温州地区甲型副伤寒临床特征及耐药性分析

目的分析温州地区1997-2003年甲型副伤寒的临床特征及耐药性,提高对该病的认识,探讨合理使用抗生素。方法回顾性分析温州地区283例甲型副伤寒的临床特征,并采用ATB半自动细菌鉴定仪(法国生物梅里埃公司制造),进行细菌鉴定及药敏试验。结果甲型副伤寒临床表现以高热为主,伴畏寒234例(82．7％),伴头痛、头晕141例(49．8％),伴呼吸道症状105例(37．1％),伴消化道症状96例(33．9％)。血常规示嗜酸性粒细胞下降占74．1％,肝功能示SGPT升高占60．6％,SCOT升高占60．3％,SGOT升高占60．6％。肥达试验阳性率低。药敏分析：对培氟沙星、阿莫西林、阿莫西林．克拉维酸钾和头孢呋辛耐药率高,对头孢第3、4代,氨曲南,氨基糖甙类,喹诺酮类(除培氟沙星)与氯霉素敏感性强。结论温州地区甲型副伤寒的临床表现比较典型,治疗上需合理选用抗生素。     

温州地区甲型副伤寒的耐药性分析

目的　了解温州地区副伤寒的耐药情况,指导用药。方法　回顾性分析温州医学院附属一院2 0 0 2年1月～2 0 0 4年3月收治的14 5例副伤寒病例的细菌耐药情况。采用VETIK- AMS全自动微生物鉴定系统(法国生物梅里埃公司) ,进行细菌鉴定以及药敏试验。结果　药敏结果显示对复方新诺明耐药率达6 9.7% ,对培氟沙星耐药率达6 5 .5 % ,对氨苄西林耐药率达6 4 .8% ,对氯霉素耐药率仅为0 .7% ,对3代头孢菌素耐药率都<5 .0 %。结论　该地区副伤寒杆菌对3代头孢菌素基本敏感,对氯霉素敏感,而对培氟沙星及复方新诺明、半合成青霉素的耐药性高     

甲型副伤寒32例临床诊治分析

由于水源污染,2003年4～5月,常山县某中学发生一起严重的甲型副伤寒暴发流行。其中常山县人民医院共收治住院学生32例,现将32例的临床资料作一初步分析。     

甲型副伤寒的腹部超声特征

目的探讨甲型副伤寒的腹部超声图像特征,以协助早期诊断。方法对1997年至2005年经血培养证实的364例甲型副伤寒的腹部超声表现作回顾性分析。结果甲型副伤寒的患者中脾肿大最多见,占57.1%,肝肿大占36.3%,胆囊炎症性改变占18.9%。结论腹部超声检查有助于甲型副伤寒的早期诊断。     

甲型副伤寒药敏与临床分析

目的：探讨耐氟喹诺酮甲型副伤寒的防治对策。方法：按稀释法药物敏感试验（MIC法）测定细菌对抗菌药物的敏感度。结果：30株甲型副伤寒杆菌,药敏试验对培氟沙星耐药率为46．7％（14／30）、中敏率为43．3％（13／30）、敏感率仅10％（3／30）,而对哌拉西林与第三代头孢菌素均敏感。5例患者静滴环丙沙星治疗仅1例有效,4例环丙沙星治疗无效及其他25例患者予静滴哌拉西林、头孢噻肟、头孢曲松、头孢哌酮2－7d体温降至正常。结论：本地区甲型副伤寒对氟喹诺酮耐药率高,宜选用哌拉西林或第三代头孢菌素治疗。     

甲型副伤寒沙门菌培养条件的优化

优化甲型副伤寒沙门菌的培养条件,提高菌体产量。方法通过单因素及正交试验,对影响甲型副伤寒沙门菌生长的培养温度、NaCl浓度和pH等条件进行优化。结果甲型副伤寒沙门菌在NaCl浓度0.75%、温度35℃、pH6.5时菌体产量最高。结论通过对甲型副伤寒沙门菌培养条件进行优化,获得较高的菌体产量,为后期诊断试剂盒的开发奠定了基础。     

