炭疽芽胞杆菌的感染与生物恐怖

综述了炭疽生物恐怖、炭疽在中国的流行概况、实验室诊断方法的最新进展。同时介绍了炭疽的预防与控制，提出了应对可能发生的生物恐怖应采取的措施。     

High Case-Fatality Rate for Human Anthrax,Northern Ghana, 2005–2016

The human cutaneous anthrax case-fatality rate is ≈1% when treated, 5%–20% when untreated. We report high case-fatality rates (median 35.0%; 95% CI 21.1%–66.7%) during 2005–2016 linked to livestock handling in northern Ghana, where veterinary resources are limited. Livestock vaccination and access to human treatment should be evaluated.     

2019-2020年宁夏炭疽芽胞杆菌毒力鉴定及基因分型研究

目的 了解宁夏2019-2020年分离的炭疽芽胞杆菌菌株致病力及基因分型特征,为宁夏皮肤炭疽疫情判定与分子溯源提供实验室依据。方法 收集2019-2020年宁夏各地区分离的炭疽芽胞杆菌,对其进行毒力鉴定,并运用MLVA-15和canSNP分型技术进行基因分型研究。结果 2019-2020年宁夏分离到的炭疽芽胞杆菌均为强毒株,MLVA-15分型为同一种群,canSNP分型为A.Br.001/002组。结论 2019-2020年宁夏分离到的炭疽芽胞杆菌致病力较强,且菌株呈现相同的基因分型特征,提示菌株间存在流行病学关联。此研究结果填补了宁夏炭疽芽胞杆菌实验室检测中菌株致病力及基因分型的空白。     

The IL‐23/Th17 axis is involved in the adaptive immune response to Bacillus anthracis in humans

The neutralization of toxins is considered essential for protection against lethal infection with Bacillus anthracis (BA), a select agent and bioterrorism threat. However, toxin‐neutralizing activity alone would not be expected to provide sterile immunity. Therefore, we hypothesized that the development of an adaptive immune response against BA is required for bacterial clearance. We found that human monocyte‐derived dendritic cells (hDCs) kill germinated BA bacilli, but not nongerminated BA spores. hDCs produce IL‐1β, IL‐6, IL‐12, and IL‐23, and these cytokines are differentially regulated by germination‐proficient versus germination‐deficient BA spores. Moreover, the IL‐23 response to BA spores is regulated by IL‐1R‐mediated signaling. hDCs infected with germinating BA spores stimulated autologous CD4⁺ T cells to secrete IL‐17A and IFN‐γ in a contact‐dependent and antigen‐specific manner. The T‐cell response to BA spores was not recapitulated by hDCs infected with germination‐deficient BA spores, implying that the germination of spores into replicating bacilli triggers the proinflammatory cytokine response in hDCs. Our results provide primary evidence that hDCs can generate a BA‐specific Th17 response, and help elucidate the mechanisms involved. These novel findings suggest that the IL‐23/Th17 axis is involved in the immune response to anthrax in humans.     

Special Considerations for Prophylaxis for and Treatment of Anthrax in Pregnant and Postpartum Women

In August 2012, the Centers for Disease Control and Prevention, in partnership with the Association of Maternal and Child Health Programs, convened a meeting of national subject matter experts to review key clinical elements of anthrax prevention and treatment for pregnant, postpartum, and lactating (P/PP/L) women. National experts in infectious disease, obstetrics, maternal fetal medicine, neonatology, pediatrics, and pharmacy attended the meeting, as did representatives from professional organizations and national, federal, state, and local agencies. The meeting addressed general principles of prevention and treatment for P/PP/L women, vaccines, antimicrobial prophylaxis and treatment, clinical considerations and critical care issues, antitoxin, delivery concerns, infection control measures, and communication. The purpose of this meeting summary is to provide updated clinical information to health care providers and public health professionals caring for P/PP/L women in the setting of a bioterrorist event involving anthrax.     

