细菌L型感染与慢性子宫内膜炎

本文应用微生物培养、免疫组织化学等方法,对876例子宫内膜进行了组织病理学研究。发现:1.子宫内膜细菌 L 型感染病例中,32.5%的内膜间质有淋巴细胞浸润、淋巴滤泡形成或伴有浆细胞浸润。尚有部分病例虽有感染,但无慢性炎细胞浸润。2.细菌学检查阴性病例,内膜间质无慢性炎细胞浸润。3.病原微生物培养显示70.8%为金黄色葡萄球菌 L 型感染。4.免疫组织化学证明子宫内膜间质细菌型和 L 型的检出率高于腺体。作者提出子宫内膜间质中淋巴细胞浸润或淋巴滤泡形成系细菌 L 型感染的病变特征。故也是慢性子宫内膜炎的诊断依据。     

金黄色萄葡球菌L型特异性抗体的免疫组化试验在妇科感染性疾病诊断上的应用

本文对49例慢性子宫内膜炎、慢性宫颈炎等妇科疾病的病理切片,用金黄色葡萄球菌细菌型及L型的特异性杭体作酶免疫组化染色(PAP法)证明在金黄色葡萄球菌引起的各种妇科感染中,细菌型及L型混合感染占60％,单独细菌型感染占28.9％,单独L型感染占11.1％。本研究证明了金葡菌变异为L型后,有特异性杭原出现,并证明细菌L型的特异性抗原有一定的免疫学诊断价值。     

Asymptomatic Urinary Tract Infection in Gynaecological Outpatients

In this study mid-stream specimens of urine were collected from all new patients attending a gynaecological outpatient department and tested for significant bacteriuria. Those having an asymptomatic infection were folloWed up, treated, and investigated adiologically.Of 1,506 women screened for bacteriuria 82 (5·4%) were found to have a persistent infection. The predominant organism was Escherichia coli, present in 83% of infections. Treatment with sulphonamides produced a good cure rate, which was improved by ampicillin given to failures. Some patients, however, had infections that persisted or recurred despite several antibiotics. The radiological investigations showed that a high proportion of women with asymptomatic urinary infection had severe renal disease which was quite symptomless. This was more pronounced in those with persistent or recurrent infections.     

鼻咽癌与细菌L型的关系

大量研究表明,鼻咽癌与ＥＢ病毒有关。通过对９８例鼻咽癌组织的切片革兰氏染色Ｌ型检查、电镜和Ｌ型抗体免疫组化染色等研究,发现鼻咽癌组织中细菌Ｌ型亦甚常见,切片革兰氏染色有７８例查见细菌Ｌ型,其阳性率为７９．６％;免疫细化染色Ｌ型抗原检出阳性率为６２．２％,电镜不仅在细胞间质见到细菌Ｌ型,而且在癌细胞、巨噬胞细等细胞胞质内也见到细菌Ｌ型。提示,细菌Ｌ型与鼻咽癌关系十分密切,很可能是鼻咽癌致癌因子之一。     

Brushing cytology of the upper gastrointestinal tract. Obsolete or not?

The merit of brushing cytology of the upper gastrointestinal tract has been questioned since it appears to duplicate biopsy. To determine its value, the reports on all endoscopic biopsy and cytology specimens from a one-year period were reviewed. The 683 procedures included 481 in which only a histologic biopsy sample was obtained, 47 in which only a cytologic brushing sample was obtained and 155 in which both types of samples were obtained ("combined specimens"). Among the 155 combined specimens, 4 of the confirmed malignancies were detected by histology only while 2 were detected by cytology only. A diagnosis of suspicious or positive for malignancy was made for 20% of the combined specimens as compared to less than 5% of the biopsy-only or brushing-only specimens. While 15% of the specimens that included a brushing sample (either alone or with biopsy) showed fungal infections, only 1.2% of the biopsy-only specimens did. It appears that the clinicians at this hospital tend to use brushing in combination with biopsy when either a malignancy or a fungal infection is suspected. Other empiric advantages of endoscopic brushing cytology include its rapid turn-around time, minimal invasiveness and good recognition of lymphoid cells. The selective use of brushing cytology should increase the probability of detecting malignancies and fungal infections without any increased risk or discomfort to the patients.     

