1例流行性脑脊髓膜炎死亡病例的流行病学及病原学特征分析  

Epidemiological and etiological characteristics of a death case of meningococcal meningitis

作　　者：刘然 楼萍 贺子翔 方明礼[1] 彭水姣 向婧 湛志飞[1] 周奇文 Liu Ran;Lou Ping;He Zixiang;Fang Mingli;Peng Shuijiao;Xiang Jing;Zhan Zhifei;Zhou Qiwen(Hunan Provincial Key Laboratory of Microbial Molecular Biology,Hunan Provincial Center for Disease Control and Prevention,Changsha 410000,China;Department of Microbiology,Hengyang Center for Disease Control and Prevention,Hengyang 421200,China)

机构地区：[1]湖南省疾病预防控制中心,微生物分子生物学湖南省重点实验室,长沙410000 [2]衡阳市疾病预防控制中心微生物检验科,衡阳421000

出　　处：《中华微生物学和免疫学杂志》2024年第10期899-905,共7页Chinese Journal of Microbiology and Immunology

摘　　要：目的分析2024年湖南省衡阳市1例流行性脑脊髓膜炎(流脑)死亡病例的流行病学及病原学特征分析。方法对死亡病例开展流行病学调查,采集病例及其密切接触者相关标本,进行脑膜炎奈瑟菌(Neisseria meningitidis,Nm)分离培养鉴定、药敏检测、脉冲场凝胶电泳(PFGE)和基因测序,分析死亡病例的流行病学和病原学特征。基于核心基因组多位点序列分型(cgMLST)进行系统进化分析。结果病例为16岁高中寄宿学生,患暴发型流脑,伴休克症状,发病24 h内死亡。从病例及其室友中分离到6株Nm,分别来自不同的2个分支。死亡病例分离株144569与密切接触者分离株144572高度同源,属于高致病CC4821 L44.1子系,其抗原式为C:P1.7-2,14:F5-101:ST4821(CC4821)。耐药基因分析显示这2株菌存在gyrA-71和penA-552,提示喹诺酮类药物、β-内酰胺酶类药物不敏感,与耐药表型相符。其他4株密切接触者分离株在同一分支,抗原式为B:P1.18-25,9-18:ST5829(UA)。结论该起死亡病例由来自高致病性CC4821 L44.1子系的C群Nm引起。该型菌株的扩散传播存在引起流脑暴发的潜在风险,应加强Nm分子流行病学的监测。青少年间多种型别Nm的传播以致其暴露风险增大,需要引起关注。ObjectiveTo analyze the epidemiological and etiological characteristics of a death case of meningococcal meningitis in Hengyang city,Hunan Province in 2024.MethodsEpidemiological investigation of the death case was performed,and samples from the patient and close contacts were collected.Following cultivation and isolation,Neisseria meningitidis(Nm)strains were analyzed by antimicrobial susceptibility testing,pulsed field gel electrophoresis(PFGE),and whole-genome sequencing for analyzing epidemiological and etiological characteristics.Phylogenetic analysis was carried out using core genomic multilocus sequence typing(cgMLST).ResultsThe case was a 16-year-old high school boarding student with fulminant meningococcal meningitis.He had shock symptoms,and died within 24 h of the onset of symptoms.Six Nm strains were isolated from the patient and his roommates,belonging to two distinct clades.Isolate 144569 from the patient was highly homologous to isolate 144572 from a close contact,both belonging to the highly pathogenic sublineage L44.1 of CC4821.The typical molecular features was C:P1.7-2,14:F5-101:ST4821(CC4821).The two strains carried the antimicrobial resistance genes of gyrA-71 and penA-552,indicating reduced susceptibility to quinolone and penicillin,which was with their resistance phenotype.The isolates from four close contacts clustered within the same clade,characterized by the molecular features of B:P1.18-25,9-18:ST5829(UA).ConclusionsThe death case is caused by Nm serogroup C from highly pathogenic sublineage L44.1 of CC4821.The spread of this isolate has the potential risk of outbreaks of invasive meningococcal disease.It is necessary to enhanced the molecular epidemiological surveillance,particularly focusing on the transmission of multiple serogroups of Nm among adolescents and the increasing exposure risk.

关 键 词：流行性脑脊髓膜炎 脑膜炎奈瑟菌 核心基因组多位点序列分型 CC4821 

分 类 号：R515.2[医药卫生—内科学] R446.5[医药卫生—临床医学]