艰难梭菌研究现状

艰难梭菌(Clostridium difficile,CD)是产芽胞革兰阳性厌氧菌,产毒素艰难梭菌可导致艰难梭菌感染(Clostridium difficile infection,CDI)。产毒素艰难梭菌已被公认是抗菌药物相关性腹泻最常见的病原体,也是发达国家最常见的导致住院患者腹泻感染的原因之一。高毒力菌株导致全世界范围内CDI的发病率和死亡率增加。如何快速而准确地检测CD一直是备受关注的问题,国内外多推荐两步法和三步法进行检测。艰难梭菌治疗的一线用药是甲硝唑、万古霉素以及非达霉素,应用粪便微生物移植(faecal microbiota transplantation,FMT)也可作为治疗轻度或严重复发CDI(recurrence Clostridium difficile infection,rCDI)的可选方法。艰难梭菌的芽胞能抵抗不良环境,但抗菌药物的使用,医院环境的复杂性和医务工作者的手等因素会导致艰难梭菌易于传播,因此医疗机构应加强艰难梭菌的预防。本文主要对艰难梭菌的流行病学、致病机制、检测及治疗进行综述。     

Internalization of Clostridium difficile cytotoxin into cultured human lung fibroblasts

In cultured human lung fibroblasts treated with Clostridium difficile cytotoxin, the latency before appearance of the cytopathogenic effect was dose-related with a minimum of 45 min. At 37°C, the toxin was accessible on all cells to inactivation with trypsin or neutralization with antitoxin during the first tenth of the latency. At 0°C, the toxin was accessible considerably longer. The cytopathogenic effect was reversibly prevented by the lysosomotropic agents chloroquine and ammonium chloride, which had to be added within one-fifth of the latency to protect all cells. In the presence of chloroquine, but not of ammonium chloride, the time period during which the toxin remained amenable to neutralization with antitoxin was prolonged. The protective effect of ammonium chloride was not influenced by dropping the extracellular pH to 4.5, but that of chloroquine was abolished. The expression of the intoxication was not affected by inhibitors of the DNA, RNA or protein synthesis. Inhibitors of the energy metabolism prevented the cytopathogenic effect when added before the last phase of the latency. The results suggest that expression of the cytopathogenic effect requires internalization of the toxin, and that metabolic energy but no macromolecular synthesis is needed for the action of the toxin after this internalization.     

Ultrastructural effects of Clostridium difficile toxin B on smooth muscle cells and fibroblasts

The mechanism by which Clostridium difficile toxin B causes cells in culture to round was investigated. Cultured human lung fibroblasts and rabbit aortic smooth muscle cells were treated with partially purified or purified toxin B and monitored by light and transmission electron microscopy (TEM). Both preparations caused progressive cell rounding which correlated with disorganization of actin-containing myofilament bundles. Thin myofilaments became fragmented and finally disappeared (after 24 h) and dense bodies became more prominent, while all other organelles appeared unaffected.     

四川地区猪源艰难梭菌分子分型调查

[背景] 艰难梭菌是一种重要的人畜共患肠道病原菌,可引起人和多种动物抗生素相关性腹泻或假膜性肠炎。四川作为我国主要的生猪产区,还未有猪源艰难梭菌流行病学调查的相关报道,对猪源艰难梭菌的防控及保障猪肉安全带来挑战。[目的] 调查四川地区猪源艰难梭菌的感染、流行情况,并对分离出的艰难梭菌进行分子分型研究。[方法] 收集来自四川生猪主要产区6个养殖场中猪的粪便标本（n=110）,采用厌氧培养技术在艰难梭菌鉴别培养基上进行分离培养;采用PCR方法扩增艰难梭菌4个毒素基因（tcdA、tcdB、cdtA、cdtB）和7个管家基因（adk、atpA、dxr、glyA、recA、sodA、tpi）,对分离株进行毒素基因分型和多位点序列分型。[结果] 从110份样品中,经革兰氏染色镜检及PCR鉴定,共分离出20株艰难梭菌,分离率高达18.18%;毒素基因分型结果显示共获得3种毒素基因型,包括tcdA⁺tcdB⁺cdtA/cdtB⁺（n=3）、tcdA⁺tcdB⁺cdtA/cdtB^—（n=6）、tcdA^—tcdB^—cdtA/cdtB^—（n=11）;多位点序列分型结果显示获得5个ST型,包括ST11（n=3）、ST3（n=1）、ST35（n=2）、ST36（n=4）、ST109（n=10）;进化树结果显示,所有分离株聚集为2个大群,分别为3个分支和17个分支。[结论] 四川主要生猪产区猪群存在艰难梭菌感染,分离株的分子分型呈多样性,主要流行型为ST11、ST3、ST35、ST36、ST109型,并且存在ST11型高毒力菌株流行的风险。     

Identification and characterization of Clostridium difficile promoter element that is functional in Escherichia coli

The promoter element involved in the expression of a previously characterized cloned clostridial antigen was isolated and characterized. A restriction fragment containing the promoter element of the Clostridium difficile insert was cloned using the promoter probe vector, pGA46. Subclones of the clostridial DNA insert in pGA46 were then analyzed by nucleotide sequencing and by S1 nuclease experiments. The clostridial promoter element exhibits a high degree of homology with typical Escherichia coli promoter elements. This sequence probably represents a unique class of clostridial promoter elements which, given their ability to function in E. coli and C. difficile, can be used in the construction of a shuttle vector capable of gene expression in E. coli and C. difficile.     

