PCR结合反向斑点杂交法检测侵袭性曲霉感染的初步实验研究

目的评价PCR结合反向斑点杂交法检测动物模型和临床免疫抑制患者的侵袭性曲霉感染的可行性。方法建立侵袭性曲霉感染动物模型,收集动物血清和健康人群、免疫抑制患者的血清,进行PCR-种特异性探针检测。以1对真菌特有的28S rRNA保守序列结构作为真菌通用引物,以临床常见的4个曲霉菌种,即烟曲霉、黄曲霉、黑曲霉、土曲霉的种特异性序列为种特异性探针,与扩增产物进行反向斑点杂交。结果PCR-探针杂交检测动物接种后24h时阳性血清为16/24,48h为18/24,72h为19/24,96h为24/24。阳性率为80%,特异性为95.8%。同时取血行真菌培养,烟曲霉阳性率仅为5%。临床标本显示两例确诊IA患者血清均为阳性,且能鉴定菌种。健康对照人群标本检测显,阴性38例,假阳性2例。结论PCR-探针杂交法较传统血培养法能更快速、灵敏地检测动物模型的侵袭性曲霉感染,并可用于对IA高危患者的监测。     

1935例深部曲霉临床分离株资料回顾性分析

目的了解我院深部分离的曲霉菌种构成和临床分布特点,了解烟曲霉感染患者的基础疾病,指导临床烟曲霉深部感染的防治。方法收集2012年1月～2018年12月我院真菌室分离自临床深部标本的曲霉菌株以及其宿主的临床资料进行统计分析。结果 2012～2018年我院真菌室临床深部标本分离的曲霉菌株共计1935例,其中烟曲霉863例,黑曲霉159例,黄曲霉77例,未分类曲霉836例。烟曲霉主要分离自呼吸道标本,标本来源患者主要分布在传染科、呼吸科、老年高干科、ICU、抗生素科以及神经外科等科室。这些患者常见基础疾病为感染性疾病、肿瘤、非感染性的呼吸系统疾病、皮肤及风湿免疫系统疾病、内分泌系统疾病。结论我院深部标本分离的曲霉菌种主要为烟曲霉,主要引发肺部感染。我院分布于上述科室并合并上述基础疾病患者需警惕烟曲霉感染的发生。     

应用反向线点杂交技术鉴定临床常见曲霉属和毛霉目真菌

目的应用反向线点杂交技术(reverse line blot hybridization,RLB)快速鉴定临床常见的曲霉属和毛霉目真菌。方法收集我院真菌和真菌病研究中心保存的5种曲霉菌(烟曲霉、黄曲霉、黑曲霉、土曲霉、构巢曲霉)和7种毛霉目真菌(冻土毛霉菌、总状毛霉菌、卷枝毛霉菌、少根根霉、小孢根霉、微小根毛霉、伞状犁头霉),共计98株菌株。利用真菌通用引物ITS1和ITS4对菌株进行PCR扩增,用12个真菌种特异性探针与扩增后产物进行反向线点杂交。将RLB结果与真菌传统形态学鉴定结果、ITS区DNA测序结果进行比较。结果 RLB可以正确鉴定98株实验菌株,与形态学方法和ITS区测序方法鉴定结果100%一致,种特异性探针之间未见交叉杂交,显示出该方法的高度敏感性和特异性。8株阴性对照菌株(白念珠菌、茄病镰刀菌、尖端赛多孢、马尔尼菲青霉、疣状瓶霉、棒曲霉、日本曲霉以及雅致小克银汉霉),使用RLB方法无法鉴定。通过烟曲霉基因组DNA浓度10倍倍比稀释法验证RLB的敏感性为1.8×10-3 ng/μL。结论 RLB技术为实验室早期快速诊断、鉴定临床常见的曲霉属和毛霉目真菌提供参考。     

临床罕见曲霉菌属的研究进展

全世界每年有超过20万例危及生命的曲霉病感染,其中以烟曲霉感染最为多见。近年来,分子技术的进步发现曲霉病也可以由表型与烟曲霉相似,遗传上截然不同的新菌种引起。临床上,超过20%的曲霉分离株是未被识别的或不常见的菌种,我们称其为罕见曲霉菌种。越来越多侵袭性曲霉病(invasive aspergillosis,IA)的病例报道与它们相关。这些菌种表现出与烟曲霉不同的毒力和药物敏感性,其临床菌株基因组序列和表型图谱的缺乏,导致其研究受到阻碍。本文就临床罕见曲霉菌属的流行病学、鉴定方法、药敏情况等方面进行文献综述。     

