汉中市中心医院细菌性痢疾志贺菌16S rRNA序列分析、毒力基因与耐药检测

目的对汉中市中心医院细菌性痢疾患者分离的70株志贺菌进行16S rRNA序列分析、毒力基因与耐药检测。方法对2018年6月至2018年12月我院收治的细菌性痢疾患者进行病原菌分离鉴定,并进行16S rRNA遗传进化分析;PCR法检测其6种毒力基因;K-B法检测其对8种抗生素的敏感性。结果 16S rRNA测序结果显示,福氏志贺菌感染率为57.14%(40/70),宋内志贺菌感染率为42.86%(30/70)。16S rRNA系统进化分析结果显示,40株福氏志贺菌与参考菌株(NR_026331.1)同源性为95.2%～99.0%,30株宋内志贺菌与参考菌株(NR_104826.1)同源性为96.3%～99.9%。毒力基因检测结果表明,70株志贺菌均可以检测出6个相关毒力基因set1A、set1B、sen、Ial、ipaH、virA,毒力基因检出率最高的为ipaH,达到100.00%,其次为Ial、virA,均达到90.00%;其中福氏志贺菌set1A、set1B、Ial基因的检出率高于宋内志贺菌,sen和virA基因的检出率低于宋内志贺菌,二者ipaH基因的检出率都为100.00%。药敏试验结果表明,70株志贺菌耐药率最高的抗生素为氨苄西林,耐药率达到80.00%,其次为强力霉素,耐药率达到75.71%,耐药率最低的为头孢吡肟,耐药率为20.00%;其中40株福氏志贺菌耐药率最高的抗生素为强力霉素,其次为氨苄西林,最低的为头孢吡肟;30株宋内志贺菌耐药率最高的抗生素为氨苄西林,其次为哌拉西林,最低的为氧氟沙星。结论 2018年下半年汉中市中心医院从细菌性痢疾患者身上分离得到的志贺菌主要为福氏志贺菌与宋内志贺菌,毒力基因检测和耐药性试验结果显示分离菌株有较强致病性,提示对细菌性痢疾的监测、防控与治疗应进一步加强。     

小儿细菌性痢疾临床特点及病原学分析

目的 了解蚌埠医学院第一附属医院近3年小儿急性细菌性痢疾的临床特点、致病菌群分布以及耐药情况.为临床合理使用抗生素提供依据.方法 对2010年1月至2012年12月收住该院儿科的44例急性细菌性痢疾患儿为研究对象,对患儿的一般资料、症状、血常规、生化常规以及病原菌的分型以及耐药性情况的临床特点及药敏结果进行回顾性分析.结果 小儿细菌性痢疾多流行于5～11月,以1～6岁患儿高发.病例多以普通型为主,偶有中毒型.脓血便已不是细菌性痢疾的典型表现.血液学检测白细胞增高,中性粒细胞,C反应蛋白明显增高.福氏志贺菌是主要流行菌群.志贺菌属对头孢唑啉、氨苄青霉素几乎全部耐药,对喹诺酮类以及氨基糖苷类以及头孢曲松的耐药率也较高,对哌拉西林他唑巴坦、头孢派酮舒巴坦则全部敏感.结论 小儿细菌性痢疾临床表现亦趋于不典型和多样化,尽早做大便培养以明确.在治疗上应当首选含有β-内酰胺酶抑制剂的复方制剂.     

