新生隐球菌的生态学,流行病学,分子生物学及临床研究

在我国，对新生隐球菌已进行了较系统的研究，生态学方面，由鸽粪分离的环境株具有表型的多态性，包括新生变种的Ａ、Ｄ血清型及尿素酶阴性株，而这些多态性菌株均已在临床发现。分子生物学方面，Ｇ＋Ｃｍｏｌ％和核型已被进行分析。由ＰＦＧＥ分析所得到的有意义的信息是两个变种和５种血清型新生隐球菌株具有明显不同的核型谱。临床方面，研制的一种新的可同时检测酚氧化酶和尿素酶的培养基可用于该菌的临床鉴定。使用一种高渗培养     

利用微卫星标记研究新生隐球菌分子流行病学

目的 研究国内隐球菌临床分离株的遗传多态性和分子流行病学.方法 选择与新生隐球菌遗传相关的9个微卫星标记,分析这9个位点从1993 ～2009年国内分离到的新生隐球菌临床株遗传背景、来源及变异程度.结果 116株被研究的隐球菌临床分离株,主要归属于3个微卫星复合物(MC2,MC3和MC12),其中大部分为MC2(103株).8株菌株属于目前为止未被国内外认识的新复合物(MC12).结论 利用微卫星DNA多态性研究新生隐球菌分子流行病学有较大的应用价值.     

艾滋病合并新生隐球菌感染的研究进展

新生隐球菌感染是全世界艾滋病患者死亡的主要原因,尤其是在撒哈拉以南非洲地区发病率最高[1]。新生隐球菌除了容易感染HIV个体外,还易感染其他免疫功能低下的个体,如造血系统恶性肿瘤、器官移植后服用免疫抑制剂及免疫缺陷病患者。格特隐球菌主要侵犯免疫功能正常的个体,但也感染免疫功能低下患者如合并艾滋病毒的患者[2]。     

氯喹与氟康唑联合对新生隐球菌的体外药敏实验

目的研究氯喹与氟康唑体外联合应用对隐球菌生长作用的影响。方法参考M27-A方案,检测10μmol/L,100μmol/L与1 000μmol/L 3种浓度氯喹与氟康唑联合后对20株菌株的氟康唑对隐球菌最小抑菌浓度与最小杀菌浓度的变化。结果与10μmol/L氯喹组相比,100μmol/L以上浓度的氯喹组可以显著降低氟康唑对隐球菌的M IC与MFC。结论氯喹在体外可以提高氟康唑抗隐球菌的作用,与氟康唑具有协同抗隐球菌的作用。     

新生隐球菌感染流行病学现状及耐药机制相关研究进展

新生隐球菌是一种广泛存在于环境中的酵母类真菌,主要侵犯中枢神经系统引起隐球菌性脑膜炎。HIV感染是导致隐球菌感染的主要危险因素之一,但近年来关于非HIV患者隐球菌感染的报道不断增加。体外药敏试验证实大部分新生隐球菌对棘白菌素类药物具有内在抗性。两性霉素B和氟康唑是用于隐球菌感染治疗的一线药物,而长期广泛用药引起新生隐球菌对氟康唑的耐药率逐年升高,患者临床治疗失败率居高不下。为进一步加深对新生隐球菌的认识,本文结合国内外流行病学报道及相关研究,从感染现状、生物学特征、诊治方法和耐药性等方面进行综述,以期为新生隐球菌性脑膜炎的临床诊治提供参考。     

新生隐球菌荚膜研究现状

新生隐球菌是一种专性需氧条件致病菌,它的细胞壁外包绕着一个多糖荚膜,是其主要毒性因子之一。荚膜主要包含两种多糖-葡萄糖醛酸木糖和半乳糖甘露聚糖,此外还有少部分的甘露糖蛋白。这些多糖分子除构成多糖荚膜外,同时也参与新生隐球菌与宿主之间的免疫反应。该文对新生隐球菌荚膜的结构、生物合成、免疫反应及针对荚膜的抗真菌治疗等方面作一综述,旨在为新生隐球菌相关疾病的研究提供新的思路。     

新生隐球菌感染与细胞因子的相互关系

新生隐球菌是重要的条件致病真菌,可导致免疫抑制患者产生致命的新生隐球菌性脑膜炎;继而在脑部损伤部位有多种细胞因子的表达和炎症细胞的浸润,形成了一个细胞因子网络,介导一系列致病机制和防御机制的产生。为明确细胞因子与新生隐球菌在致病和防御过程中的相互作用,本文就新生隐球菌与细胞因子的关系进行综述。     

新生隐球菌的荚膜多糖合成研究进展

新生隐球菌是一重要的致病真菌,其细胞壁外层的多糖荚膜是第1个被公认的新生隐球菌毒性因子。本文总结了在荚膜生理和生化合成方面的研究进展,介绍了研究新生隐球菌荚膜合成的常用方法以及在新生隐球菌的荚膜代谢途径、生化合成酶、分泌、组装和调节这些广泛的研究领域存在的许多未解决的问题。     