浅部真菌病1948份临床标本的真菌学分析

目的 通过对浅部真菌病患者临床送检标本的病原真菌菌种进行系统分析,了解感染及病原真菌的分布情况。方法 采用直接镜检、培养及真菌鉴定等方法对临床送验标本进行检验和鉴定,大部分标本鉴定到种。结果 1948份临床送验标本中,直接涂片镜检阳性率53．41％,培养阳性率40．28％,而镜检＋培养的阳性率为66．98％。对上述3种方法的真菌检出率进行比较,均存在显著差异（χ^2检验P均〈0．005）。在培养的1944份标本中,共分离出18个属,36种真菌,其中,红色毛癣菌24．52％、须癣毛癣菌16．48％、白念珠菌12．64％。结论 ①镜检结合培养的阳性率显著高于单一的镜检或培养的阳性率。②在患者即时的真菌镜检阴性时,应选择培养方法进一步检测,不轻易排除浅部真菌病感染可能。③皮肤癣菌居患者浅部真菌病致病菌首位,而白念珠菌及酵母类菌也是重要病原菌。     

烟曲霉引起肺部感染致患者死亡2例

近年来,随着新药物和新方法的广泛应用,医院内部深部菌感染（DFI）的发病率目益增高。就曲霉病而言,在过去的10年里,发病率上升了300％,其中烟曲霉是主要的致病菌,占曲霉类真菌所致人类感染的80％～90％。由于烟曲霉病无特异的临床表现,CT扫描和X片无明显特异性。通常的感染途径是通过呼吸道吸入侵入肺部,在免疫缺陷患者中可进一步播散,导致全身多个系统受损。烟曲霉毒力大,且容易被忽视,以致误诊漏诊,危及患者生命。2004年嵊州市人民医院收治2例肺部烟曲霉感染患者,现报道如下。     

实时荧光PCR结合融解曲线分析快速鉴定临床常见曲霉菌

目的 采用实时荧光PCR结合融解曲线分析的方法快速将临床常见曲霉菌鉴定到种的水平.方法 ①普通PCR扩增真菌ITS区后进行序列比对,准确鉴定菌种并设计种特异性引物和探针.②采用实时荧光PCR的方法及融解曲线分析,根据不同的解链温度将5种临床常见曲霉菌鉴定到种的水平.③特异性、敏感性、重复性试验.结果 ①解链曲线分析显示,不同种曲霉菌的种特异性探针有特异的Tm值,根据Tm值的不同可以将5种曲霉菌区分开来:烟曲霉Tm =61.4℃,黄曲霉Tm=57.4℃,黑曲霉Tm=67.7℃,土曲霉Tm=55.2℃和64.5℃,构巢曲霉Tm=65.8℃.其中小孢根霉和疣状瓶霉与烟曲霉探针发生交叉反应,阴性对照不出现特异性的解链曲线.②该方法对5种曲霉菌的检测下限分别为:烟曲霉56.8 fg,黄曲霉1 110fg,黑曲霉13.7 fg,土曲霉123 fg,构巢曲霉780 fg.③重复性试验结果显示,同一种曲霉菌的Tm值波动范围不超过0.5℃.结论 采用实时荧光PCR结合融解曲线分析的方法可以快速准确地将临床常见曲霉菌鉴定到种的水平,具有良好的敏感性、特异性和可重复性,有助于临床侵袭性曲霉感染的诊断和指导抗真菌药物使用.     

