.3% and 27.9%, 35.9% and 36.6%, and 18.2% and 26.6%, compared with the initial concentrations, in clam tissue at the two stations. In bivalves from site II the counts of total bacteria, fecal coliforms, and bacterial pathogens were reduced by more than 90%, whereas phage counts were only reduced by 56% after 4 days of depuration. The depuration of bivalves collected from the heavily polluted site (I) was not effective, as coliforms were reduced only by 85% after 4 days, whereas counts of pathogens and pathogenic indicators such as Vibrio, fecal Streptococcus, and coliphage decreased to less than 50% of the initial concentration. The time necessary to decrease contamination to 10%, 50%, and 90% for clams at both stations was consistently shorter for heavy metals than for microorganisms. Investigation of the effects of heavy-metal and microbiological depuration on valve movement and physiological rates (oxygen consumption and ammonia excretion) was carried out on R. decussatus to test the utility of physiological stress indices in assessing the health of depurated animals. Clams in the experimental tanks exhibited various states of activity, which were rated by identifying and scoring (0-4) the different parameters, including shell gap, siphon extension, and foot protrusion. Moreover, an increase in ammonia excretion was usually associated with an increase in respiration rate. The oxygen-to-nitrogen ratio provided a sensitive indicator of bivalve health. It can be concluded that shellfish monitoring and depuration data depended on the initial concentration of the pollutants. There were differences in the physiological responses of clams from the two sites during the periods of pre- and postdepuration of the contaminants. There was a significant correlation between reduction of metal concentration in clam tissue and enhancement of valve movement, as well as activity and increasing respiration rate.     

Blood and body fluid exposure risks among health care workers: results from the Duke Health and Safety Surveillance System

BACKGROUND: Health care workers (HCWs) are at risk of exposures to human blood and body fluids (BBF). Needlestick injuries and splashes place HCWs at risk for numerous blood-borne infections including human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV). Utilizing a new comprehensive occupational health surveillance system, the objective of this research was to better define the BBF exposure risk and risk factors among employees of a large tertiary medical center. METHODS: A population of 24,425 HCWs employed in jobs with potential BBF exposures was followed for BBF exposure events from 1998 to 2002. BBF exposure rates were calculated for strata defined by age, race, gender, occupation, work location, and duration of employment. Poisson regression was used for detailed analyses of risk factors for BBF exposure. RESULTS: The study population reported 2,730 BBF exposures during the study period, resulting in an overall annual rate of 5.5 events/100 FTEs and a rate of 3.9 for percutaneous exposures. Higher rates were observed for males, persons employed less than 4 years, Hispanic employees, and persons less than 45 years of age. Much higher rates were observed for house staff, nurse anesthetists, inpatient nurses, phlebotomists, and surgical/operating room technicians. Poisson regression results strengthened and extended results from stratified analyses. Rates of percutaneous exposures from hollow needles were found to decrease over the study period; however, exposure rates from suture needles appear to be increasing. CONCLUSION: While continued training efforts need to be directed toward new HCWs, our data also suggest that employees who have been in their job 1-4 years continue to be at higher risk of BBF exposures. This research also points to the need for better safety devices/products and work practices to reduce suture-related injuries.