血平板针尖样及云雾状菌落分离与鉴定

采集98份临床标本接种血平板培养,40份生长出针尖样及云雾状菌落。经分离鉴定38株为细菌L型,其中金黄色葡萄球菌（Staphyloeoccusaureus）居首位,占52．1％（20／38）．其返视性与L型平板分离相比较差。但对抗生素的敏感性则无差别。表明血平板可用于分离细菌L型,并保持了传统L型的特性。     

Cell-mediated immune responses in recurrent herpesvirus infections. I. Lymphocyte proliferation assay.

Studies in immunosuppressed and immunodeficient patients indicate that the cell-mediated immune response appears to be responsible for controlling reactivated herpesvirus infections. In this study, the various parameters of a herpesvirus (types 1 and 2) antigen specific lymphocyte proliferation assay were optimized and used to evaluate individuals with clinical, recurrent HSV-1 and HSV-2 infections. Normal individuals with neutralizing antibody to HSV-1 or HSV-2 responded to virus antigen in culture as well as individuals with recurrent disease. Normal individuals without neutralizing antibody responded with a significantly lower response. Specificity of the lymphocyte proliferation assay was observed most strikingly in normal individuals with a rare HSV-1 infection during the vesicular eruption. Specificity was also observed by determining the ratio of the response to HSV-1 as compared to the response to HSV-2. Evaluated in this manner, individuals with recurrent HSV-1 infections had significantly higher ratios than individuals with HSV-2 infections and vice versa. Data from individuals with recurrent disease was compared to that of normal individuals to determine whether the former demonstrated a specific alteration in this response. Individuals with recurrent disease were found to have higher neutralizing antibody titers than normals. The neutralizing antibody titers in normal individuals correlated well with the lymphocyte proliferation assay results, whereas a similar evaluation in individuals with recurrent disease gave a negative correlation. The ratio of HSV-1 response/HSV-2 response also demonstrated a suppressed response in recurrent infections to the homologous virus during active disease, which disappeared when the individual was convalescent. These studies indicate that individuals with recurrent HSV infections have virus antigen specific alterations of their cell-mediated immune response, which can be associated with their disease.     

应用GeneXpert MTB/RIF对肺外结核的快速检测及评估

目的 评估GeneXpert MTB/RIF检测肺外结核分枝杆菌的准确性,并与传统方法进行比较。 方法 选取2016年6月至2017年6月在本院就诊的144例疑似肺外结核病患者,对所有标本分别进行金胺“O”荧光染色镜检、液体培养及药敏试验、固体培养及比例法体外药敏试验和Xpert法检测。 结果 收集的144例疑似肺外结核标本中,确诊108例,以胸水、淋巴结活检和脓液感染较多,另36例阴性患者中,10例为非结核分枝杆菌感染。Xpert试验的敏感性为28.73%,特异性为96.00%,其阳性预测值和阴性预测值均高于其他3种检测方法。在阳性检出率方面,Xpert试验高于涂片镜检(χ2=17.39,P2=8.64,P2=2.56,P>0.05)。固体培养、液体培养和Xpert试验3种方法对结核分枝杆菌利福平耐药率检测差异无统计学意义(P>0.05),耐药率分别为8.33%、9.68%和11.11%,且Xpert试验方法检测出2株耐多药结核分枝杆菌,平均耗时2.5 h。 结论 GeneXpert MTB/RIF可以作为一种筛选及快速检测工具应用于肺外结核的诊断,同时可作为检测MDR TB的一种指标。     

Bacterial L-forms require peptidoglycan synthesis for cell division

Cell-wall-less bacterial variants, or L-forms, have been described in many bacterial species under laboratory conditions, in infected eukaryotic cell cultures and inside animals. Of special interest for human health is the formation of L-forms as a consequence of specific antibiotic treatments, and the potential involvement of L-forms in persistent and relapsing infections. An old enigma about L-forms is how they can divide in the absence of cell wall synthesis, since septum formation is an essential requisite for cell division. However, the classical definition of L-forms as cell-wall-less bacterial variants may need a revision to accommodate recent observations by Richard d'Ari and coworkers: genetic and biochemical evidence indicates that E. coli L-forms induced by beta-lactam antibiotics do contain small amounts of peptidoglycan, essential for their growth and probably required for septum formation. If these observations are extrapolated to all known L-forms, the very concept of cell-wall-less bacteria may need revision, and be restricted to mycoplasmas and their relatives.     

