新生隐球菌感染12例临床特点及实验室检测的回顾性分析

目的:了解新生隐球菌深部感染的临床特点及实验室检测,分析其耐药性.方法:对12例新生隐球菌感染患者的临床资料进行网顾性分析;应用美国BD9240全自动血液分析仪进行细菌培养和真菌培养,阳性酵母样真菌经API20C鉴定到种;FUNGS 3进行真菌药敏试验.结果:12例患者均经病原学确诊;其中中枢神经系统感染6例,血液感染5例,腹腔感染1例;新生隐球菌对临床常用5种抗真菌药物除2例氟康唑中介外,其余均敏感.结论:新生隐球菌不仅引起中枢神经系统感染,也可引起身体多部位感染,死亡率较高;早期病原学检测对疾病的诊断和治疗十分重要,联合用药预后较好.     

肝肾移植术后患者隐球菌感染的临床特征分析

目的研究肝、肾移植术后患者隐球菌感染的临床特征。方法选取2010年1月到2015年7月来浙江大学医学院附属第一医院就诊的肝、肾移植术后并确诊为隐球菌感染的患者,对其临床特征进行回顾性分析。结果研究周期内有23例患者符合入组要求,其中肾移植术后21例、肝移植术后2例。对23例患者进行分析,发现单纯隐球菌肺炎6例(占26.0%)、单纯隐球菌性脑膜炎6例(占26.0%)、隐球菌性脑膜炎合并隐球菌肺炎8例(占34.7%)、隐球菌败血症2例(占8.6%),皮肤隐球菌感染1例(占4.3%)。所有隐球菌肺炎均经肺穿刺病理确诊,临床表现以发热,咳嗽咳痰,气急症状居多。胸部CT表现为结节、空洞、肿块、渗出等。所有隐球菌脑膜炎患者中9例经脑脊液培养出新生隐球菌、7例脑脊液墨汁染色见隐球菌,其中3例培养及涂片均为阳性。临床表现以头痛、发热、呕吐症状居多,1例并发癫痫,1例并发意识障碍。所有患者分别给予氟康唑、两性霉素B、氟胞嘧啶针、伏立康唑等抗真菌治疗,其中3例隐球菌脑膜炎患者予两性霉素B鞘内注射。经1~6个月治疗后,总体预后情况良好(好转22例,死亡1例)。结论肝、肾移植术后患者因免疫抑制剂的长期使用,隐球菌感染值得重视,其临床症状不典型,易误诊及漏诊,通过对其主要症状及影像学特点判断,结合肺穿刺活检、脑脊液检查、血培养等检查手段,可明显提高隐球菌感染的检出率,从而做到早诊断,早治疗,降低病死率。     

肾移植术后隐球菌性脑膜炎的临床分析

目的 分析肾移植术后隐球菌性脑膜炎的临床特点,以期提高临床医生的诊治水平.方法 回顾性分析肾移植术后隐球菌性脑膜炎的临床表现、实验室检查和治疗预后.结果 4例患者中,男2例,女2例,全部为首次同种异体肾移植.所有患者均有发热和头痛症状,多表现为轻度头痛和低热.3例患者隐球菌涂片和培养均为阳性.所有患者分别给予两性霉素B脂质体、伏立康唑、5-氟胞嘧啶等抗真菌治疗,其中1例合并两性霉素B鞘内注射.经2～4个月治疗后,4例隐球菌涂片转阴,临床症状消失,均在我院随访,至今未复发.结论 肾移植术后隐球菌性脑膜炎首发症状隐匿,临床表现不典型,极易误诊漏诊.早期明确诊断、多科室协作、规范足量治疗是提高此病救治成功的关键.     

腰椎置管治疗隐球菌性脑膜炎4例并文献复习

目的 观察早期腰椎置管引流加鞘内注射两性霉素B治疗伴有恶性高颅压隐球菌性脑膜炎的临床效果及探讨临床应用的可行性.方法 详细分析和归纳整理了我科应用腰椎置管法治疗的4例隐球菌性脑膜炎患者的临床资料.结果 4例患者经早期腰椎置管引流加鞘内注射两性霉素B治疗后临床症状迅速改善.经联合治疗后,痊愈3例,好转1例,4例患者随访至今均无复发.结论 早期腰椎置管引流加鞘内注射两性霉素B治疗隐球菌性脑膜炎能有效的降低隐球菌脑膜炎患者的高颅压,改善临床症状,提高疗效.     

