男性泌尿生殖道非淋球菌奈瑟菌感染的诊断与治疗研究  

Diagnosis and Treatment of Genitourinary Infection with Non-Gonococcal Neisseria in Men

作　　者：王丹霓[1] 罗振华[1] 王和[1] 

机构地区：[1]贵阳医学院微生物学教研室,贵州贵阳550004

出　　处：《中华男科学杂志》2009年第6期499-504,共6页National Journal of Andrology

基　　金：贵州省科技基金(黔科合2004NGY034)~~

摘　　要：目的:探讨非淋球菌奈瑟菌感染对男性泌尿生殖道感染诊断与治疗的影响。方法:采集8例急性尿道炎或慢性前列腺炎患者的尿道分泌物、前列腺按摩液或/和精液标本,分别接种淋球菌培养基、血琼脂培养基、沙保氏琼脂培养基和支原体培养基分离淋病奈瑟菌与其他细菌、真菌、支原体以及Gemenez染色检查衣原体。对分离的革兰阴性双球菌分别进行氧化酶、生化反应、药物敏感试验及淋病奈瑟菌核酸荧光聚合酶链反应(PCR)检测与鉴定。根据药物敏感试验结果选择和使用抗菌药物,对患者以静脉注射或/和口服治疗。结果:从8例患者前列腺按摩液或精液内分离的8株革兰阴性双球菌分别鉴定为粘液奈瑟菌3株、灰色奈瑟菌4株、嗜乳糖奈瑟菌1株,各菌株的隐蔽质粒pJD1基因PCR检测均表现与淋病奈瑟菌相似的阳性反应。男性生殖道分离的非淋球菌奈瑟菌具有多重耐药性,对喹诺酮类药物和磷霉素具有显著高的耐药性。静脉或/和口服给予病原菌敏感的头孢菌素或/和米诺环素治疗7d后,病原学复查无菌和患者症状消失。结论:寄生人体上呼吸道的某些正常菌群奈瑟菌也可以感染男性泌尿生殖器官,引起淋病样尿道炎与慢性前列腺炎。仅仅通过形态、氧化酶试验或/和检测隐蔽质粒基因以及其他淋病奈瑟菌非特异性核苷酸序列的PCR方法,可导致淋病的临床和病原学诊断错误。根据病原学检查结果选择药物静脉注射或/和口服,能够有效治愈非淋病奈瑟菌引起的急性尿道炎与慢性前列腺炎等男性生殖器官感染疾病,病原菌耐药性是影响治疗效果的主要因素。Objective ： To explore the influence of non-gonococcal Neisseria on the diagnosis and treatment of male genitourinary infection. Methods ： The samples of urethral exudates, prostatic secretions or/and semen were collected from 8 cases of male patients with acute urethritis or chronic prostatitis, then inoculated into gonococcal agar medium, blood agar medium, Sabouraud agar medium and Mycoplasma agar medium, respectively. Neisseria gonorrhoeae, Mycoplasmae, fungi and other bacteria were isolated, Chlamydiae examined by Gemenez staining, and the gram-negative diploeocci from the samples identified by oxidase test, biochemical examination and drug sensitivity test. The PCR products of the cryptic plasmid pJD1 gene of the isolated strains were amplified for the identification of Neisseria gonorrhoeae. Based on the results of drug sensitivity tests, intravenous or oral antibiotics were selected for treatment. Results ： Eight strains of gram-negative diplococci were isolated in this study, 3 identified as N. mucosa, 4 as N. cinerea and the other 1 as N. lactamica. The PCR identification test of the cryptic plasmid pJD1 gene showed the same positive results in all the strains as in N. gonorrhoeae. The non-gonococcal Neisseria isolated from the male genital tract secretions exhibited a muhidrug resistance, especially to quinolones and fosfomycin. All the symptoms disappeared and no pathogens were detected in the patients after a 7-day treatment with Cephalosporins or/and Minocycline. Conclusion ： Some Neisseria species normally parasitizing the upper respiratory tract can also cause male genitourinary infections, such as gonorrhea-like urethritis and chronic prostatitis. Neisseria gonorrhea could be clinically and etiologically misdiagnosed through such conventional methods as morphological examination, oxidase test and PCR identification test of cryptic plasmid and other nonspecific genes. Intravenous and/or oral antibiotic medication based on the results of drug sensitivity tests can cure acute urethritis and

关 键 词：奈瑟菌属 淋病 前列腺炎 聚合酶链反应 尿道炎 

分 类 号：R759.2[医药卫生—皮肤病学与性病学] R691[医药卫生—临床医学]