Quantitation of Microorganisms in Sputum

A method of quantitating microbial cultures of homogenized sputum has been devised. Possible application of this method to the problem of determining the etiologic agent of lower-respiratory-tract infections has been studied to determine its usefulness as a guide in the management of these infections. Specimens were liquefied by using an equal volume of 2% N-acetyl-L-cysteine. The liquefied sputum suspension was serially diluted to 10^-1, 10^-3, 10^-5, and 10^-7. These dilutions were plated on appropriate media by using an 0.01-ml calibrated loop; they were incubated and examined by standard diagnostic methods. Quantitation of fresh sputum from patients with pneumonia prior to antimicrobial therapy revealed that probable pathogens were present in populations of 10⁷ organisms/ml or greater. Normal oropharyngeal flora did not occur in these numbers before therapy. Comparison of microbial counts on fresh and aged sputum showed that it is necessary to use only fresh specimens, since multiplication or death alters both quantitative and qualitative findings. Proper collection and quantitative culturing of homogenized sputum provided information more directly applicable to patient management than did qualitative routine methods. Not only was the recognition of the probable pathogenic organism in pneumonia patients improved, but serial quantitative cultures were particularly useful in recognizing the emergence of superinfections and in evaluating the efficacy of antimicrobial therapy.     

细菌L型与喉癌关系的研究

用组织切片革兰氏染色、免疫组织化学染色等方法,对８５例喉癌重新切片,进行细菌Ｌ型检查,结果发现有６５例革兰氏染色Ｌ型菌阳性,其阳性率为７６．５％。５３例（６４．７％）Ｌ型抗体免疫组化染色和革兰氏染色Ｌ型菌均阳性,两者总符合率为８３．５％。细菌Ｌ型呈多形性,分布于癌巢、癌间质,常聚集成堆,也可呈散在性分布。５８例（６８．２％）癌细胞胞浆内也见到Ｌ型菌。提示细菌Ｌ型感染与喉癌关系密切。     

Microbial associations in chronic respiratory tract diseases

In the peripheral blood of patients with chronic bronchitis the presence of Mycobacterium pneumoniae antigens has been registered in 20.0% of cases and the presence of group A Streptococcus haemolyticus antigens, in 24.0% of cases, the transformation of streptococci into the L-form being observed in 12.0% of cases. The presence of M. pneumoniae, streptococci and their L-forms, as well as associations of these microorganisms, is characteristic of patients with chronic obstructive bronchitis, which is, probably, one of the reasons for the maintenance of bronchial obstruction. In patients with chronic pneumonia and fibrosing alveolitis the antigens of the bacterial form of streptococcus and its L-forms have been detected only in a few cases.     

L-Form Induction, Morphology, and Development in Two Related Strains of Erysipelothrix rhusiopathiae

Two related strains of Erysipelothrix rhusiopathiae, one the parent and the other an L-form revertant, were studied for their propensity or ability to produce L-forms under the influence of penicillin. The parent strain produced L-forms in nutrient solid media in an osmolarity range between 0.85 and 5.0% NaCl concentration whereas the revertant strain did so between 0.5 and 3.0% NaCl concentration. When various hyperosmolar media were tried without penicillin, recovery of L-forms from the revertant strain was optimal at a salt concentration of 2.0%, whereas the parent strain occasionally produced a few L-forms on 3.0% salt medium only. The process of penicillin-induced transformation from bacteria to L-form followed an unusual morphological sequence, beginning with beading of the bacterial body, followed by disintegration into granules from which the L-form colony derived. No large bodies were seen during the initial process of L-form induction, but they evolved later from the original granules and had the potential to reproduce L-type growth. The spontaneous development of L-forms in hyperosmolar media had a different morphological sequence starting with elongation of the bacteria into filaments which later developed polar and central dilatations from which granules and L-type growth developed. The differences in biological behavior between these related bacterial strains suggest that the revertant strain developed new properties, probably of genetic origin. Consequently, the assumption that L-forms revert to the "parent" bacteria may not always be justified. It can be made only after the biological properties of the parent and the revertant organisms have been properly identified.     