播散性隐球菌病1例及其实验研究

目的 播散性隐球菌病1例临床及实验研究.方法 患者男,72岁,红皮病1年2个月,口服醋酸泼尼松治疗,双下肢出现结节、溃烂6个月.皮损组织病理、皮损组织真菌培养、尿素酶试验、PCR扩增测序比对明确诊断,同时做胸部及脑部CT.结果 皮损组织病理显示为感染肉芽肿改变,可见大量圆形和椭圆形酵母细胞.皮损组织真菌培养可见酵母样菌落生长,菌株尿素酶试验阳性,ITS区测序比对鉴定为新生隐球菌grubii变种.血清隐球菌荚膜多糖抗原乳胶凝集试验阳性(++++).胸部CT显示左下肺后基底段空洞性病灶.依据临床及实验室检查确诊为由新生隐球菌grubii变种引起的 播散性隐球菌病.给予患者静滴氟康唑400 mg/d治疗2周,之后改口服300 mg/d治疗,3个月后结节性皮损全部消退,胸片显示左肺陈旧性病变,血清隐球菌荚膜多糖抗原乳胶凝集试验阳性(++).治疗15个月后,血清隐球菌荚膜多糖抗原乳胶凝集试验仍阳性(++).结论 对该病例的临床和实验室研究为临床明确诊断和治疗提供了依据,确定菌种需要进行分子生物学研究.     

树突细胞与新生隐球菌

新生隐球菌( Cn) 是临床上重要的病原真菌, 树突细胞( DC) 则是最重要的抗原呈递细胞。作为宿主固有免疫和适应性免疫的联系枢纽,DC 对于识别病原、呈递抗原、诱导宿主免疫应答十分重要。许多研究证明,DC 可通过细胞表面的多种受体有效识别新生隐球菌抗原( CnAg) , 诱导宿主产生有效的细胞免疫应答。DC 本身也有一定的杀菌能力, 但DC 的不同亚群以及成熟状态对宿主的免疫防御功能有重要影响。另外, 隐球菌除具有甘露糖蛋白等主要免疫显性抗原外, 还有多种抑制机体保护性免疫应答的毒性因子。本文就近年来国内、外对两者之间复杂机制的研究进行概述。     

Resistance to amphotericin B associated with defective sterol Δ8→7 isomerase in a Cryptococcus neoformans strain from an AIDS patient

Abstract Two Cryptococcus neoformans strains isolated from an AIDS patient were investigated, a pretreatment isolate (CN1) and a second isolate (CN3) following failure of fluconazole and amphotericin B treatment. No difference in fluconazole sensitivity, but relative resistance to amphotericin B was observed for CN3. The sterol composition of CN3 indicated a defect in sterol Δ ^8→7 isomerase in this strain and depletion of ergosterol, the major sterol of the CN1.     

Sensibilidad de aislamientos de Candida albicans de hemocultivos a 3 fármacos: estudio retrospectivo en Rio Grande do Sul,Brasil, 1999 a 2009

BackgroundCandidiasis is one of the most important among recurrent invasive yeast infections in patients, thus antifungal treatment becomes a challenge.AimsThe aim of this study was to evaluate the in vitro activity of clinical Candida albicans isolates from blood cultures to fluconazole, amphotericin B and anidulafungin, in a hospital from Rio Grande do Sul, Brazil.MethodsThe susceptibility of 153 isolates to the 3 drugs mentioned was tested according to Clinical and Laboratory Standars Institute. Minimal inhibitory and fungicidal concentrations (MIC, MFC, respectively) of each drug were determined, as well as the epidemiological cutoff value (ECV).ResultsAll of the isolates were susceptible to anidulafungin, MIC and MFC ≤ 1 μg/ml; however, when compared with ECV, 3% of the isolates exhibited higher values against fluconazole, 96% were susceptible, 3% susceptible dose-dependent, and 1% resistant. Also, it was observed that 21% of the isolates exhibited higher values than ECV. One isolate was resistant to amphotericin B; the other ones, susceptible, based on the MFC; furthermore, 1.5% of the isolates exhibited higher values.ConclusionsC. albicans isolates exhibited more susceptibility to anidulafungin, and 90% of them (MIC₉₀) exhibited the lowest values against amphotericin B. Based on ECV and Pfaller classification, isolates could be resistant to fluconazole, demonstrating the importance of the combination of these parameters.     