肝移植术后曲霉的气道定植与侵袭性曲霉病的关系

目的评价肝移植术后曲霉气道的定植及其发生侵袭性感染的风险。方法回顾2003—2004年南京八一医院和上海长征医院56例肝移植患者进行的连续组织学检查和曲霉培养结果。结果24例患者被分离出曲霉,2例发生侵袭性烟曲霉感染。这2例患者在移植后6个月内都有烟曲霉的定植,并且都死亡,占所有移植后死亡的29％。无曲霉定植者都未发生侵袭性曲霉感染。结论肝移植术后的侵袭性曲霉感染较为少见,但常致死,曲霉定植常见但为一过性,由于气管侵袭性曲霉感染只发生在有烟曲霉定植的移植后6个月内的患者,所以在此期间进行预防性的治疗能否有效降低侵袭性曲霉感染值得研究。     

中国大陆地区曲霉病流行现状分析

目的了解中国大陆地区曲霉病流行状况及诊治现状。方法通过CNKI及Pubmed搜索1991年来中国大陆地区曲霉病及曲霉相关文献,进行数据统计和总结。结果 1991年1月～2009年10月报道曲霉病1457例,其中481例有病原学证据,258例进行菌种鉴定,其中烟曲霉153例。感染部位最常见于肺,为1047例。病原学诊断依据主要是镜检和培养;菌种鉴定主要依赖形态学特征,仅4例进行分子生物学鉴定;仅少数进行半乳甘露聚糖及葡聚糖检测;体外药敏试验少,仅报道2株黄曲霉对两性霉素B耐药,2株烟曲霉多药耐药。伊曲康唑为侵袭性曲霉感染经验治疗(抢先治疗)的首选药物。过敏性支气管肺曲霉病则多单用糖皮质激素或联合伊曲康唑,大部分慢性及腐生型曲霉病及鼻窦曲霉病患者行手术治疗。结论中国大陆地区曲霉病流行趋势与国际一致,非烟曲霉感染有所增加,感染部位仍以肺为主。应提高菌种形态学和分子生物学鉴定水平,积极开展非培养检测手段,保证正确和及时地诊断;加强药敏监测,为临床治疗提供有效信息。     

非粒细胞减少患者肺曲霉病22例回顾性分析

目的提高对非粒细胞减少患者肺曲霉病的认识及诊疗水平。方法回顾性分析22例非粒细胞减少患者肺曲霉病的临床、影像学及实验室资料,随诊其转归。结果22例肺曲霉病（PA）患者,男性12例,女性10例,平均年龄（56．3±21．4）岁。确诊、临床诊断各8例,拟诊6例。侵袭性肺曲霉病（IPA）11例,单纯性曲霉球6例,慢性坏死性肺曲霉病（CNPA）5例。常见基础疾病为继发型肺结核（8／22）、糖尿病或类固醇性糖尿病（6／22）、高血压病（5／22）、慢性阻塞性肺疾病（5／22）,4例系原发社区感染。常见临床症状咳嗽咳痰（18／22）、咯血（11／22）、气促（7／22）。影像学表现为肺部渗出或实变病灶9例、空洞改变及典型曲霉球12例,结节或肿块1例。首选药物治疗依次为伏立康唑（10／22）、卡泊芬净（4／22）、伊曲康唑（3／22）。结论非粒细胞减少伴IPA好发于糖尿病、慢性阻塞性肺疾病,亦可发生在免疫功能正常患者。单纯曲霉球多继发或并发于肺结核。应注意鉴别CNPA与单纯曲霉球。IPA临床表现缺乏特征性。影像改变未见典型晕征及空气半月征,肺外播散少见,药物治疗首选伏立康唑。     

PCR detection of Actinobacillus pleuropneumoniaeapxIV gene in formalin-fixed,paraffin-embedded lung tissues and comparison with in situ hybridization

AIMS: Formalin-fixed, paraffin-embedded lung tissues from pigs experimentally infected with 12 Actinobacillus pleuropneumoniae serotypes were used to develop nested PCR for the detection of apxIV gene. METHODS AND RESULTS: The PCR results from formalin-fixed, paraffin-embedded tissues were compared with in situ hybridization. The apxIV gene was detected in formalin-fixed, paraffin-embedded lung tissues from all 39 pigs experimentally infected with 12 A. pleuropneumoniae serotypes by nested PCR. In situ hybridization produced a distinct positive signal in all 39 pigs experimentally infected with 12 A. pleuropneumoniae serotypes. Agreement rates between nested PCR and in situ hybridization were 100% for the detection of apxIV gene in formalin-fixed paraffin-embedded lung tissues. Acceptable PCR signals were detected from lung tissues fixed for periods up to 180 days. CONCLUSIONS: The apxIV gene is species-specific rather than serotype-specific and is therefore an important diagnostic marker. The nested PCR assay would be a useful method for the detection of apxIV gene to diagnose A. pleuropneumoniae infection when formalin-fixed tissues are submitted. SIGNIFICANCE AND IMPACT OF THE STUDY: This study confirmed the possibility of using formalin-fixed, paraffin-embedded tissues for the diagnosis of A. pleuropneumoniae infection in pigs.     

