念珠状链杆菌引起鼠咬热1例
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摘要
目的通过对一株念珠状链杆菌及其引发的鼠咬热病例的回顾性分析,为临床微生物室和临床医生提供诊治经验。方法病例回顾性分析:患者因被老鼠咬伤左手拇指引起发热就诊,入院后进行血培养,并用美华Ma120、梅里埃Vitek 2细菌鉴定系统、杭州滨河微量生化管、梅里埃TM质谱仪和16SrRNA基因测序进行细菌鉴定。临床给予阿莫西林氟氯西林联合左氧氟沙星抗感染治疗12 d。结果血培养分离出革兰阴性呈链状、菌体有念珠状肿胀的L型细菌;该菌用美华Ma120、梅里埃Vitek 2细菌鉴定系统、杭州滨河微量生化管、梅里埃TM质谱仪均无法鉴定;16sRNA基因测序结果显示该菌与念珠状链杆菌的相似度为100%;临床确诊为念珠状链杆菌型鼠咬热,用阿莫西林氟氯西林联合左氧氟沙星治疗有效。结论念珠状链杆菌能引起人类鼠咬热,该菌用16sRNA基因测序能准确鉴定,常规细菌鉴定仪和质谱仪均难以鉴定。临床医生对于有鼠咬史的患者,血液中检出革兰阴性呈链状、菌体有念珠状肿胀的L型细菌时需考虑念珠状链杆菌引发鼠咬热的可能。。
Objective Through a retrospective analysis of a strain of Streptobacillus moniliformis and the rat bite fevercaused by it, the experience of diagnosis and treatment was provided for the clinical microbiology laboratory and clinicians.Methods Retrospective analysis of cases:The patient had a fever caused by a rat biting his left thumb. Blood culture wascarried out after admission, bacteria were identified by Ma120, Merier Vitek 2 bacterial identification system, Hangzhou Binhemicro-biochemical tube, Merier TM mass spectrometer and 16 SrRNA gene sequencing. Amoxicillin and flucloxacillincombined with levofloxacin were given for 12 days. Results Gram-negative L-type bacteria with candidal swelling wereisolated from blood culture; the strain could not be identified by Ma120, Merier Vitek 2 bacterial identification system,Hangzhou Binhe microbiochemical tube and Merier TM mass spectrometer. The 16 sRNA gene sequencing results showed thatthe similarity between the strain and Streptobacillus moniliformis was 100%. Amoxicillin flucloxacillin combined withlevofloxacin was effective in the treatment of rat biting fever with Streptobacillus moniliformis. Conclusion Streptobacillus moniliformis can cause bite heat in humans. The bacteria can be identified by 16 sRNA gene sequencing. It is difficult toidentify by conventional bacterial identification and mass spectrometry. Clinicians should consider the possibility of Streptobacillus moniliformis causing rat bite fever when they detect gram-negative L-type bacteria with candidal swelling in theblood of patients with a history of rat bite.
Objective Through a retrospective analysis of a strain of Streptobacillus moniliformis and the rat bite fevercaused by it, the experience of diagnosis and treatment was provided for the clinical microbiology laboratory and clinicians.Methods Retrospective analysis of cases:The patient had a fever caused by a rat biting his left thumb. Blood culture wascarried out after admission, bacteria were identified by Ma120, Merier Vitek 2 bacterial identification system, Hangzhou Binhemicro-biochemical tube, Merier TM mass spectrometer and 16 SrRNA gene sequencing. Amoxicillin and flucloxacillincombined with levofloxacin were given for 12 days. Results Gram-negative L-type bacteria with candidal swelling wereisolated from blood culture; the strain could not be identified by Ma120, Merier Vitek 2 bacterial identification system,Hangzhou Binhe microbiochemical tube and Merier TM mass spectrometer. The 16 sRNA gene sequencing results showed thatthe similarity between the strain and Streptobacillus moniliformis was 100%. Amoxicillin flucloxacillin combined withlevofloxacin was effective in the treatment of rat biting fever with Streptobacillus moniliformis. Conclusion Streptobacillus moniliformis can cause bite heat in humans. The bacteria can be identified by 16 sRNA gene sequencing. It is difficult toidentify by conventional bacterial identification and mass spectrometry. Clinicians should consider the possibility of Streptobacillus moniliformis causing rat bite fever when they detect gram-negative L-type bacteria with candidal swelling in theblood of patients with a history of rat bite.
