Non-toxigenic Clostridium sordellii: clinical and microbiological features of a case of cholangitis-associated bacteremia

Toxigenic Clostridium sordellii strains are increasingly recognized to cause highly lethal infections in humans that are typified by a toxic shock syndrome (TSS). Two glucosylating toxins, lethal toxin (TcsL) and hemorrhagic toxin (TcsH) are believed to be important in the pathogenesis of TSS. While non-toxigenic strains of C. sordellii demonstrate reduced cytotoxicity in vitro and lower virulence in animal models of infection, there are few data regarding their behavior in humans. Here we report a non-TSS C. sordellii infection in the context of a polymicrobial bacterial cholangitis. The C. sordellii strain associated with this infection did not carry either the TcsL-encoding tcsL gene or the tcsH gene for TcsH. In addition, the strain was neither cytotoxic in vitro nor lethal in a murine sepsis model. These results provide additional correlative evidence that TcsL and TcsH increase the risk of mortality during C. sordellii infections.     

Detection of Helicobacter pylori in bile of cats

Lymphocytic cholangitis (LC) in cats is a biliary disease of unknown etiology. Helicobacter spp. were recently implicated in human primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC). Because of the similarities between PSC/PBC with LC, we hypothesized that Helicobacter spp. are involved in feline LC. A PCR with Helicobacter genus-specific 16S rRNA primers was performed on DNA isolated from feline bile samples. Four of the 15 (26%) LC samples were positive, whereas only 8/51 (16%) of non-LC samples were PCR positive (p=0.44). Sequence analysis of the amplicons revealed a 100% identity with the Helicobacter pylori specific DNA fragments. Our data suggest an etiological role of H. pylori in feline LC and that cats are a potential zoonotic reservoir.     

减黄治疗后早期胆管炎的相关因素分析

摘要 目的：探讨恶性梗阻性黄疸患者接受减黄治疗后早期胆管炎的相关因素。方法：回顾性分析自2013年1月至2020年7月上海瑞金医院北部院区普外科收治的恶性梗阻性黄疸患者的临床资料,根据减黄治疗后2周内是否发生胆管炎分为早期胆管炎组与非早期胆管炎,采用SPSS 21.0统计软件进行数据分析处理。结果：共入组69例临床资料,男性40例,女性29例,减黄治疗后早期发生胆管炎者17例,中位时间3（2, 11.5）天。两组患者在年龄、性别、病程、总胆红素、引流方式上未发现统计学差异,而引流物直径、胆道梗阻部位存在统计学差异（P＜0.05）,进一步Logistic回归分析提示引流物直径是减黄治疗后发生早期胆管炎的相关因素[OR=0.889, 95% CI（0.792, 0.998）,P=0.046]。结论：恶性梗阻性黄疸行减黄治疗时,应选择直径较大的引流物,对胆道进行充分、有效的引流,可减少减黄治疗后早期胆管炎的发生。     

急诊ERCP对急性胆源性胰腺炎伴胆管炎患者血清淀粉酶水平及肠功能恢复的影响

摘要 目的：探讨急诊经内镜逆行性胰胆管造影术（ERCP）对急性胆源性胰腺炎（ABP）伴胆管炎患者血清淀粉酶水平及肠功能恢复的影响。方法：回顾性收集2020年2月至2022年2月期间我院肝胆胰腺外科收治的93例ABP伴胆管炎患者作为本次实验的研究对象,依据治疗方法的不同将患者分为实验组（n=48）和对照组（n=45）,对照组患者采用保守药物治疗,实验组患者在对照组治疗基础上于入院24至48小时内行急诊ERCP术,比较两组患者症状缓解时间、住院时间、治疗费用、肝功能[谷丙氨酸转氨酶（ALT）、谷草氨酸转氨酶（AST）和谷氨酰转肽酶（GGT）]、肠功能恢复时间、炎症因子[C反应蛋白（CRP）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）和肿瘤坏死因子-α（TNF-α）]、血清淀粉酶（SAMY）、白细胞（WBC）、总胆红素（TBIL）水平及恢复时间,记录两组患者并发症发生情况。结果：实验组恶心呕吐消失时间、腹痛缓解时间、退烧时间、住院时间均低于对照组,治疗费用高于对照组（P<0.05）。治疗后两组ALT、AST和GGT等肝功能指标均降低,且实验组低于对照组（P<0.05）。实验组肛门恢复排气时间、开始进食时间和初次自行排便时间较对照组更短（P<0.05）。治疗后两组CRP、IL-6、IL-8和TNF-α等炎症因子水平均降低,且实验组低于对照组（P<0.05）。治疗后两组SAMY、WBC和TBIL等指标均降低,且实验组低于对照组（P<0.05）。实验组SAMY、WBC和TBIL恢复时间均较对照组更短（P<0.05）。实验组并发症发生率为8.33%,低于对照组20.00%,差异无统计学意义（P>0.05）。结论：急诊ERCP治疗ABP伴胆管炎患者,可有效缓解相关症状,改善肝功能,降低炎症因子和SAMY水平,促进肠功能恢复,安全可靠。