炎症性肠病与艰难梭菌感染相关性研究的文献计量学和可视化分析

【背景】近年来,炎症性肠病患者中艰难梭菌（Clostridium difficile）感染率逐年上升,受到国内外学者广泛关注。我国在该领域的研究起步较晚,但患者数量众多,学习国际上对于炎症性肠病合并艰难梭菌感染的研究,对推动我国在该领域的深入发展具有重要意义。【目的】通过文献计量和可视化分析帮助研究者把握炎症性肠病与艰难梭菌感染相关性研究中的研究主题、方向、热点与前沿。【方法】同时检索Web of Science （WOS）中Science Citation Index Expanded （SCI-E）和CNKI中收录的关于炎症性肠病和艰难梭菌的相关文献,应用CiteSpace 6.2.2r软件进行国家/地区、机构、作者、关键词共现及被引文献、期刊共被引分析,同时进行可视化分析。【结果】经过数据检索和查重,最终可供分析的文献为WOS数据库1 030篇、CNKI数据库80篇。全球范围内,发文最多的国家是美国,主要研究机构有Harvard University、University of California System和Mayo Clinic等,高产作者有Khanna S、Shen B和Ananthakrishnan AN等,高频关键词包括Inflammatory bowel disease、Ulcerative colitis、Clostridium difficile、Clostridium difficile infection和Crohn’s disease等,聚类方向有#0 Diarrhea、#1 Ulcerative colitis、#2 Probiotics、#3 Pouchitis、#4 Gut microbiota、#5 Fecal microbiota transplantation、#6 Depression、#7 Entamoeba histolytica、#8 Pseudomembranous colitis、#9 Clostridium difficile和#10 Clindamycin。国内主要研究机构有南方医科大学和河北医科大学,高产作者有王浦、王斯淇等,高频关键词包括粪菌移植、艰难梭菌、肠道菌群、危险因素和克罗恩病等,聚类方向有#0艰难梭菌、#1益生菌、#2危险因素、#3腹泻和#4粪菌移植。【结论】利用CiteSpace软件对炎症性肠病和艰难梭菌感染相关性研究进行计量及可视化分析可知,该方向仍得到全球各医疗机构及研究者的关注,腹泻及粪菌移植这两个关键词分别代表了WOS数据库和CNKI数据库关于炎症性肠病合并艰难梭菌感染研究的热点。     

Plasmid detection and isolation in strains of Clostridium acetobutylicum and related species

Summary Twenty-one strains of Clostridium acetobutylicum, C. butylicum and Clostridium saccharoperbutylacetonicum were examined. Seven of them contained extrachromosomal DNA molecules, with a size ranging from 2.6 to more than 50 megadaltons. Strain M1 carries a small plasmid of 2.6 megadaltons, AB10 at least one plasmid of 2.6 megadaltons, AB12 one plasmid of 5.2 megadaltons, AB14 and AB16 a plasmid of about 7 megadaltons and a large one of more than 50 megadaltons, AB17 carries at least one plasmid of 6.7 megadaltons and AB18 two plasmids (4–6 megadaltons and 10–12 megadaltons). All of them are cryptic as at present no function can be correlated with their presence in a bacterial strain.     

123例腹泻患儿粪便中艰难梭菌毒素基因特征及感染危险因素分析

探讨腹泻患儿粪便中艰难梭菌毒素基因特征, 并分析产毒艰难梭菌感染的危险因素。

采集2019年1月至2021年3月嘉兴市第二医院儿科收治的腹泻患儿的粪便标本共123份, 其中社区获得性腹泻患儿60例, 医院获得性腹泻患儿63例。标本进行厌氧培养, 采用实时荧光PCR鉴定艰难梭菌tpi基因, 并检测tcd A、tcd B毒素基因。收集患儿临床资料, 采用Logistic回归分析产毒艰难梭菌感染的危险因素。