Herpes Simplex Virus-Specific IgM,IgA and IgG Subclass Antibody Responses in Primary and Nonprimary Genital Herpes Patients

To clarify the humoral immunity in herpes simplex virus (HSV) infection, HSV-specific IgM, IgA and IgG subclass antibody responses were studied in patients with genital herpes: 17 primary, 13 recurrent and 6 nonprimary first episode. A total of 181 serum samples serially collected from the patients, 5 per patient until 213 days after the onset of disease (on average), were analyzed by an enzyme-linked immunosorbent assay. IgGl, IgG3 and IgA were detected in all patients with primary and nonprimary infections, whereas IgG4 was detected in 74% of only those with nonprimary infections and IgG2 was detected in none. IgM was detected in 100% of the patients with primary infections, but also in 68% of those with nonprimary infections. IgA showed a peak similar to that of IgM in patients with primary infections. No significant difference was observed in the detection rate or pattern of antibody responses between the recurrent and nonprimary first episode infections, nor between the HSV-1 and HSV-2 infections. These findings may be useful to improve the diagnostic potential of HSV serology.     

慢性肾盂肾炎L型细菌感染及耐药分析

目的了解L型细菌在慢性肾盂肾炎的感染及耐药状况。方法对71例患者清洁中段尿做普通细菌培养(B型)、L型细菌培养(L型)及耐药分析。结果细菌阳性率为77.5%,其中单独L型阳性率为49.3%、B型与L型混合感染为15.5%,而B型阳性率仅为12.7%。主要是大肠埃希菌,其次是葡萄球菌;青霉素及头孢噻肟均有较高的耐药率(88.9%及73.6%)。结论L型细菌在慢性肾盂肾炎感染中占主导,β-内酰胺类药物有较高的耐药性,临床治疗应据药敏结果合理选择及时调整抗生素。     

咽部活组织中细菌L型的检出及意义

应用病原微生物培养、电镜、组织切片细菌学检查及Ｌ型抗体免疫组化染色等方法,检测６４例慢性咽炎组织的细菌Ｌ型。结果有４２例培养出细菌Ｌ型,其阳性率为６５．６％;它与切片革兰氏染色Ｌ型检出阳性率（６７．２％）无显著性差异,Ｐ＞０．０５。透射电镜在慢性咽炎组织的间质及上皮细胞、巨噬细胞等细胞内见皮细菌Ｌ型;且Ｌ型抗体免疫组化染色亦证实组织中有细菌Ｌ型抗原。提示,细菌Ｌ型感染与慢性咽炎关系密切,Ｌ型侵入组织并在宿主细胞内生长的特征,可能是慢性咽炎反复发作,迁延不愈的重要原因。     

大肠杆菌L型生物学特性及致病性的研究

我们对人工诱导的大肠杆菌L型从生物学特性、致病性以及耐药性R质粒传递等方面进行了初步的研究。结果表明:L型菌从菌体形态、菌落特征、生化反应等方面与原型菌有较大差别;原型大肠杆菌和相应的L型菌接合试验均阳性,但后者接合频率较前者明显低;将L型菌经膀胱和尾静脉感染小鼠,引起实验鼠脏器的间质性炎症,通过病理学和细菌学检查证明,L型菌可直接引起脏器感染,并非只有返祖后才能致病。     

