四川省一起伴中毒性休克综合征的人感染猪链球菌2型暴发  

An outbreak of human Streptococcus suis serotype 2 infections presenting with toxic shock syndrome in Sichuan,China

作　　者：杨维中[1] 余宏杰[1] 景怀琦[2] 徐建国[2] 陈志海[3] 祝小平[4] 汪华[5] 刘学成[4] 王世文[1] 刘伦光[4] 祖荣强[6] 罗隆泽[4] 向妮娟[1] 刘红露[4] 钟文君[1] 刘莉[4] 孟玲[1] 袁珩[4] 高永军[1] 杜化茂 欧阳宾[4] 叶长芸[2] 金冬 吕强[4] 崔志刚[2] 黄燕[4] 张守印[2] 安向东[6] 黄婷[4] 周兴余[4] 冯燎[4] 庞启迪[4] 舒跃龙[7] 王宇[1] 

机构地区：[1]中国疾病预防控制中心,北京100050 [2]中国疾病预防控制中心传染病预防控制所 [3]北京地坛医院 [4]四川省疾病预防控制中心 [5]江苏省疾病预防控制中心 [6]中国疾病预防控制中心中国现场流行病学培训项目 [7]中国疾病预防控制中心病毒病预防控制所

出　　处：《中华流行病学杂志》2006年第3期185-191,共7页Chinese Journal of Epidemiology

摘　　要：目的调查2005年7月中旬四川省资阳市一家医院报告5例以败血症休克为主要临床表现的聚集性病例的病因。方法建立了病例主动发现、报告的加强监测系统,根据病例的流行病学暴露史和临床表现进行临床诊断;采集患者标本进行细菌分离培养和生化反应鉴定,应用PCR方法对猪链球菌2型的种属和毒力基因进行检测和序列测定;与当地往年报告的流行性脑脊髓膜炎发病数进行比较。结果2005年6月10日至8月21日,四川省共报告了68例实验室确诊人感染猪链球菌病例,发病前都有屠宰、洗切、加工等病(死)猪的直接暴露史。其中26例(38%)表现为中毒性休克综合征,15例(58%)死亡。其他病例临床表现为轻型败血症或脑膜炎。分离菌株应用PCR方法检测猪链球菌2型的种属和毒力基因(tuf、16S rRNA、cps2J、mrp、sly、ef)均为阳性。同期还报告了136例有相似暴露史,但缺乏实验室确诊依据的临床诊断病例。结论证实该起发生在四川省部分农村地区直接暴露于病(死)猪后的疾病为猪链球菌2型感染暴发。推测这种罕见的、表现为高病死率的中毒性休克综合征可能是由于感染某种高致病性菌株循环所致。Objective In mid-July 2005, five patients presented with septic shock to a hospital in Ziyang city in Sichuan, China, to identify the etiology of the unknown reason disease, an epidemiological, clinical, and laboratory study were conducted. Methods An enhanced surveillance program were established in Sichuan, the following activities were introduced, active case finding in Sichuan of （a） laboratory diagnosed Streptococcus suis infection and （b） clinically diagnosed probable cases with exposure history; supplemented by （c） monitoring reports on meningococcal meningitis. Streptococcus suis serotype 2 infection was confirmed by culture and biochemical reactions, followed by sequencing for specific genes for serotype and virulence factors. Results From June 10 to August 21, 2005, 68 laboratory confirmed cases of human Streptococcus suis infections were reported. All were villagers who gave a history of direct exposure to deceased or sick pigs in their backyards where slaughtering was performed. Twenty six （38 % ） presented with toxic shock syndrome of which 15 （58%） died, Other presentations were septicaemia or meningitis. All isolates were tested positive for genes for tuf, species-specifie 16S rRNA, cps2J, mrp, ef and .sly. There were 136 clinically diagnosed probable cases with similar exposure history but incomplete laboratory investigations. Conclusion An outbreak of human Streptococcus suis serotype 2 infections occurred in villagers after direct exposure to deceased or sick pigs in Sichuan. Prohibition of slaughtering in backyards brought the outbreak to a halt. A virulent strain of the bacteria is speculated to be in circulation, and is responsible for the unusual presentation of toxic shock syndrome with high case fatality.

关 键 词：猪链球菌 中毒性休克综合征 

分 类 号：R181.3[医药卫生—流行病学]