一种快速定量检测炭疽杆菌方法的建立

目的：建立一种快速、准确、特异定量检测炭疽杆菌的方法。方法：根据复合探针荧光定量分析原理，以炭疽杆菌染色体rpoB基因为靶序列，设计合成引物和探针，对炭疽杆菌进行实时定量聚合酶链反应（PCR）检测，并探讨荧光探针与淬灭探针用量及比例、镁子浓度、淬灭探针长度对定量结果的影响。结果：本法最适条件：荧光探针浓度300mmol/L、荧光探针与淬灭探针的比例为1／2，镁离子浓度为3mmol/L，淬灭探针长15个核苷酸，该法检测炭疽杆菌的灵敏度达10^3拷贝，能特异区分炭疽杆菌与其他蜡样杆菌。结论：复合探针荧光定量PCR技术能够快速准确、特异、敏感地对炭疽杆菌进行定量分析，可为临床诊断提供帮助。     

芽孢杆菌外毒素保护性抗原与上游强启动子穿梭载体的构建

目的 构建携带炭疽芽孢杆菌保护性抗原（PA）的两种穿梭载体与上游强启动子。方法 将解淀粉芽孢杆菌的α-淀粉酶启动子克隆到载体pblueseript—sk（＋）上，构建载体pBLKSP；以A16R疫苗株（Tox＋，Cap-，弱毒株）DNA为模板，设计合成内外侧引物巢式PCR扩增获得保护性抗原（PA）的全基因，先克隆到载体pBLKSP，再将其和质粒PUB110重组构建成两种穿梭载体。结果 酶切鉴定显示所切下的片段大小均与预计相符。测序结果与文献报道序列及预计结果一致。结论 成功构建了带有强启动子的两种穿梭载体。为在无毒炭疽疫苗株中的高效表达和炭疽芽孢杆菌的分子疫苗研究奠定了基础。     

炭疽杆菌保护性抗原基因探针构建

首次在国内构建了炭疽杆菌ｐＸＯ１质粒基因文库，经ＰＣＲ方法和酶切分析筛选出保护性抗原基因重组子，同位素标记保护性抗原基因片段而制成探针．摸索出一种炭疽杆菌原位杂交膜处理法、杂交结果表明，探针特异性强、重复性好，可弥补常规检测法之不足。     

An overview of adverse events reported by participants in CDC's anthrax vaccine and antimicrobial availability program

PURPOSE: The CDC's Anthrax Vaccine and Antibiotic Availability Program was implemented under an Investigational New Drug (IND) application to provide additional post-exposure prophylaxis for individuals potentially exposed to Bacillus anthracis in the fall of 2001. Participants were provided with two options: (1) 40 additional days of antimicrobial prophylaxis (i.e., ciprofloxacin, doxycycline, or amoxicillin); or (2) 40 additional days of antimicrobial prophylaxis plus three doses of anthrax vaccine adsorbed (AVA). METHODS: Participants were monitored for adverse events (AEs). Participants were asked to complete 2-week AE diaries for 6 weeks post-enrollment, and approximately 2 months after enrollment, active surveillance was conducted through telephone interviews with 1113 (64%) participants. RESULTS: A total of 1727 of approximately 10 000 previously prophylaxed persons enrolled to receive 40 additional days of antibiotics. Of these, 199 opted at enrollment to receive three doses of AVA in addition to the additional 40 days of antibiotic. Overall, 28% of participants reported at least one AE on their diaries. Results varied by surveillance mechanism, the diary data indicated differences in the proportion reporting AEs between participants receiving antibiotic only and participants receiving antibiotic and AVA. However, during the active 2-month telephone follow-up, the rates of AEs reported for both the antibiotic only and antibiotic plus AVA treatment regimens were similar. Additionally, ciprofloxacin and doxycycline had similar AE profiles, with only rigors reported significantly more often among ciprofloxacin recipients. CONCLUSIONS: Overall, the rates of AEs experienced by all participants were acceptable given the seriousness of potential B. anthracis exposure.