甲型副伤寒菌O—特异性多糖与破伤风类毒素结合菌苗的制备 …

以脱毒后去除类脂Ａ的甲型副伤寒杆菌高分子量Ｏ－ＳＰ１和低分子量Ｏ－ＳＰ２为特异笥抗原,以破伤风类毒素（ＴＴ）为蛋白质载体,用已二酸二肼（ＡＤＨ）作为连接剂制备的两种结合物及其多糖免疫ＮＩＨ小鼠,结果显示单独注射Ｏ＿ＳＰ１或Ｏ－ＳＰ２免疫小鼠后,均不能刺激小鼠产生抗ＬＰＳ抗体;而用Ｏ－ＳＰ１－ＴＴ和Ｏ－ＳＰ２－ＴＴ结合物免疫后,小鼠血甭中均产生了特异性抗－ＬＰＳ－ＩｇＧ抗体,且Ｏ－ＳＰ１－ＴＴ免疫组     

需氧厌氧培养方式对甲型副伤寒沙门菌检出率的影响

目的探讨需氧和厌氧血培养方式的选择对甲型副伤寒沙门菌检出率的影响。方法使用mini VI-TAL自动荧光血培养仪或BacT/Alert 3D培养仪对18684例疑似血流感染患者血液(含骨髓)标本进行需氧和(或)厌氧培养(其中仅做需氧培养935例,仅做厌氧培养16例,需氧和厌氧配对培养17733例,每瓶注入约5 ml血液)。结果18684例血液标本,共分离到甲型副伤寒沙门菌3888例(20.81%)。在17733例需氧和厌氧配对培养中检出3613例,其中仅需氧阳性406例占11.24%(406/3613),仅厌氧阳性405例占11.21%(405/3613),需氧和厌氧培养均阳性者2802例占77.55%(2802/3613),需氧和厌氧均生长的阳性报警时间分别为(22.56±13.22)h和(26.69±15.80)h,仅需氧阳性的报警时间为(32.85±23.33)h,仅厌氧阳性的报警时间为(34.46±18.44)h。结论需氧和厌氧血培养方式获得甲型副伤寒沙门菌的阳性率相同,采用需氧和厌氧瓶配对培养可提高阳性检出率,只做厌氧或需氧培养将有11.24%或11.21%阳性病例被漏检。     

伤寒杆菌和甲型副伤寒杆菌的稳定L型外膜蛋白和染色体DNA酶切研究

非高渗培养基传代培养的伤寒杆菌和甲型副伤寒杆菌的稳定L型丧失了主要外膜蛋白、特异性表面抗原和染色体DNA部分片段,保留了沙门氏菌共同的内部抗原和形成L型独特的表面抗原。提示伤寒杆菌和甲型副伤寒杆菌的稳定L型多种特性的丧失同其基因或主要外膜蛋白的缺失有关。     

121株甲型副伤寒病原菌的噬菌体型和脉冲场凝胶电泳型

目的认识甲型副伤寒疫病区甲型副伤寒沙门菌的噬菌体型和脉冲场凝胶电泳（PFGE）型,确定噬菌体型和PFGE型之间的关系以及菌型的分布和流行率。方法采用沙门菌组合噬菌体和SpeI、XbaI消化染色体DNA的PFGE对来自玉溪市7县（区）的121株甲型副伤寒菌进行分型。结果121株菌存在4个完全噬菌体型或1个噬菌体型;用SpeI或XbaI消化产物分别得出以SpeI01、SpeI02或XbaI01占优势的5种或4种PFGE型,SpeI01型和SpeI02型分别占37．2％和57．9％,XbaI01型占95．1％。结论121株菌的噬菌体型与PFGE型之间无一致性联系,PFGE型的SpeI01和SpeI02或XbaI01是玉溪地区的主要流行型,采用SpeI和XbaI的PFGE是鉴别甲型副伤寒菌流行克隆的一项有用技术。     