2019年肇庆市不同来源金黄色葡萄球菌分离株分子流行与耐药特征研究

目的了解2019年肇庆市不同来源金黄色葡萄球菌(Staphylococcus aureus,本文简称金葡菌)分子流行特征和耐药谱构成情况。方法对2019年分离自食品样、医院环境涂抹样和患者样中的117株金葡菌进行肠毒素基因聚合酶链式反应(polymerase chain reaction, PCR)检测、抗生素敏感性试验及多位点序列分型(multilocus sequence typing, MLST),并对优势序列型(sequence type,ST)菌株进行脉冲场凝胶电泳(pulsed field gel electrophoresis,PFGE)分析。结果 117株金葡菌中sea、seb毒力基因在不同来源的菌株间的携带情况存在差异,pvl毒力基因在不同耐药表型的菌株间携带情况也存在差异;肇庆市金葡菌耐药表型分为耐甲氧西林金葡菌(methicillin-resistant Staphylococcus aureus, MRSA)株和甲氧西林敏感金葡菌(methicillin sensitive staphylococcus aureus, MSSA)株,MRSA株有4个优势耐药谱型,MSSA株则有3个优势耐药谱型。MSRA株耐药表型以多重耐药的MRSA株为主,且耐药情况严重;MLST分型、PFGE和ST型遗传进化分析显示,117株金葡菌可分为50个ST型,其中优势ST型有4个,分别为ST239、ST1891、ST3191和ST7,以患者分离株为主。4个优势ST型菌群间亲缘聚类距离较远,除ST7型菌群外,其他3个ST型菌株群中,不同来源的金葡菌间存在一定的亲缘关系。50个ST型可分为2个进化分支,其中有43个ST型在进化分支1上,7个ST型在进化分支2上,进化分支1与进化分支2间的菌株进化差异较大。结论肇庆市金葡菌毒力基因sea、seb在不同来源的菌株间携带情况存在差异,毒力基因pvl在不同耐药表型的菌株间携带情况也存在差异;耐药表型以多重耐药的MRSA株为主;肇庆市金葡菌流行4个优势ST型。不同来源间金葡菌存在相互散播的风险。肇庆市菌株主要位于进化分支1;防控部门应对不同来源和不同耐药表型的金葡菌制定相应的分级防控方案,并警惕不同来源的金葡菌相互散播的风险,防止高毒力强耐药的菌株引起本地区流行。同时注意ST1981型菌株,警惕该型菌株引起食源性疾病和院内感染的风险。     

分离自腹泻成人志贺菌的血清分群及耐药性分析

目的 调查志贺菌在成人腹泻患者中的主要血清群和耐药性,为临床治疗和预防提供依据.方法 对2008年1月至2012年10月浙江萧山医院临床分离自腹泻成人志贺菌菌株,进行生化鉴定、血清学分群和抗生素敏感性试验,所有数据用WHONET 5.6软件进行回顾性分析.结果 共检出125株志贺菌,其中66(52.8％)株为宋内志贺菌,58(46.4％)株为福氏志贺菌;氨苄西林耐药率最高达95.9％,复方新诺明耐药率达79.8％,头孢噻肟为48.6％,未检出头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南和美罗培南耐药株,福氏志贺菌对环丙沙星和左旋氧氟沙星耐药率为87.0％和57.1％,而宋内志贺菌未检出氟喹诺酮类耐药株;福氏志贺菌和宋内志贺菌耐药率在哌拉西林、头孢他啶、头孢噻肟、头孢吡肟、复方新诺明和氟喹诺酮间差异有统计学意义(P＜0.01).结论 萧山地区成人志贺菌感染以宋内和福氏两种血清群为主,青霉素类和复方新诺明耐药率太高已不适合临床使用,含酶抑制剂抗生素是治疗志贺菌感染的首选药物.     

183株志贺菌的菌群分布及药敏分析

目的了解本地区细菌性痢疾菌群分布及药敏情况。方法对183株志贺菌进行菌群分型及药敏分析。结果183株志贺菌有福氏志贺菌168株（91．8％）;宋内志贺菌9株（4．9％）;痢疾志贺菌4株（2．2％）;鲍氏志贺菌2株（1．1％）。药敏试验显示志贺菌对四环素、氨苄西林、复方新诺明耐药严重;对头孢他啶、阿米卡星、诺氟沙星比较敏感。结论本地区志贺菌主要是福氏志贺菌Ⅱa,应根据药敏试验结果选择合适抗菌药物。     

志贺菌属致病的研究进展

致病岛是指细菌染色体上具有典型结构特征的基因片段,主要编码细菌毒力及代谢相关产物。志贺菌属基因组中已发现了多个致病岛,并广泛存在于该菌属的各群细菌中,与致病性和耐药性等密切相关。对志贺菌属致病岛的研究为进一步深入理解其致病机制、开发防治细菌性痢疾的新策略提供了理论依据。     

志贺菌毒力检测的常用方法

志贺菌属的细菌以人类为特异性宿主,感染人类肠上皮细胞,多导致痉挛性腹痛、腹泻、发烧等症状,是细菌性痢疾最为常见的病原菌。志贺菌的致病机理主要由其Ⅲ型分泌系统调节。志贺菌侵袭力的高低及毒力强弱决定了其致病性的强弱。我们简要介绍志贺菌属细菌的毒力检测方法。     