新疆哈萨克族2型糖尿病患者粪便中韦荣球菌的分离鉴定

目的从新疆哈萨克族2型糖尿病患者粪便中分离培养并鉴定韦荣球菌。方法收集新鲜哈萨克族2型糖尿病患者的粪便样本,用韦荣球菌专属培养基进行分离培养,微量生化反应管进行初步鉴定;提取所得菌株的DNA,使用韦荣球菌属引物对此DNA进行特异性扩增,结合全自动细菌鉴定仪对菌株进行鉴定。结果 (1)所得到的菌株经微量生化反应管初步鉴定为韦荣球菌;(2)使用韦荣球菌属引物对此菌株DNA进行特异性扩增获得预期产物;(3)经全自动细菌鉴定仪最终确定所得菌株为韦荣球菌。结论从新疆哈萨克族2型糖尿病患者粪便中分离培养得到韦荣球菌。     

2例太岁样品分离菌的初步研究

目的:太岁是自然界中一种未知生命体,本实验对2例来源地不同的太岁样品进行菌株分离培养与鉴定。方法:太岁经表面消毒后无菌研磨,采用多种培养基涂板以分离可培养菌株,并进行16S rDNA、18S rDNA序列PCR扩增、测序及Blast比对。结果:从2例太岁样本中分别获得4株相似菌株,经鉴定,分离菌株TS-1为荧光假单胞菌(Pseudomonas flulorescens),TS-2为地中海短波单胞菌(Brevundimonas mediterranea),TS-3为红串红球菌(Rhodococcus erythropolis),TS-4为鞘氨醇单胞菌(Sphingomonas sp.)。结论:2例来源不同的太岁中均含有上述4种菌株,在生物学组成中具有一定的共性,为研究太岁的形成提供了新的思路。     

分析青光眼浅前房形成及术后处理方法

目的分析青光眼术后浅前房的形成原因及处理措施。方法对67例青光眼小梁切除术患者的临床资料进行回顾性分析。结果67例患者中,22例(32.84%)发生术后浅前房,原因包括滤过过强7例,脉络膜脱离5例,结膜瓣渗漏4例,睫状环阻滞性6例。术后经药物保守治疗20例,经手术治疗2例,对症处理后患者前房与视力均有良好恢复。结论及时、正确辨别青光眼术后浅前房形成原因,给予合理的处理措施,对促进患者良好预后有积极意义。     

非霍奇金淋巴瘤伴播散性隐球菌感染1例

患者男,16岁,非霍奇金淋巴瘤化疗5个月,发热1周,血培养新生隐球菌生长。脑脊液真菌镜检可见少量孢子,真菌培养阴性。血清及脑脊液隐球菌荚膜多糖抗原乳胶凝集试验及胶体金试验阳性。头颅核磁平扫未见明显异常,胸部增强CT可见左肺下叶后基底段结节,感染可能性大。分离菌株ITS及NL区测序比对菌种鉴定为新生隐球菌新生变种。确诊播散性隐球菌病。予两性霉素B及氟胞嘧啶强化治疗4周,后由于副作用严重,予氟康唑巩固及维持治疗1年获得痊愈,随访4年多无复发。     

致眼部感染病原菌及其耐药性分析

目的探讨眼部感染患者的病原菌组成及其耐药性。方法选取2010年1月至2014年6月就诊于温州医科大学附属眼视光医院的眼部感染患者,对临床送检的标本进行鉴定培养。培养阳性的菌株经API或ATB试剂条鉴定,并对标本进行分类及药物敏感性分析。结果阳性细菌610株,以革兰阳性球菌为主,占69.84%,革兰阴性杆菌次之,占16.89%;真菌115株,以镰刀菌属为主,占43.48%。万古霉素、夫西地酸、左氧氟沙星等对大部分菌株有较好的敏感性。结论掌握眼科感染病原菌分布及药物敏感性规律,可有效预防和控制眼部感染。     

2009-2011年胆石症患者胆汁肠球菌菌群分布及菌种耐药性变迁

目的 了解2009年1月年2011年12月胆石症患者胆汁中肠球菌的分布及菌种耐药性变迁,指导临床合理应用抗菌药物.方法 采用法国生物梅里埃公司生产的VITEK-2细菌分析仪对胆汁标本中分离的肠球菌做鉴定及药敏试验.结果 2009年1月至2010年6月共分离到74株肠球菌;2010年7月至2011年12月共分离到115株肠球菌,排在前两位的均为粪肠球菌和屎肠球菌.药敏结果显示粪肠球菌对除红霉素和喹努普汀/达福普汀外的其他抗菌药物具有较高的抑菌活性;屎肠球菌对除喹努普汀/达福普汀、利奈唑胺、万古霉素外的其他抗菌药物具有较高的耐药率;首次检测到耐利奈唑胺的肠球菌.结论 胆石症患者胆汁中肠球菌感染以粪肠球菌和屎肠球菌为主,且多种细菌对抗菌药物均有不同程度的耐药,因此加强细菌耐药监测对临床合理使用抗菌药物有重要的参考意义.     