Detection of Aspergillus in lung and other tissue samples using the MycAssay Aspergillus real-time PCR kit

The MycAssay? Aspergillus real-time PCR kit was tested on tissues from patients with invasive fungal infections. Tissue samples from nine organ transplant recipients and 33 patients with haematological malignancy were from lung (n = 30), skin (n = 4), and others. Samples were preprocessed with proteinase K and lyticase, followed by DNA extraction and real-time PCR. For all samples, the sensitivity of the MycAssay Aspergillus test was 82% and specificity 79% relative to microscopy and 90% and 64%, respectively, compared with Aspergillus culture. The positive predictive value and negative predictive values compared with culture were 69% and 88% and were 88% and 69% compared with microscopy, respectively. The MycAssay Aspergillus test detected tissue invasive infections with Aspergillus fumigatus , Aspergillus flavus , and Aspergillus terreus.     

PCR and in situ hybridization for the detection and localization of a new pathogen Francisella-like bacterium (FLB) in ornamental cichlids

Archived formalin-fixed, paraffin-embedded tissues from 28 diseased ornamental cichlid fish associated with visceral granulomas were examined by polymerase chain reaction (PCR) and in situ hybridization (ISH) for detection of Francisella-like bacteria (FLB). The 16S rDNA FLB-specific primer pair 180f/465r was used on naturally infected ornamental cichlids, resulting in 11 positive cases (39%). Using DNA probes, all 28 cases (100%) showed a positive reaction, and most labeled cells were observed in the visceral granulomas of infected individuals. FLB was detected in cells morphologically resembling epithelioid and endothelioid macrophages. ISH was more sensitive than PCR or routine histopathological examination, based on the examination of archived formalin-fixed, paraffin-embedded tissues in this study. Furthermore, this technique located a new fish pathogen, FLB, in ornamental cichlids. The causative agent was similar to the pathogen inducing systemic granulomas in tilapia.     

Identification of the pathogenic Aspergillus species by nested PCR using a mixture of specific primers to DNA topoisomerase II gene

For PCR-based identification of Aspergillus species, a common primer of the DNA topoisomerase II genes of Candida, Aspergillus and Penicillium, and species-specific primers of the genomic sequences of DNA topoisomerase II of A. fumigatus, A. niger, A. flavus (A. oryzae), A. nidulans and A. terreus were tested for their specificities in PCR amplifications. The method consisted of amplification of the genomic DNA topoisomerase II gene by a common primer set, followed by a second PCR with a primer mix consisting of 5 species-specific primer pairs for each Aspergillus species. By using the common primer pair, a DNA fragment of approximately 1,200 bp was amplified from the Aspergillus and Penicillium genomic DNAs. Using each species-specific primer pair, unique sizes of PCR products were amplified, all of which corresponded to a species of Aspergillus even in the presence of DNAs of several fungal species. The sensitivity of A. fumigatus to the nested PCR was found to be 100 fg of DNA in the reaction mixture. In the nested PCR obtained by using the primer mix (PsIV), the specific DNA fragment of A. fumigatus was amplified from clinical specimens. These results suggest that this nested PCR method is rapid, simple and available as a tool for identification of pathogenic Aspergillus to a species level.     

The application of immunoperoxidase staining for the detection of causative fungi in tissue specimens of mycosis I

This study was performed in order to identify the fungi of four species (Aspergillus fumigatus, Fusarium anthophilum, Candida albicans, Cryptococcus neoformans) in formalin-fixed, paraffin-embedded tissue sections by the indirect method of immunoperoxidase staining. Mature albino rabbits were immunized by formalin-killed organisms. The antibodies were prepared by precipitation at a 50% saturation of ammonium sulfate and were checked for cross-reactivities by Ouchterlony's double immunodiffusion and precipitin test. The immunoperoxidase staining was applied to the paraffin-embedded tissue sections of infected mice, human autopsy and biopsy specimens. Although each fungus was stained clearly the cell wall, cross-reactivities appeared among them, however it was possible to identify four fungi by absorption and dilution of the antisera.     