苏州地区儿童感染志贺菌的耐药监测

目的调查苏州地区2000年至2006年儿童感染志贺菌的耐药情况,了解其耐药趋势,以指导临床合理用药。方法对2000年至2006年苏州大学附属儿童医院临床标本中分离的589株志贺菌（福氏志贺菌470株,宋内志贺菌119株）采用K-B法对氨苄西林、哌拉西林、头孢哌酮、头孢曲松、环丙沙星、SMZ＋TMP、亚胺培南进行药敏试验。结果于7年中470株福氏志贺菌的耐药率：氨苄西林：始终在90．0％以上;哌拉西林：从22．6％逐渐上升到63．2％;头孢哌酮：1．1％～56．1％;头孢曲松：2．2％～43．9％;环丙沙星：一直在10．0％左右;SMZ＋TMP：在70．0％～96．0％波动;对亚胺培南均敏感。119株宋内志贺菌的耐药率：氨苄西林：从7．1％逐渐上升到82．8％;哌拉西林：0～79．3％;头孢哌酮：0～55．2％;头孢曲松：0～51．7％;SMZ＋TMP：在62．5％～100．0％波动;对环丙沙星和亚胺培南均敏感。结论本地区儿童感染福氏志贺菌对氨苄西林严重耐药,同时伴有对SMZ＋TMP的高耐药率,对哌拉西林和3代头孢菌素的耐药率呈逐年上升趋势。宋内志贺菌的耐药率在2004年之前（除对复方新诺明外）,远低于福氏志贺菌,但在2005年其对氨苄西林和3代头孢菌素的耐药率突然上升,大有赶超福氏志贺菌之势。因此苏州地区儿童感染志贺菌的耐药情况不容乐观,对儿童细菌性痢疾的治疗将会面临困境。     

志贺菌CRISPR的检测及其与耐药的关系

【目的】检测志贺菌成簇规律间隔的短回文重复序列(Clustered regularly interspaced short palindromic repeats,CRISPR),并分析其与志贺菌耐药的关系。【方法】根据CRISPR DB数据库公布的志贺菌确定的CRISPR结构序列CRISPR-S2、CRISPR-S4和可能的CRISPR结构序列CRISPR-S1、CRISPR-S3设计四对引物,对60株志贺菌进行PCR扩增。采用CRISPR Finder分析CRISPR,采用改良K-B药敏纸片法检测志贺菌耐药情况,并分析CRISPR-S4与耐药的关系。【结果】确定的CRISPR结构的总阳性率为95%,四个CRISPR位点组成12种CRISPR谱型(A-L),除K型外均含确定的CRISPR结构,新发现1种重复序列和12种间隔序列。60株志贺菌的多重耐药率为53.33%。CRISPR-S4阳性菌株与阴性菌株之间,耐药的分布差异无统计学意义,但多重耐药菌株和耐TE菌株CRISPR-S4的重复序列多为R4.1,其3’末端缺失碱基AC;多重耐药菌株CRISPR-S4的间隔序列多为Sp5.1、Sp6.1和Sp7。【结论】CRISPR在志贺菌中广泛分布。CRISPR重复序列的变异和间隔序列的多样性可能与志贺菌耐药有关。     

大连地区感染性腹泻病原监测结果分析

目的 了解大连地区感染性腹泻病原菌的种类和流行特征,为感染性腹泻的预防控制和临床治疗提供依据.方法 采用常规粪便培养方法,对分离菌做血清学分型,用MicroScan WalkAway-40全自动细菌鉴定及药敏分析仪对分离菌做生化鉴定,对检出的志贺菌做药敏试验,并用WHONET 5.4软件对药敏结果进行统计分析.结果 监测872例腹泻患者样本,检出感染性腹泻病原菌109株,阳性率为12.5％,其中志贺菌所占比例最大,其次为沙门菌,副溶血弧菌排第三.志贺菌对碳青霉烯类、氟喹诺酮类和头孢菌素类等敏感,对青霉素类和复方磺胺类耐药.结论 志贺菌是大连地区感染性腹泻的首要病原菌,沙门菌和副溶血弧菌次之,应依据此监测结果做好大连地区腹泻病的防治工作;同时根据耐药性监测结果合理使用抗生素应对志贺菌,减少耐药菌株出现.     

