猪链球菌2型感染的临床特征和治疗效果分析

目的 分析猪链球菌2型感染部分病例的临床特征及治疗效果.方法 回顾分析68例2005年夏季四川省猪链球菌2型感染的临床及病原学确诊的患者资料,从流行病学、临床特征及治疗效果等方面进行总结和分析.结果 猪链球菌2型感染流行于6～8月,传染源主要为猪,易感人群主要为农民,常见的暴露方式为宰杀、洗切病/死猪肉.临床表现为急起畏寒、发热、头昏、头痛、全身不适及疼痛,重者出现休克及昏迷.临床类型主要有单纯败血症型、休克型、脑膜炎型及混合型4型.所分离的猪链球菌2型均对四环素耐药,对其它多种抗菌药物均敏感.本组68例患者治疗后总有效率为76.5%(52/68),病死率为23.5%(16/68).有休克的患者治疗后有效率为42.3%(11/26),病死率为57.7%(15/26).化脓性脑膜炎患者治疗的有效率为97.5%(39/40).结论 猪链球菌2型感染的主要临床表现为化脓性脑膜炎和休克.治疗效果以脑膜炎型为好,休克型及混合型差,病死率高.

Clinical Features and Outcome of Infection of Type 2 Streptococcus suis in Human

OBJECTIVE: To analysis the clinical features and efficacy of treatment for patients with type 2 Streptococcus suis (S. suis 2) infection, and to inform better diagnosis and treatment of S. suis 2. METHODS: Clinical data of 68 patients with S. suis 2 infection were retrieved retrospectively. The diagnoses were confirmed by clinical symtom or/and isolation of S. suis 2 from the infected sites in Shichuan province in the summer of 2005. The patients ranged from general type (simple sepsis) to septic shock type; meningitis type and mixed type. RESULTS: The outbreak of S. suis 2 infection occurred in June to August in 2005. The common source of infection came from pigs. The people in great risks were farmers who exposed to sick or dead pigs with S. suis 2 infection. Most infection occurred on the people who slaughtered infected pigs, followed by those who dressed infected meats. The prominent symptoms included fever with sharp chills, dizziness, headache, malaise and myalgia. Some patients had abdominal pain and diarrhea. Septic shock and coma often occurred in severe cases. According to the clinical manifestations, patients were categorized into four different clinical types: general type, septic shock type, meningitis type, and mixed type. S. suis 2 isolated from the patients were susceptible to most antimicrobial agents, except for tetracycline. All of the patients were treated with beta-lactam antibiotics (penicillins or cephalosporins). Some were given combined antimicrobial agents. Seventy seven percent (52/68) of patients survived. All of the general patients recovered completely. Fifty eight percent (15/26) of patients with septic shock died. The artificial ventilation and persistent blood filtering treatment played an important role for treating patients with septic shock. Although most patients with meningitis (97.5%) survived, a decrease in hearing or even hearing loss occurred to some of the survivors. CONCLUSION: Purulent meningitis and septic shock are the major clinical manifestations for S. suis 2 infection in human. The treatment for patients with meningitis is more effective than that for patients with septic shock.