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目的对浙江省2005~2007年流行性脑脊髓膜炎(流脑)病原学监测结果进行分析,了解脑膜炎奈瑟菌(Neisseria Meningitidis,Nm)的菌群分布、变迁、耐药状况及分子分型特征。方法常规方法做表型鉴定,聚合酶链反应(PCR)特异性引物扩增,脉冲场凝胶电泳(PFGE)参考中国疾病预防控制中心(CDC)传染病预防控制所推荐的方法进行;药物敏感试验参考美国临床和实验室标准机构(CLSI-2007)制定的标准进行。结果116株疑似Nm的血清群构成比分别为:A群52.58%,B群15.52%,C群31.90%;从病人分离的49株中,A群占61.23%,C群占32.65%,而B群仅占6.12%。菌株对环丙沙星、奈啶酸、甲氧苄氨嘧啶产生不同程度耐药,但对青霉素、氨苄西林、美罗培南、氯霉素敏感,分离自不同人群的血清群菌株的耐药性有一定差异。PFGE酶切图谱及聚类分析发现,相同血清群的病人和其密切接触者的分离菌株的PFGE酶切图谱相似度达100%,属同一克隆系;A群和C群菌株的PFGE酶切图谱相似度相对较高,亲缘关系较近,分别有一定相关性,各存在一紧密相关的流行克隆群;B群菌株PFGE酶切图谱呈现较高的多态性。结论浙江省Nm流行菌群正在发生变迁,目前仍以A群为主,但C群是近年来新出现的主要致病血清群。分子分型结果也显示,浙江省存在优势克隆群的A群和C群主要流行菌株。青霉素、氨苄西林、美罗培南、氯霉素类仍可作为浙江省治疗流脑的首选药物。鉴于多数人群对C群Nm缺乏免疫力,以及C群流脑的高病死率,应密切关注C群流脑的发生,以防C群流脑的爆发或流行。
Objective To analyze the epidemiological surveillance results of epidemic cerebrospinal meningitis (MCI) in Zhejiang Province from 2005 to 2007, and to understand the flora distribution, change, drug resistance and molecular weight of Neisseria meningitidis (Nm) Type feature Methods Conventional methods were used for phenotyping, polymerase chain reaction (PCR) specific primer amplification and pulsed-field gel electrophoresis (PFGE) with reference to the methods recommended by the CDC for infectious disease prevention and control. Drug susceptibility The test was performed according to the standard set by the American Society for Clinical and Laboratory Standards (CLSI-2007). Results The percentages of 116 suspected Nm serogroups were 52.58% in A group, 15.52% in B group and 31.90% in C group, among which, A group accounted for 61.23%, C group accounted for 32.65% and B Group only accounted for 6.12%. The strains of ciprofloxacin, nalidixic acid, trimethoprim to varying degrees of resistance, but penicillin, ampicillin, meropenem, chloramphenicol susceptibility isolated from different populations of serogroup strains have Some difference. PFGE enzyme digestion mapping and cluster analysis found that the same serogroups of patients and close contacts of isolates of PFGE enzyme digestion map similarity of 100%, belong to the same clonal line; A group and C group of strains PFGE digestion map The similarity was relatively high and the genetic relationship was close. There was a certain correlation between them, and there was a closely related epidemic clonal group. The PFGE digestion pattern of group B showed a high polymorphism. Conclusion The prevalence of Nm is changing in Zhejiang Province. At present, group A is still predominant, but group C is the newly emerged major pathogenic serogroup in recent years. Molecular typing results also showed that there are dominant clonal groups in Zhejiang Province A and C major epidemic strains. Penicillin, ampicillin, meropenem, chloramphenicol can still be used as the treatment of meningitis in Zhejiang Province of choice drugs. Given the lack of immunity to N-C Nm in most populations and the high case-fatality rate in C-cluster meningitis, close attention should be paid to the occurrence of C-group meningitis to prevent the outbreak or spread of C-cluster meningitis.