Cell fusion between L-forms and protoplasts of Staphylococcus aureus

Mixtures of various combinations of Lysostaphin protoplasts and stable L-forms of Staphylococcus aureus, which have different markers for drug resistance, were treated with polyethylene glycol (PEG) to examine the development of doubly resistant fusion products (fusants). To recover doubly resistant colonies as L-forms, they were incubated in 4.5% NaCl-brain heart infusion (BHI) broth containing penicillin G (PCG) for enrichment culture and cultured in PCG-4.5% NaCl-BHI agar medium (method 1), while to recover doubly resistant fusants as L-forms and coccal forms, they were grown on reversion medium (R medium) which causes reversion of protoplasts or fusants to parent type cells, and then cultured on assay media, i.e., R medium, BHI agar medium or PCG-4.5% NaCl-BHI agar medium (method 2). Under both experimental conditions, doubly resistant fusants developed as L-form cells by PEG treatment of pairs of protoplasts carrying the chloramphenicol (CP)-resistance plasmid and L-forms having chromosomal resistance to streptomycin (SM). In the reverse combinations, i.e., protoplasts showing chromosomal SM-resistance and L-form cells carrying the CP-resistance plasmid, the first method gave no doubly resistant colonies. By the second method, without enrichment culture on R medium, the latter combination gave doubly resistant fusants as L-form, coccal-type and mixed-type colonial forms, while when the PEG-treated mixture was enriched on R medium, fusants were obtained exclusively as the coccal type on either R medium or BHI agar assay medium. Neither of the methods yielded colonies of doubly resistant fusants on PEG-treatment of pairs of protoplasts and L-forms both of which were chromosomal, but with different drug resistances. These results show that PEG-induced cell fusion between protoplasts and L-forms of S. aureus, unlike the fusion between protoplasts or between L-forms, resulted in transfer of the drug resistance controlled by the plasmid to the fusion products. The fusants obtained were L-forms in method 1, and coccal type in the method 2.     

Non-secretion of ABO blood group antigens: a host factor predisposing to recurrent urinary tract infections and renal scarring

In a study of 718 women referred for specialist investigation for recurrent urinary tract infections, 250 (34.8%, P less than 0.01) were non-secretors. The proportion of non-secretors among the women with renal scars (42.6%) was higher than that found for women with no evidence of renal scars (36.6%). Among 29 patients in whom symptoms began in childhood or adolescence, 51.7% were non-secretors. The proportion of non-secretors among individuals with renal scars in this study (42.6%) and that reported in the accompanying paper for Swedish children (40%) suggests that non-secretion might influence the pathogenic sequelae of these infections. Possible host-parasite interactions underlying the increased proportion of non-secretors among women with recurrent urinary tract infections and those leading to development of renal scars are discussed.     

Impaired neutrophil functions in the pathogenesis of an outbreak of recurrent furunculosis caused by methicillin-resistant Staphylococcus aureus among mentally retarded adults

Staphylococcus aureus is an important cause of skin infections. We recently described an outbreak of recurrent furunculosis involving methicillin-resistant S. aureus among mentally retarded adults. We sought to determine the role of impaired neutrophil functions in its pathogenesis. Blood neutrophil functions were determined during both the outbreak (1997) and a disease-free period (2000). Chemotaxis was measured by migration toward formyl-methionyl-leucyl-phenylalanine (FMLP), specifically and randomly; phagocytosis of opsonized zymosan (OZ) was assessed by microscopy; superoxide production was determined by cytochrome c reduction in unstimulated neutrophils and after stimulation with 50 ng/ml phorbol myristate acetate, 1 mg/ml OZ or 5 x 10(-7)M FMLP. Functions were compared between recurrent furunculosis (n=10) and non-recurrent furunculosis patients (n=13). During 2000, functions were normal among the 23 subjects, except for specific/nonspecific chemotaxis (mean 68%+/-26 and 69%+/-28). During infection, recurrent furunculosis patients had a significantly increased basal superoxide production as compared to disease-free period (10.5+/-4.7 vs. 4.9+/-1.9 nmol O(-)(2)/10(6) cells/min, p=0.003). During the disease-free period, recurrent furunculosis patients had lower basal superoxide production (4.9+/-1.9 vs. 7.7+/-3.5, p=0.067) and impaired specific chemotaxis (57%+/-28 vs. 76%+/-21, p<0.05) as compared to non-recurrent furunculosis patients. Only specific chemotaxis was an independent risk factor for recurrent furunculosis. Mentally retarded adults have impaired chemotaxis, with recurrent furunculosis cases having an even greater impairment. Abnormal specific chemotaxis is an independent risk factor for recurrent furunculosis. Impaired neutrophil functions thus have a role in the pathogenesis of outbreaks of recurrent furunculosis.