New animal model of shigellosis in the Guinea pig: its usefulness for protective efficacy studies

It has been difficult to evaluate the protective efficacy of vaccine candidates against shigellosis, a major form of bacillary dysentery caused by Shigella spp. infection, because of the lack of suitable animal models. To develop a proper animal model representing human bacillary dysentery, guinea pigs were challenged with virulent Shigella flexneri serotype 2a (strains 2457T or YSH6000) or S. flexneri 5a (strain M90T) by the intrarectal (i.r.) route. Interestingly, all guinea pigs administered these Shigella strains developed severe and acute rectocolitis. They lost approximately 20% of their body weight and developed tenesmus by 24 h after Shigella infection. Shigella invasion and colonization of the distal colon were seen at 24 h but disappeared by 48 h following i.r. infection. Histopathological approaches demonstrated significant damage and destruction of mucosal and submucosal layers, thickened intestinal wall, edema, erosion, infiltration of neutrophils, and depletion of goblet cells in the distal colon. Furthermore, robust expression of IL-8, IL-1beta, and inducible NO synthase mRNA was detected in the colon from 6 to 24 h following Shigella infection. Most importantly, in our new shigellosis model, guinea pigs vaccinated with an attenuated S. flexneri 2a SC602 strain possessing high levels of mucosal IgA Abs showed milder symptoms of bacillary dysentery than did animals receiving PBS alone after Shigella infection. In the guinea pig, administration of Shigella by i.r. route induces acute inflammation, making this animal model useful for assessing the protective efficacy of Shigella vaccine candidates.     

High Mean Water Vapour Pressure Promotes the Transmission of Bacillary Dysentery

Bacillary dysentery is an infectious disease caused by Shigella dysenteriae, which has a seasonal distribution. External environmental factors, including climate, play a significant role in its transmission. This paper identifies climate-related risk factors and their role in bacillary dysentery transmission. Harbin, in northeast China, with a temperate climate, and Quzhou, in southern China, with a subtropical climate, are chosen as the study locations. The least absolute shrinkage and selectionator operator is applied to select relevant climate factors involved in the transmission of bacillary dysentery. Based on the selected relevant climate factors and incidence rates, an AutoRegressive Integrated Moving Average (ARIMA) model is established successfully as a time series prediction model. The numerical results demonstrate that the mean water vapour pressure over the previous month results in a high relative risk for bacillary dysentery transmission in both cities, and the ARIMA model can successfully perform such a prediction. These results provide better explanations for the relationship between climate factors and bacillary dysentery transmission than those put forth in other studies that use only correlation coefficients or fitting models. The findings in this paper demonstrate that the mean water vapour pressure over the previous month is an important predictor for the transmission of bacillary dysentery.     

The Shigella virulence gene regulatory cascade: a paradigm of bacterial gene control mechanisms

Shigella flexneri is the causative agent of bacillary dysentery and is a facultative intracellular pathogen. Its virulence regulon is subject to tight control by several mechanisms involving the products of over 20 genes and an array of environmental signals. The regulon is carried on a plasmid that is prone to instability and to integration into the chromosome, with associated silencing of the virulence genes. Closely related regulons are found in other species of Shigella and in enteroinvasive Escherichia coli . A wealth of detailed information is now available on the Shigella virulence gene control circuits, and it is becoming clear that these share many features with regulatory systems found in other bacterial pathogens. All of this makes the S. flexneri virulence gene control system a very attractive topic for those interested in the nature of gene regulatory networks in bacteria.     

The pathogenesis of Shigella flexneri infection: lessons from in vitro and in vivo studies

Shigella flexneri is a Gram-negative facultatively intracellular pathogen responsible for bacillary dysentery in humans. More than one million deaths occur yearly due to infections with Shigella spp. and the victims are mostly children of the developing world. The pathogenesis of Shigella centres on the ability of this organism to invade the colonic epithelium where it induces severe mucosal inflammation. Much information that we have gained concerning the pathogenesis of Shigella has been derived from the study of in vitro models of infection. Using these techniques, a number of the molecular mechanisms by which Shigella invades epithelial cells and macrophages have been identified. In vivo models of shigellosis have been hampered since humans are the only natural hosts of Shigella. However, experimental infection of macaques as well as the murine lung and rabbit ligated ileal loop models have been important in defining some of the immune and inflammatory components of the disease. In particular, the murine lung model has shed light on the development of systemic and local immune protection against Shigella infection. It would be naive to believe that any one model of Shigella infection could adequately represent the complexity of the disease in humans, and more sophisticated in vivo models are now necessary. These models require the use of human cells and tissue, but at present such models remain in the developmental stage. Ultimately, however, it is with such studies that novel treatments and vaccine candidates for the treatment and prevention of shigellosis will be designed.     