Improvements of PCR-based identification targeting the DNA topoisomerase II gene to determine major species of the opportunistic fungi Candida and Aspergillus fumigatus

For the simple and rapid detection/identification of major pathogenic fungal species such as Candida albicans, C. tropicalis, C. parapsilosis, C. glabrata and Aspergillus fumigatus, common primers for these species and specific primers for each species, designed on the basis on the genomic nucleotide sequences of the DNA topoisomerase II genes, were prepared and tested for their specificities in PCR amplifications. Twelve specific primers were pooled and designated PsVI. Genomic DNAs were amplified by the common primer pair, and followed by PCR amplification using PsVI. Using PsVI, six unique DNA fragments, all of which corresponded to a Candida or A. fumigatus species, were specifically and acceptably amplified from each template DNA even in the presence of other DNAs. Similarly, the results of identification of clinical samples based on the PCR amplification coincided with those of conventional identification techniques. The sensitivities of the direct PCR and the nested PCR using PsVI were found to be 1,000 and 50 yeast cells, respectively.     

PCR detection of Clostridium perfringens type D in formalin-fixed, paraffin-embedded tissues of goats and sheep

A polymerase chain reaction (PCR) was used to identify the genes encoding the alpha, epsilon and beta toxins of Clostridium perfringens in formalin-fixed, paraffin-embedded intestinal tissues of goats and sheep. When pure cultures of Cl. perfringens types B and D were used as control templates in the PCR, products of the following sizes were observed on the agarose gel: 247 bp (alpha primers), 1025 bp (beta primers) and 403 bp (epsilon primers). When used to identify Cl. perfringens type D in formalin-fixed, paraffin-embedded intestinal tissues of goats and sheep, the PCR technique resulted in the detection of this micro-organism in 11 out of 13 samples known to be infected with Cl. perfringens. No false positive results were obtained when 13 culturally negative samples were analysed by the PCR technique.     

Prevalence and in vitro antifungal susceptibility of Candida spp isolated from clinical specimens in São Paulo, Brazil

The specifity of gene encoding the ribotoxin protein in Aspergillus fumigatus was determined by PCR amplification of a portion of the gene. All A. fumigatus strains studied showed the presence of amplifiable ribotoxin product, while none of the other fungal species, with the exception of Aspergillus restrictus, showed this amplification product. Hence, this method may be used for rapid and specific identification of A. fumigatus.     

Pyrosequencing method to detect KRAS mutation in formalin-fixed and paraffin-embedded tumor tissues

KRAS mutation status has been reported to be a predictive marker of tumor response to epidermal growth factor receptor (EGFR) inhibitors. We have designed a pyrosequencing assay based on nested polymerase chain reaction (PCR) to characterize KRAS mutation status using formalin-fixed and paraffin-embedded tumor tissues. Mutant and wild-type KRAS cell lines were used to determine the specificity and sensitivity (detection limit ∼5% mutant alleles) of the method. The results obtained for tumor samples were 95% comparable to those obtained by dideoxy sequencing. Analysis of KRAS mutation using nested PCR and pyrosequencing is a simple, robust, fast, and sensitive method that can be used with formalin-fixed and paraffin-embedded tissues.     

小鼠烟曲霉角膜炎的实验研究

目的 比较伊曲康唑和氟康唑对烟曲霉的体外抗菌活性,观察伊曲康唑对小鼠烟曲霉角膜炎的治疗作用.方法 通过角膜基质注射法建立烟曲霉角膜炎小鼠模型.造模后观察角膜病变,取角膜病变处分泌物做真菌镜检、真菌培养以证实造模成功.用药基法检测伊曲康唑和氟康唑对烟曲霉的最低抑菌浓度( MIC)和最低杀菌浓度(MFC).对烟曲霉角膜炎小鼠给予伊曲康唑治疗,治疗结束行临床评分、炎性评分、菌落形成单位测定以评价疗效.结果 伊曲康唑对烟曲霉的MIC和MFC分别为6.25 μg/mL、12.5 μg/mL;氟康唑对烟曲霉的MIC和MFC分别为500 μg/mL、1 000 μg/mL.伊曲康唑治疗组临床评分、炎性评分和测定的菌落数较对照组均明显减少(P＜0.05).结论 伊曲康唑对烟曲霉的体外抗菌活性优于氟康唑,并且对烟曲霉性角膜炎有明显疗效.