引文
[1]陈东科,孙长贵.实用临床微生物学检验与图谱[M].1版.北京:人民卫生出版社,2011:493-494.
[2]刘星,李红.念珠状链杆菌的研究现状[J].中国实验动物学报,2007,15(6):474-476.
[3]SCHACHTER M E,WILCOX L,RAU N,et al.Rat-bite fever,Canada[J].Emerg Infect Dis.2006,12(8):1301-1302.
[4]Centers for Disease Control and Prevention.Fatal rat-bite feverFlorida and Washington,2003[J].Mmwr Morbidity&Mortalite Weekly Report.2005,7(53):1198-1202.
[5]周吕.疑为念珠状链杆菌感染一例[J].攀枝花医药,2004,26(1):111-112.
[6]艾彪,朱丽莎.患者血液中分离出1株念珠状链杆菌[J].国际检验医学杂志,2008,29(9):865.
[7]张伟铮,邓光远,屈平华.应用16SrRNA基因序列分析与细菌生化反应鉴定膝关节脓液分离的念珠状链杆菌[J].实用医学杂志,2014,30(11):1814-1817.
[8]李红,陈卫兰,蒋观成,等.念珠状链杆菌在小鼠群中的自然感染和发病特征的观察[J].中国实验动物学报,1995,3(2):80-86.
[9]王春玲,关伟红,蔡锦霞,等.实验小鼠念珠状链杆菌和鼠痘病毒混合感染的诊断[J].实验动物科学与管理,1999,16(1):3-5.
[10]叶仕宏.普济消毒饮治疗小螺菌性鼠咬热7例报告[J].中国热带医学,2001,1(1):43-43.
[11]赵惠敏.鼠咬热-新墨西哥1996[J].疾病监测,1998,13(8):315-316.2018-08-28
[2]刘星,李红.念珠状链杆菌的研究现状[J].中国实验动物学报,2007,15(6):474-476.
[3]SCHACHTER M E,WILCOX L,RAU N,et al.Rat-bite fever,Canada[J].Emerg Infect Dis.2006,12(8):1301-1302.
[4]Centers for Disease Control and Prevention.Fatal rat-bite feverFlorida and Washington,2003[J].Mmwr Morbidity&Mortalite Weekly Report.2005,7(53):1198-1202.
[5]周吕.疑为念珠状链杆菌感染一例[J].攀枝花医药,2004,26(1):111-112.
[6]艾彪,朱丽莎.患者血液中分离出1株念珠状链杆菌[J].国际检验医学杂志,2008,29(9):865.
[7]张伟铮,邓光远,屈平华.应用16SrRNA基因序列分析与细菌生化反应鉴定膝关节脓液分离的念珠状链杆菌[J].实用医学杂志,2014,30(11):1814-1817.
[8]李红,陈卫兰,蒋观成,等.念珠状链杆菌在小鼠群中的自然感染和发病特征的观察[J].中国实验动物学报,1995,3(2):80-86.
[9]王春玲,关伟红,蔡锦霞,等.实验小鼠念珠状链杆菌和鼠痘病毒混合感染的诊断[J].实验动物科学与管理,1999,16(1):3-5.
[10]叶仕宏.普济消毒饮治疗小螺菌性鼠咬热7例报告[J].中国热带医学,2001,1(1):43-43.
[11]赵惠敏.鼠咬热-新墨西哥1996[J].疾病监测,1998,13(8):315-316.2018-08-28