志贺菌流行株药物敏感性及质粒图谱分析

目的：分析志贺菌流行株的质粒图谱及其与细菌药物敏感性的相关性。方法：从菌痢患者粪便标本中分离6株 福氏志力和4株宋内志贺菌,分别对其质粒图谱与药物敏感性进行检测和对其相关性进行分析。结果：不同菌株的质粒图谱具有明显的差异,各菌株的质粒图谱与其对头孢三嗪、头孢唑林、环丙沙星、诺氟沙星、氯霉素的耐药特性无明显相关性。结论：获自患者的福氏志贺菌和宋内志贺菌具有不同的质粒图谱以及抗菌药物敏感性,提示在我市引起菌痢的志贺菌具有不同的来源。     

To die or not to die: Shigella has an answer

Invasion of epithelial cells by Shigella is a critical step in the pathogenesis of bacillary dysentery. In this issue of Cell Host & Microbe, Bergounioux et?al. (2012) uncover a complex interplay of proinvasion, prosurvival, and prodeath signals centered on the activation of calpain protease by the Shigella VirA protein.     

Genome dynamics and diversity of Shigella species, the etiologic agents of bacillary dysentery

The Shigella bacteria cause bacillary dysentery, which remains a significant threat to public health. The genus status and species classification appear no longer valid, as compelling evidence indicates that Shigella, as well as enteroinvasive Escherichia coli, are derived from multiple origins of E.coli and form a single pathovar. Nevertheless, Shigella dysenteriae serotype 1 causes deadly epidemics but Shigella boydii is restricted to the Indian subcontinent, while Shigella flexneri and Shigella sonnei are prevalent in developing and developed countries respectively. To begin to explain these distinctive epidemiological and pathological features at the genome level, we have carried out comparative genomics on four representative strains. Each of the Shigella genomes includes a virulence plasmid that encodes conserved primary virulence determinants. The Shigella chromosomes share most of their genes with that of E.coli K12 strain MG1655, but each has over 200 pseudogenes, 300 approximately 700 copies of insertion sequence (IS) elements, and numerous deletions, insertions, translocations and inversions. There is extensive diversity of putative virulence genes, mostly acquired via bacteriophage-mediated lateral gene transfer. Hence, via convergent evolution involving gain and loss of functions, through bacteriophage-mediated gene acquisition, IS-mediated DNA rearrangements and formation of pseudogenes, the Shigella spp. became highly specific human pathogens with variable epidemiological and pathological features.     

Development of a new guinea-pig model of shigellosis

Shigellosis is a major form of bacillary dysentery caused by Shigella spp. To date, there is no suitable animal model to evaluate the protective efficacy of vaccine candidates against this pathogen. Here, we describe a successful experimental shigellosis in the guinea-pig model, which has shown the characteristic features of human shigellosis. This model yielded reproducible results without any preparatory treatment besides cecal ligation. In this study, guinea-pigs were discretely infected with virulent Shigella dysenteriae type 1 and Shigella flexneri type 2a into the cecocolic junction after ligation of the distal cecum. All the experimental animals lost ～10% of their body weight and developed typical dysentery within 24-h postinfection. In the histological analysis, distal colon showed edema, hemorrhage, exudation and inflammatory infiltrations in the lamina propria. Orally immunized animals with heat-killed S. dysenteriae type 1 and S. flexneri type 2a strains showed high levels of serum immunoglobulin G (IgG) and mucosal IgA antibodies and conferred significant homologous protective immunity against subsequent challenges with the live strains. The direct administration of shigellae into the cecocolic junction induces acute inflammation, making this animal model useful for assessing shigellosis and evaluating the protective immunity of Shigella vaccine candidates.