摘要
目的对一起聚集性发热事件的病原体进行分离鉴定,为今后类似事件的预防和诊断提供参考。方法 2017年8月,某部报告营区内出现不明原因群体性发热病例。发病后第2~3 d,医院收治8例发热病例,采集其咽拭子标本,分别进行呼吸道病毒核酸荧光定量PCR检测、细菌学涂片、细菌分离培养和鉴定及药敏试验。结果 8例咽拭子标本中,6例血培养分离出溶血性链球菌,经全自动微生物分析仪鉴定为停乳链球菌似马亚种。药敏实验发现该菌株耐药性较低,对青霉素、氨苄西林、环丙沙星等常用抗生素均较为敏感,对红霉素、克林霉素、四环素耐药。患者经阿莫西林或左氧氟沙星治疗,症状消失,细菌复检为阴性。结论引起这次聚集性发热事件的病原菌为乙型溶血性停乳链球菌似马亚种,细菌分离株耐药性较低。
Objective To isolate and identify the pathogen that has caused a cluster of fever cases and to provide reference for future prevention and diagnosis in case of similar events. Methods In August 2017, the occurrence of a cluster of fever cases of unknown origin in a camp was reported by a military unit. On the 2-3 rd d after the outbreak of fever, eight patients with fever were admitted to our hospital, the throat swab specimens were collected from these patients, and the quantitative real time polymerase chain reaction(PCR) detection for the nuclei acid of viruses associated with respiratory infection, the preparation of bacteriological smears,the isolation, cultivation and identification of bacteria and the antimicrobial susceptibility test were performed respectively. Results Among the eight throat swab specimens, strains of streptococcus hemolyticus were isolated from the blood culture of six specimens and identified by automatic microorganism analyzer as streptococcus dysgalactiae subspecies equisimilis. The antimicrobial susceptibility test suggested that these strains had low drug resistance and they were sensitive to penicillin, ampicillin, ciprofloxacin and other commonly used antibiotics and resistant to erythromycin, clindamycin and tetracycline. After treatment with amoxicillin or levofloxacin, patients recovered from symptoms and the bacterial re-examination turned out to be negative. Conclusion The pathogen that has caused this cluster of fever cases is beta-hemolytic streptococcus dysgalactiae subspecies equisimilis and the bacterial isolates have low drug resistance.
引文
[1]陈诹,王远萍,徐红梅,等.2013~2015年上海市浦东新区聚集性发热疫情分析[J].实用预防医学,2017,24(5):563-565.
[2]邓丽梅,韦连珍.大学城校区学生群体性发热防控措施的探讨[J].基层医学论坛,2011(4):188-189.
[3]张彦丽,刘容珍,张桂玲,等.从一起聚集感染事件中分离培养出停乳链球菌似马亚种[J].中国卫生检验杂志,2014(13):1889-1891.
[4]张辉,刘继锋,龚建仁.一起停乳链球菌似马亚种暴发感染的调查分析[J].中国食品卫生杂志,2015,27(6):707-710.
[5]韩秀兰,李云,柳连顺,等.一起乙型溶血性停乳链球菌感染爆发的检测报告[J].中华流行病学杂志,2004,25(7):636-636.
[6]张彦丽,刘容珍,张桂玲,等.从一起聚集感染事件中分离培养出停乳链球菌似马亚种[J].中国卫生检验杂志,2014(13):1889-1891.
[7]韩秀兰,李云,董永辉.从一起暴发疫情分离的停乳链球菌似马亚种检测分析[J].预防医学论坛,2004,10(6):670-671.
[8]翟永志,刘梦林,张志强,等.一起食源性停乳链球菌类马亚型暴发感染调查[J].解放军医学院学报,2013(11):1135-1137.