Septicaemia associated with an Aerococcus viridans infection in immunodeficient mice

This report describes a case series of septicaemia caused by infection with Aerococcus viridans in immunodeficient NOD/LtSz-Prkdc(scid) (NOD/SCID) mice. During a period of 3 weeks more than 40 animals died or became ill with clinical signs of ruffled coat, weight loss, laboured breeding, and distended abdomen. At necropsy it was found that the animals displayed symptoms of sepsis with widespread abscesses in the liver, heart, lungs or pyogenic peritonitis. A Gram-positive coccus was isolated in pure culture from the abscesses or peritoneum from affected animals. According to phenotypic and phylogenetic characterization, the isolate was identified as A. viridans. This is the first report of a spontaneous outbreak of septicaemia caused by A. viridans infection in immunodeficient laboratory mice and we conclude that A. viridans should be considered as a pathogen in immunodeficient mice.     

猪源绿色气球菌的分离鉴定与药敏特性研究

目的鉴定研究2006年和2008年本实验室分别从广东清远和广西北流两个猪场发病小猪的膝关节积液中分离到2株呈四联状或成对排列,在山羊血琼脂平板上能形成明显的α-溶血圈的G+球菌。方法采用小白鼠致病性试验、细菌常规生理生化鉴定、药敏试验、耐药基因检测及16S rRNA序列分析等方法对上述分离的2株细菌进行鉴定及药敏特性研究。结果确定这2株G+球菌为正常情况下非致病性绿色气球菌(登录号分别为:GQ161096;GQ161097)。系统发育分析表明,两分离株与绿色气球菌15MS(登录号:EU075039.1)同源性分别高达99.4%和98.7%。药敏试验及耐药基因检测发现,这2株绿色气球菌除了对新霉素、氟哌酸、恩诺沙星、菌必治和环丙沙星等5种药物呈高敏外,对先锋V等13种抗菌素均不敏感。耐药基因检测结果表明,GXBL-1可检出6个耐药基因,GDQY-1则可检出多达10个耐药基因。结论从这2株分离株耐药谱检测结果可以看出,正常菌株同样携带多重耐药基因,存在着通过质粒转座子和整合子将耐药基因转移给敏感菌,导致耐药性传播的可能,应引起足够重视。     

Esophageal diverticulum associated with Aerococcus viridans infection in a loggerhead sea turtle (Caretta caretta)

A juvenile loggerhead sea turtle (Caretta caretta) stranded in Gran Canaria, Spain was necropsied. The turtle was underweight, had sunken eyes, and small amounts of crude oil were in the oral cavity. The most significant lesion was a large esophageal diverticulum at the junction of the esophagus and stomach. The diverticulum was full of gas and green mucoid fluid and a diffuse thick yellow fibrinonecrotic membrane covered the mucosa. The lumen of the diverticulum also contained moderate numbers of cephalopods, crustaceans, and anthropogenic debris including crude oil balls, plastics, and fishing lines. Histologically there was a severe diffuse fibrinonecrotic esophagitis. Aerococcus viridans was isolated from the diverticulum. This is the first report of an esophageal diverticulum in a sea turtle. Although A. viridans is a known pathogen of lobsters and fishes, there are no reports of A. viridans infection in sea turtles.     

Rapid identification of Aerococcus viridans using the polymerase chain reaction and an oligonucleotide probe

A polymerase chain reaction/oligonucleotide probe method was developed for the specific identification of the Gram-positive bacterium Aerococcus viridans. Primers for the enzymatic amplification reaction were designed from specific sequences within the 16S rRNA. The method was also highly sensitive and 10 cfu of A. viridans could be detected in 5 h although the reliability of detection was poor in mixed cultures with Escherichia coli.     

