首例由拥挤棒状杆菌引起白喉样病例的调查分析  

Investigation and analysis of the first suspected diphtheria case caused by Corynebacterium accolens

作　　者：张岩[1] 刘桂芳[1] 李漫时[1] 宋修光[2] 冯蕾[1] 许青[1] 宋立志[1] 宁桂军[3] 徐爱强[1] 

机构地区：[1]山东省疾病预防控制中心,山东省传染病预防控制重点实验室,山东济南250014 [2]济南市传染病医院,山东济南250000 [3]中国疾病预防控制中心免疫规划中心,北京100050

出　　处：《中国疫苗和免疫》2017年第1期13-17,共5页Chinese Journal of Vaccines and Immunization

基　　金：泰山学者工程专项经费资助

摘　　要：目的对一例由拥挤棒状杆菌引起的白喉样病例进行流行病学调查和病原学分析,为临床鉴别诊断和治疗提供依据。方法对白喉样病例及其密切接触者进行流行病学调查,并采集咽部病灶拭子标本进行细菌分离、培养和鉴定。对分离菌株进行16S rRNA基因扩增和序列比对,进行细菌种属鉴定和同源性分析,采用微量肉汤稀释法进行细菌耐药性检测。结果当地近期无相同病例发生,患儿无类似病例接触史,发病前已完成无细胞百白破联合疫苗基础免疫。患儿咽部病灶及其母亲咽部的拭子培养物中均分离到拥挤棒状杆菌。该菌株生化反应不活泼,对青霉素、红霉素、克林霉素、头孢西丁、氯霉素等存在不同程度的耐药。结论本调查实验室确诊了由拥挤棒状杆菌感染引起的白喉样病例,在国内外均为首次报道,细菌的致病性及多重耐药现象应引起重视。Objective To analyze the epidemiological and bacterial etiological characteristics of a suspected diphtheria case caused by corynebacterium accolens,and to provide evidence for its clinical diagnosis and treatment.Methods The suspected diphtheria case and his close contacts were investigated,and their pharyngeal swabs were collected for the bacterial isolation,culture,and identification.The phylogeny and homology of the isolated strains were analyzed by biochemical reactions and 16 S rRNA sequence alignment.Bacterial antimicrobial resistance was tested by the broth microdilution method.Results No other cases with the same symptoms as the patient were found in the same locality.The patient had no contact with other similar cases,and had completed a primary immunization series with diphtheria,tetanus,and acellular pertussis combined vaccine（DTa P）.Corynebacterium accolens was isolated from pharyngeal swabs from the patient and his mother.The strain was not active in biochemical reactions,and was resistant to penicillin,erythromycin,clindamycin,cefoxitin,and amphemycin to varying degrees.Conclusions This was the first report of a suspected diphtheria case found to be caused by corynebacterium accolens and diagnosed by laboratory methods,either in China or abroad.We should pay attention to the pathogenicity and multi-drug resistance of this bacteria.

关 键 词：拥挤棒状杆菌 白喉样病例 流行病学 病原学 

分 类 号：R186[医药卫生—流行病学]