An ectophosphatase activity in Cryptococcus neoformans

There is increasing evidence in the literature showing that fungal pathogens express biologically active ectoenzymes. The expression of surface phosphatases at the cell surface of Cryptococcus neoformans, the etiologic agent of cryptococcosis, was evaluated in the present study. Different isolates of C. neoformans express ectophosphatase activity, which is not influenced by capsule size or serotype. The cryptococcal enzyme is an acid phosphatase, inhibited by classic inhibitors of ectophosphatases, including ammonium molybdate and sodium salts of fluoride and orthovanadate. Only the inhibition of enzyme activity caused by sodium orthovanadate has been shown to be irreversible. The cryptococcal ectoenzyme is also inhibited by Zn2+ and inorganic phosphate, the final product of reactions catalyzed by phosphatases. The ectophosphatase from C. neoformans efficiently releases phosphate groups from different phosphorylated amino acids, giving a higher rate of phosphate removal when phosphothreonine is used as a substrate. Yeast cells with irreversibly inhibited ectophosphatases are less capable of adhering to animal epithelial cells than fungi fully expressing enzyme activity, suggesting that ectoenzyme expression can contribute to the pathogenesis of C. neoformans.     

对两种新生隐球菌选择性培养基的比较研究

比较鸟籽琼脂（GASA,Guizotia abyssinica seed agar）和咖啡酸玉米琼脂（CACA,Caffeic acidcommeal agar）对新生变种和格特变种的培养效果。再同时用两种培养基分离命粪和澳洲赤桉标本中的新生隐球菌。结果表明,CACA对新生隐球菌的培养和选择性分离效果与GASA相同,能够用于新生隐球菌的选择性分离。     

Do major species concepts support one, two or more species within Cryptococcus neoformans?

Cryptococcus neoformans, the agent of cryptococcosis, had been considered a homogeneous species until 1949 when the existence of four serotypes was revealed based on the antigenic properties of its polysaccharide capsule. Such heterogeneity of the species, however, remained obscure until the two morphologically distinct teleomorphs of C. neoformans were discovered during the mid 1970s. The teleomorph Filobasidiella neoformans was found to be produced by strains of serotype A and D, and Filobasidiella bacillispora was found to be produced by strains of serotype B and C. Ensuing studies revealed numerous differences between the anamorphs of the two Filobasidiella species with regard to their ecology, epidemiology, pathobiology, biochemistry and genetics. At present, the etiologic agent of cryptococcosis is classified into two species, C. neoformans (serotypes A and D) and Cryptococcus gattii (serotypes B and C). Intraspecific genetic diversity has also been revealed as more genotyping methods have been applied for each serotype. As a result, the number of scientifically valid species within C. neoformans has become a controversial issue because of the differing opinions among taxonomists as to the appropriate definition of a species. There are three major species concepts that govern classification of organisms: phenetic (morphologic, phenotypic), biologic (interbreeding) and cladistic (evolutionary, phylogenetic). Classification of the two C. neoformans species has been based on the phenetic as well as the biologic species concept, which is also supported by the cladistic species concept. In this paper, we review and attest to the validity of the current two-species system in light of the three major species concepts.     

Potential of plant oils as inhibitors of Candida albicans growth

Minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) were determined for 38 oils of plant origin against Candida albicans. Four strains including one standard strain were used in this study. The antifungal agents, Fluconazole and Amphotericin B were used as positive controls. The standard strain (ATCC10231) used in this study was found to be highly resistant to Fluconazole: 3000 microg ml(-1) of Fluconazole was required to inhibit the growth of this strain partially, and complete inhibition could not be achieved. Other Candida strains were sensitive to 5 microg ml(-1) of Fluconazole. All the strains used were sensitive to Amphotericin B. Of the 38 oils tested, 23 were found effective and fifteen were ineffective. Based on their MFCs, effective oils were categorized into three categories. Seven oils, which exerted fungicidal effect at less than 0.15% concentration of oils, were grouped into the most effective class. The oils exhibiting MFCs in the range of 0.16-1.5% concentration were considered moderately effective. Nine oils, which required more than 1.5% concentration, were regarded as less effective. The Fluconazole-resistant strain (MTCC 227) was sensitive to at least 23 of the plant oils. Results of this study indicate that oils of plant origin may find use as potential anti-Candida agents.     

中枢神经系统真菌感染的诊断与治疗

分析中枢神经系统真菌感染患者的临床特征、预后及其影响因素。收集我院2001年1月至2009年12月收治的42例中枢神经系统真菌感染患者的临床资料,对患者的诊断与误诊、实验室和病原学检查、治疗与预后等进行回顾性统计分析。42例患者中合并其他疾病者29例,占69.0%;首诊误诊32例,占76.2%。两性霉素B(AmpB)治疗者25例,其中6例在疾病早期联合5-氟胞嘧啶治疗,15例单用氟康唑治疗。治愈20例,占47.6%;好转11例,占26.2%;死亡11例,占26.2%。中枢神经系统真菌感染误诊率高,各种原因所致的免疫缺陷是引发中枢神经系统真菌感染的主要危险因素,尽早明确诊断,联合AmpB与5-FC抗真菌治疗、积极控制颅内压是降低病死率及改善预后的关键。