Genetic characterization of the lobster pathogen Aerococcus viridans var. homari by 16S rRNA gene sequence and RAPD

A combination of 16S rRNA sequencing and random amplified polymorphic DNA (RAPD) analysis was used to evaluate the genetic diversity within Aerococcus viridans var. homari, the causative agent of gaffkemia in lobsters. A collection of 7 A. viridans var. homari strains and 2 avirulent A. viridans-like cocci isolated from homarid lobsters harvested from different regions on the Atlantic Coast of North America were analyzed. The isolates are separated geographically and temporally between the years 1947 and 2000. Sequencing of 16S rRNA genes confirmed the inclusion of all 9 isolates in the monophyletic A. viridans clade (99.8 to 100% similarity). RAPD analysis revealed that the 9 A. viridans var. homari isolates could be separated into 2 distinct subtypes. Subtype 1 included the 7 pathogenic lobster isolates and constituted a homogeneous group regardless of their geographical, temporal or virulence differences. Subtype 2 contained the 2 avirulent A. viridans-like cocci that had distinct RAPD patterns and clustered separately with the non-marine A. viridans. RAPD analysis represented a useful method for determining molecular subtyping for the intraspecific classification and epidemiological investigations of A. viridans var. homari.     

Use of dye affinity chromatography for the purification of Aerococcus viridans lactate oxidase

Lactate oxidase was purified from Aerococcus viridans (A. viridans) by dye affinity chromatography and FPLC ion exchange chromatography. The lactate oxidase could be purified by comparatively simple procedures, the purification achieved from a crude extract of A. viridans was 41-fold with a specific activity of 143 units/(mg of protein). The purified enzyme was a L-lactate oxidase, which catalyses the conversion of L-lactate in the presence of molecular oxygen to pyruvate and H(2)O(2). This purified lactate oxidase showed an apparent molecular mass of 48,200 in SDS-PAGE and the native molecular weight, as estimated by FPLC gel filtration, was 187,300. This molecular weight indicates that lactate oxidase exists in tetrameric form after gel filtration. To differing degrees, all the triazine dyes tested were inhibitors of lactate oxidase, solutions of free triazine dyes showing an inhibition mechanism which was both time- and pH-dependent.     

Classification of Homarus americanus hemocytes and the use of differential hemocyte counts in lobsters infected with Aerococcus viridans var. homari (Gaffkemia)

Hemocytes of the American lobster (Homarus americanus H. Milne Edwards) were classified after examination of Wright-Giemsa stained cytocentrifuge preparations by brightfield light microscopy. Eleven hemocyte types were identified using morphologic criteria. The classification system was then used to monitor changes in the differential hemocyte count (DHC) of lobsters infected with the Gram positive coccus Aerococcus viridans var. homari, etiologic agent of gaffkemia. The appearance of less mature hemocytes in the DHCs of lobsters in the late stages of infection was similar to the 'left shift' of vertebrate inflammation. Results from this study suggest that DHCs can be used to assess and characterize inflammation in H. americanus and possibly other crustaceans.     

Genome sequence of Aerococcus viridans LL1

Aerococcus viridans is a catalase-negative Gram-positive bacterium and has been described as an airborne organism widely distributed in the hospital environment or in clinical specimens. We isolated A. viridans strain LL1 from indoor dust samples collected by a patient. Here, we prepared a genome sequence for this strain consisting of 31 contigs totaling 1,994,039 bases and a GC content of 39.42%.     

Highly efficient Aerococcus viridans L-α-glycerophosphate oxidase production in the presence of H2O2-decomposing agent: purification and kinetic characterization

Glycerophosphate oxidase was purified from Aerococcus viridans cells by phase partitioning in Triton X-114, ammonium sulfate fractionation, FPLC ion-exchange chromatography and FPLC hydrophobic-interaction chromatography. The purification achieved from a crude extract of A. viridans was 38-fold with a 32% recovery of activity. Under the growth conditions used, A. viridans strain CECT 978 proved to be an excellent glycerophosphate-oxidase producer, with enzyme production 2,800-fold greater than that described in the literature for the same microorganism. The culture medium used in the present work is that commonly used for cultivation of this microorganism, except that an H2O2-decomposing enzyme was added. The addition of catalase to the growth medium had a clear effect on the growth rate. Furthermore, methylglyoxal, a metabolite that is formed enzymatically from triose phosphates, was found to be an inactivator of glycerophosphate oxidase activity.     

Characterization of peptidoglycan stem lengths by solid-state 13C and 15N NMR

Lyophilized whole cells of Aerococcus viridans (Gaffkya homari) grown on a synthetic medium containing D-[2-13C, 15N]Ala, or containing both L-[1-13C]Lys and D-[15N]Ala, have been examined by double cross-polarization magic-angle spinning 13C and 15N nuclear magnetic resonance. Results from the double-labeled alanine experiment confirm the absence of metabolic scrambling of alanine by A. viridans. Results from the combined single-label experiment can be used to count directly the number of adjacent L-Lys and D-Ala units in peptide chains of cell-wall peptidoglycan. This count leads to the conclusion that there are no terminal D-Ala or D-Ala-D-Ala units in uncross-linked chains of the peptidoglycan of A. viridans.