1999‒2015年红塔区伤寒与副伤寒流行特征和气象变量的研究

目的 分析1999‒2015年红塔区伤寒与副伤寒（typhoid and paratyphoid fever,TPF）地方病区域流行特征和气象变量的关系,为TPF监测控制和危险因素评价提供科学依据。方法 采用描述流行病学方法和自主研发计算机软件建立中国疾病预防控制信息系统红塔区TPF病例分布与流行特征数据库,用Pearson相关分析和多元线性逐步回归分析研究TPF发病和气象变量关系。结果 1999‒2015年报告TPF病例数为8 398例,1999、2015年分别报告23、44例。1999‒2015年期间每年3~5月、6~10月、11月~次年2月分别为发病上升期（月均增长率63.8%）、高峰期（月均降低率2.0%）和下降期（月均降低率25.7%）,每年度病例数都呈现3月~10月季节性升高和11月~次年2月季节性降低;2000年8月至2010年12月每月病例数都大于8例,2000‒2002、2004‒2005、2005‒2007、2007‒2008、2008‒2010年出现五个高强度流行峰,峰期范围是12～24个月,周期范围是11～40个月;2001、2004、2006、2007、2009年五个高峰年度6~10月病例数范围分别为86～217、67～215、125～216、97～131、63～95例;1999、2000、2002、2003、2005、2008、2010、2015年八个低峰年度6月~10月病例数范围分别为1～3、1～17、32～60、30～43、46～55、43～78、22～61、2～11例。单因素分析TPF月平均发病率与月平均降雨量（r=0.825,P<0.01）、月平均气温（r=0.797,P<0.01）和月平均相对湿度（r=0.706,P<0.05）呈正相关;经多元逐步回归分析建立TPF月平均发病率（Y）与月平均降雨量（X）的拟合模型方程Y=4.563+0.051X。结论 红塔区TPF发病呈现季节性升高与降低、周期性流行、长期趋势特点;发病率与降雨量、气温、相对湿度呈正相关;传染源积累、重污染源形成、暴露人群增加驱动着流行特征与气象变量关系;相应规律、机制、政策、评估有助TPF的监测控制。     

Genetic diversity of Salmonella Paratyphi A isolated from enteric fever patients in Bangladesh from 2008 to 2018

BackgroundThe proportion of enteric fever cases caused by Salmonella Paratyphi A is increasing and may increase further as we begin to introduce typhoid conjugate vaccines (TCVs). While numerous epidemiological and genomic studies have been conducted for S. Typhi, there are limited data describing the genomic epidemiology of S. Paratyphi A in especially in endemic settings, such as Bangladesh.Principal findingsWe conducted whole genome sequencing (WGS) of 67 S. Paratyphi A isolated between 2008 and 2018 from eight enteric disease surveillance sites across Bangladesh. We performed a detailed phylogenetic analysis of these sequence data incorporating sequences from 242 previously sequenced S. Paratyphi A isolates from a global collection and provided evidence of lineage migration from neighboring countries in South Asia. The data revealed that the majority of the Bangladeshi S. Paratyphi A isolates belonged to the dominant global lineage A (67.2%), while the remainder were either lineage C (19.4%) or F (13.4%). The population structure was relatively homogenous across the country as we did not find any significant lineage distributions between study sites inside or outside Dhaka. Our genomic data showed presence of single point mutations in gyrA gene either at codon 83 or 87 associated with decreased fluoroquinolone susceptibility in all Bangladeshi S. Paratyphi A isolates. Notably, we identified the pHCM2- like cryptic plasmid which was highly similar to S. Typhi plasmids circulating in Bangladesh and has not been previously identified in S. Paratyphi A organisms.SignificanceThis study demonstrates the utility of WGS to monitor the ongoing evolution of this emerging enteric pathogen. Novel insights into the genetic structure of S. Paratyphi A will aid the understanding of both regional and global circulation patterns of this emerging pathogen and provide a framework for future genomic surveillance studies.     

Water and Food Consumption Patterns of U.S. Adults from 1999 to 2001

Objective: High water consumption has been proposed as an aid to weight control and as a means of reducing the energy density of the diet. This study examines the relationship between water consumption and other drinking and eating patterns. Research Methods and Procedures: The National Health and Nutrition Examination Survey 1999 to 2001, with responses from 4755 individuals ≥18 years of age, provides the data for this cross‐sectional analysis. A cluster analysis was performed using z‐scores of specific food and beverage consumption to examine patterns. A multinomial logit analysis was used to examine sociodemographic characteristics of each dietary pattern and to examine the effects of water consumption on the likelihood of consuming a non–dairy caloric beverage. All results were weighted to be nationally representative and controlled for design effects. Results: Within the sample, 87% consumed water, with an average daily consumption of 51.9 oz (1.53 liters) per consumer. Water consumers drank fewer soft/fruit drinks and consumed 194 fewer calories per day. Water consumers (potentially a self‐selected sample) consumed more fruits, vegetables, and low‐ and medium‐fat dairy products. Four distinct unhealthy dietary patterns were found that included little or no water consumption. Older and more educated persons used healthier food patterns. Mexican dietary patterns were much healthier than dietary patterns of blacks. Discussion: Water consumption potentially is a dietary component to be promoted, but much more must be understood about its role in a healthy diet. Because high water consumption is linked with healthier eating patterns—patterns more likely to be followed by higher‐educated, older adults—the target of water promotion and healthy diet options should focus on younger and less educated adults.