123例粪便标本共检出艰难梭菌tpi基因阳性35例(28.46%), 毒素基因中tcd A⁺ B⁺为19例(15.45%), tcd A⁺B^-为3例(2.44%), tcd A^-B⁺为2例(1.63%), tcd A^-B^-为11例(8.94%)。社区获得性腹泻患儿中tcd A/B产毒艰难梭菌感染率为28.33%, 高于医院获得性腹泻患儿的11.11%(P < 0.05)。产毒艰难梭菌感染腹泻患儿与非产毒艰难梭菌感染腹泻患儿的性别、年龄、居住地、是否早产、有无先天性疾病、既往有无胃肠道手术、抗生素应用种类、近1个月内有无机械通气、临床症状、血液白细胞计数、血红蛋白、粪便白细胞计数、血清C反应蛋白、血清白细胞介素-6、血清白蛋白、血肌酐、血清总胆红素水平比较差异无统计学意义(均P > 0.05)。产毒艰难梭菌感染腹泻患儿中的非母乳喂养、近1个月内抗生素用药史、抗生素持续用药时间 > 7 d、近1个月内糖皮质激素用药史、近1个月内抑酸药用药史、近1个月内肠内营养者的比例显著高于非产毒艰难梭菌感染腹泻患儿(均P < 0.05)。非母乳喂养(OR=2.433)、近1个月内抗生素用药史(OR=3.040)、近1个月内肠内营养(OR=2.330)是腹泻患儿产毒艰难梭菌感染的独立危险因素(均P < 0.05)。

嘉兴地区儿童艰难梭菌毒素基因主要为tcd A/B基因, 患儿以社区获得性腹泻为主, 非母乳喂养、抗生素用药史、肠内营养的儿童更容易感染艰难梭菌。

     

High resolution, on-line identification of strains from the Mycobacterium tuberculosis complex based on tandem repeat typing

Background  

Currently available reference methods for the molecular epidemiology of the Mycobacterium tuberculosis complex either lack sensitivity or are still too tedious and slow for routine application. Recently, tandem repeat typing has emerged as a potential alternative. This report contributes to the development of tandem repeat typing for M. tuberculosis by summarising the existing data, developing additional markers, and setting up a freely accessible, fast, and easy to use, internet-based service for strain identification.     

24株鸡源丁酸梭菌的分离鉴定及耐药基因与毒力基因携带情况

[目的]旨在对鸡源丁酸梭菌进行分离鉴定与安全性评估.[方法]利用厌氧培养方法对源自汶上芦花鸡与SPF鸡粪便样品进行丁酸梭菌的分离与纯化,挑选可疑菌落进行微生物质谱鉴定,进一步通过16S rRNA基因测序进行鉴定,16S rRNA测序结果与NCBI核苷酸数据库中丁酸梭菌的16S rRNA序列进行同源性分析;同时,进行所有...     

Characterization of an ATP-binding cassette from Clostridium perfringens with homology to an ABC transporter from Clostridium hathewayi

A ciprofloxacin-resistant mutant of Clostridium perfringens, strain VPI-C, which had stable mutations in the topoisomerase genes, accumulated less norfloxacin and ethidium bromide than the wild type, strain VPI. Efflux pump inhibitors both increased the accumulation of ethidium bromide by cells of the mutant and enhanced their sensitivity to this toxic dye. Cloning a gene, which codes for a putative ABC transporter protein (NP_562422) of 527 amino acids, from the mutant strain VPI-C into the wild-type strain VPI not only reduced the accumulation of ethidium bromide by the recombinant strain but also reduced its sensitivity to norfloxacin and ciprofloxacin. Efflux pump inhibitors decreased the rate at which ethidium bromide was removed from the cells of the recombinant strain. It appears that the putative ABC transporter protein (NP_562422) may contribute to extrusion of drugs from C. perfringens.     

Multi-locus variable number tandem repeat analysis for Escherichia coli causing extraintestinal infections

Discriminatory genotyping methods for the analysis of Escherichia coli other than O157:H7 are necessary for public health-related activities. A new multi-locus variable number tandem repeat analysis protocol is presented; this method achieves an index of discrimination of 99.5% and is reproducible and valid when tested on a collection of 836 diverse E. coli.     

A strategy for enrichment of claudins based on their affinity to Clostridium perfringens enterotoxin

Background  

Claudins, a family of protein localized in tight junctions, are essential for the control of paracellular permeation in epithelia and endothelia. The interaction of several claudins with Clostridium perfringens enterotoxin (CPE) has been exploited for an affinity-based enrichment of CPE-binding claudins from lysates of normal rat cholangiocytes.     

