上海市闵行区首例人感染猪链球菌2型病例流行病及病原学调查

目的调查分析上海市闵行区1例猪链球菌2型感染病例的流行病学和病原学特征,为上海地区少见和输入性人畜共患急性传染病疫情预警和防控措施制定提供依据。方法通过询问患者病史、流行病学史以及现场环境调查,查找感染来源与感染途径,并对脑脊液进行病原培养分离猪链球菌、对分离的菌株进行Vitek2GP鉴定、PCR技术检测种属特异性基因、毒力基因。结果患者临床表现为高热伴头痛、恶心、呕吐、颈部僵直,血液检测显示C-反应蛋白显著增高、淋巴细胞百分比增高,血小板计数呈下降趋势,头部CT检查显示双侧筛窦、双侧上颌窦炎症,脑脊液白细胞计数、免疫球蛋白明显升高。患者分离株种属特异性16SrRNA基因、毒力因子cps-2J和ef均呈阳性。结论该病例为人感染猪链球菌2型脑膜炎病例;预后良好无后遗症与其及时的诊断治疗以及含毒力因子种类有关;医疗机构应尽早识别早期感染病例,明确诊断,及时治疗,避免发生重症和死亡病例;农业、卫生、市场管理等部门应完善动物疫情通报,建立主动哨点监测。

Epidemiological and pathogenic investigation on the first case of human Streptococcus suis type 2infection in Minhang District,Shanghai

Objective To investigate and analyze the epidemiological and pathogenic characteristics on a case of human Streptococcus suis type 2 infection in Minhang District,Shanghai,and to provide evidence for early warning and prevention and control measures of rare and imported zoonotic acute infectious diseases in Shanghai.Methods By inquiring the patient medical history and epidemiological history and on-site environmental investigation,the infection route and source of the case were examined.The pathogenic culture of cerebrospinal fluid(CSF)was used to isolate Streptococcus suis,and Vitek2GP was used to identify the isolated strains.The PCR technique was used to detect species specific genes and virulence genes.Results The clinical manifestations of the patient were high fever with headache,nausea,vomiting and stiff neck.Blood tests showed a significant increase in c-reactive protein,an increase in lymphocyte percentage,and a decrease in platelet count.Head CT examination showed bilateral ethmoidal sinus and bilateral maxillary sinus inflammation,and significantly increased CSF white blood cell count and immunoglobulin.The case′s CSF sample was positive for species specific genes(16SrRNA)and 2 virulence genes(cps-2j and ef).Conclusion This case was human Streptococcus suis type 2 with meningitis symptoms.Good prognosis was associated with timely diagnosis and treatment as well as the types of virulence factors.Medical institutions should identify early infection and take timely treatment as soon as possible to avoid severe illness and death cases.Departments of agriculture,health,market management,and others should consummate the reporting mechanism of animal epidemic situation,and establish necessary active sentinel monitoring.