一株抑制产气荚膜梭菌的枯草芽孢杆菌BS-2特性

【背景】感染产气荚膜梭菌会引起动物坏死性肠炎,通常使用抗生素进行预防和治疗。随着我国饲料禁抗、养殖减抗的实施,寻找绿色微生态制剂及其代谢产物成为当前研究的热点。【目的】旨在研究前期筛选的一株抑制产气荚膜梭菌的枯草芽孢杆菌BS-2特性。【方法】检测了菌株生长曲线、代谢物质的抑菌特性及细菌素基因簇mRNA表达。【结果】枯草芽孢杆菌BS-2代谢物质对革兰氏阴性菌无抑制作用,而对革兰氏阳性菌具有较强的抑菌性能,并且对产气荚膜梭菌的抑菌性能在2-12 h内迅速增长,在12-24 h内抑菌性能较稳定;该抑菌性能不受胃蛋白酶、胰蛋白酶、蛋白酶K的影响,具有良好的热稳定性;进一步分析抑菌物质基因簇mRNA表达,发现枯草芽孢杆菌BS-2抑制产气荚膜梭菌的活性可能与表面活性素(surfactin)和美杀菌素(mersacidin)表达有关。【结论】枯草芽孢杆菌BS-2对产气荚膜梭菌具有较强的抑制作用,可能通过抑菌物质surfactin和mersacidin表达发挥作用。     

Molecular mechanism of pyruvate-ferredoxin oxidoreductases based on data obtained with the Clostridium pasteurianum enzyme

Pyruvate-ferredoxin oxidoreductase oxidises pyruvate in many fermentative microorganisms. The enzyme from Clostridium pasteurianum is an air-sensitive homodimer of 2×120000 daltons, for which pyruvate is the best substrate found among several -ketoacids. Each subunit contains eight iron atoms in two [4Fe---4S] clusters. Two distinct EPR signals, possibly associated with two ligand environments, arise from one of these clusters. Binding of pyruvate does not generate a radical. The results reported suggest a scheme for the electron flow in pyruvate ferredoxin oxidoreductases according to which the detailed reaction mechanism depends on the number (even or odd) of [4Fe---4S] clusters present in a given enzyme.     

Effect of pyruvate on glucose metabolism in Clostridium acetobutylicum

Pyruvate effects on the metabolism of Clostridium acetobutylicum during glucose fermentation were studied. After addition to the culture medium, the pyruvate was rapidly used, provoking several changes in the metabolic pattern of the bacteria. When pyruvate addition occurred early in the fermentation, the glucose utilization decreased and the solventogenic phase was not induced. When pyruvate was added during solventogenesis, glucose consumption was slightly affected and the cells fermented both substrates simultaneously: however, the acidogenic phase started again to the detriment of solvent formation. Usually, during the solvent phase, the cells remetabolized acetic and butyric acids into solvents, but when pyruvate was added, the utilization of acids was stopped and the specific rates of acetate and butyrate formation increased immediately. The acidogenic growth phase was characterized by high levels of acetate and butyrate kinase which dropped during the solvent phase. Addition of pyruvate limited the down shift of these two enzymes and the levels of the activities remained constant during the course of the fermentation. Conversely, the acetoacetate decarboxylase, which is characteristic of the solvent phase, decreased sharply in the presence of pyruvate. The fact that the specific rate of glucose consumption was not decreased by the pyruvate metabolism, a cosubstrate, proves that the phosphoroclastic reaction is not a limiting step. Furthermore, the pyruvate utilization represented a promising approach to obtain useful data on the intracellular compounds implicated in the mechanism for switching from the acidogenic to the solventogenic phase.     

Sporangila autolysis in Clostridium perfringens type A

The autolytic system functioning in the release of mature spores and enterotoxin from sporangia of Clostridium prefringens was partially characterized. After sporangial autolysis in buffer, the supernatant fluid of the suspension contained autolysin active against purified sporangial walls. The autolysin was most active at pH 8 and 37°C, in the presence of Co²⁺ (0.3 · 10⁻³ M CoCl₂) and trypsin (48 μg/ml). Sodium dodecyl sulfate-treated sporangial walls further extracted with trichloroacetic acid to remove teichoic acid were a better enzyme substrate than walls treated only with sodium dodecyl sulfate. N-Acetylmuramyl-l-alanine amidase activity which released N-terminal alanine, and endopeptidase activity which hydrolysed the d-alanyl-glycine linkage liberating N-terminal glycine and C-terminal alanine, were both functional at pH 8. It is not known if one or two enzyme are involved. Autolysin appeared in cells as early as 2 h after inoculation into sporulation medium. Two asporogenic Stage 0 mutants grown in sporulation medium also produced autolysin identical in mode of action to that of the sporogenic wild type. Although the active cellular autolysin concentration subsequently decreased as cells sporilated, the walls of 8-h-old sporangia containing refractile heat-resistant spores were more susceptible to digestion by autolysin, than those of 2-, 4-, or 6-h-old cells grown in sporulation medium or of 4- or 14-h vegetative cells from growth medium. The results suggest that a progressive change may occur in the structure of the sporangial wall during spore morphogenesis, thus increasing its susceptibility to autolysis.