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Objective:To determine whether these Streptococcus pneumoniae isolates identified by routine cli-nical methods that cannot be serotyped by the quellung reaction contain other species of viridans group streptococci and to determine the antibiotic susceptibility to provide reference for clinical medicine. Methods:A total of 105 isolates identified as Streptococcus pneumoniae by routine methods with negative quellung reaction results were enrolled in this study.Multilocus sequence analysis (MLSA) and matrix-assisted laser desorption/ionization time of flight mass spectrometry(MALDI-TOF-MS) were used to identify species of these isolates.Broth microdilution method was used to detect susceptibilities of 14 antibiotics. Results:Twenty-four of the 105 isolates were identified as Streptococcus pseudopneumoniae by MLSA, and the remaining 81 were Streptococcus pneumoniae.Six isolates of Streptococcus pseudopneumoniae were misidentified as Streptococcus pneumoniae, and 3 isolates as Streptococcus mitis/ oralis by MALDI-TOF-MS; and 6 isolates of Streptococcus pneumoniae were misidentified as Streptococcus pseudopneumoniae.All isolates were susceptible to Vancomycin, Levofloxacin and Moxifloxacin.The non-susceptibility rates between Streptococcus Pneumoniae and Streptococcus pseudopneumoniae against Ceftriaxone(28.4% vs.58.4%), Chloramphenicol(39.5% vs.4.2%), Erythromycin(77.8% vs.95.8%) and Azithromycin(75.3% vs.95.8%) were obviously different. Conclusions:Routine clinical methods may misidentify some Streptococcus pseudopneumoniae as Streptococcus pneumoniae, and so does the MALDI-TOF-MS.In addition, Streptococcus pneumoniae isolates with negative results of the quellung reaction showed differences in antimicrobial resistance.And misidentification may affect the evaluation of pathogenic bacteria and antibiotic resistance.
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Objective:To investigate the serotype distribution and drug resistance of Streptococcus pneumoniae ( S. pneumoniae) isolated in Urumqi Children′s Hospital and to evaluate the significances of 13-valent pneumococcal conjugate vaccine (PCV13) in preventing infection and controlling drug resistance. Methods:The S. pneumoniae isolates stored in clinical laboratory of Urumqi Children′s Hospital from January to December in 2018 were re-cultured.The serotypes were detected by capsule swelling experiment to assess the coverage rate of PCV13.The minimum inhibitory concentration (MIC) of Penicillin, Amoxicillin, Cefotaxime and Ceftriaxone were detected by E-test method, and the susceptibility of the isolates to Meropenem and other 9 antibiotics was detected by VITEC 2 Compact system. Results:A total of 225 S. pneumoniae strains were identified.The common serotypes were 19F (32.9%), 23F (12.0%), 19A (10.7%), 6B (10.2%) and 6A (8.0%). PCV13 coverage rate was 80.4%.There was no significant difference in serotype distribution and PCV13 coverage between children < 2 years old and ≥ 2 years old, as well as between Han and minority people.The 57.8% and 31.7% strains showed intermediate susceptibility and resistance against oral Penicillin, respectively.Based on the breakpoints for meningitis, 89.4% strains were resistant against pare-nteral Penicillin, and 47.5% and 64.6% strains were non-susceptible (mainly intermediately susceptible) to Ceftria-xone and Cefotaxime, respectively.The resistance rates of strains against Erythromycin, Sulfamethoxazole-trimethoprim and Tetracycline were as high as 98.1%, 67.6% and 89.6%, respectively.More than 90% tested isolates were susceptible to Amoxicillin, Meropenem, Levofloxacin or Moxifloxacin.PCV13 strains were more resistant to Penicillin than non-PCV13 strains. Conclusions:The serotypes 19F, 23F, 19A, 6B and 6A are common among the S. pneumoniae isolated in Urumqi.The coverage rate of PCV13 is about 80%.There was no significant difference in serotype distribution between Han and minority nationality children. S. pneumoniae were frequently resistant against Erythromycin.The high resistance to Penicillin and other beta-lactams should be taken into account when treatment is decided for suspected pneumococcal meningitis.Universal administration of PCV13 would be effective strategy to prevent pneumococcal infection in children and to control the drug resistance of S. pneumoniae.
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Patients with pertussis can have a variety of complications, including pneumonia and subconjunctival hemorrhage. Severe complications, such as pulmonary hypertension and encephalopathy, can be life-threatening. Younger children with pertussis may lack the characteristic clinical manifestations of pertussis, and therefore, a deeper understanding of the complications of pertussis may help to improve the diagnosis, treatment, and prognosis of pertussis. However, there is still no standard for the diagnosis and treatment of pertussis complications, and there are great differences in diagnostic name, basis, and data used in different reports. This article reviews the complications of pertussis which have been reported so far, such as pulmonary complications (pneumonia, pulmonary hypertension, pneumothorax, and mediastinal or subcutaneous emphysema), fractures, hernias, circulatory system complications, nervous system complications (convulsion, encephalopathy, hemorrhage, and hematoma), urinary system complications, and secondary infections, so as to provide a reference for the clinical diagnosis and treatment of pertussis complications, scientific research on pertussis complications, and the promotion of standardized diagnosis and treatment of pertussis complications.
Subject(s)
Humans , Brain Diseases , Pneumonia , Prognosis , Seizures , Whooping CoughABSTRACT
OBJECTIVE@#To investigate the alternative antimicrobial drugs for the treatment of neonatal pertussis and the antigen genotypes of Bordetella pertussis (B. pertussis) strains.@*METHODS@#A total of 32 B. pertussis strains isolated from neonates between May 2013 and July 2018 were used in this study. E-test stripes were used to measure the minimal inhibitory concentration (MIC) of 18 antimicrobial drugs including erythromycin, sulfamethoxazole-trimethoprim (SMZ) and ampicillin. The 23S rRNA gene of isolated strains was amplified and sequenced to identify the mutation site of erythromycin resistance gene, and the seven antigen genotypes of B. pertussis strains (ptxA, ptxC, ptxP, prn, fim2, fim3 and tcfA2) were analyzed.@*RESULTS@#Of the 32 B. pertussis strains, 25 (78%) were resistant to erythromycin, azithromycin, clarithromycin and clindamycin, with an MIC of >256 mg/L, and A2047G mutation was observed in the 23S rRNA gene. All strains had an MIC of ≤0.064 mg/L for SMZ. The MIC of ampicillin, amoxicillin, amoxicillin-clavulanic acid and ceftriaxone ranged from 0.032 to 1 mg/L. The strains resistant to macrolide antibiotics had an antigen genotype of ptxA1/ptxC1/ptxP1/prn1/fim2-1/fim3-1/tcfA2.@*CONCLUSIONS@#B. pertussis strains from neonates are often resistant to macrolides, and the in vitro test shows that off-label use of sulfonamides is a reliable regimen for the treatment of neonates with macrolide-resistant pertussis. The prevalence of drug-resistant strains further emphasizes the importance of immunoprophylaxis.
Subject(s)
Humans , Infant, Newborn , Anti-Bacterial Agents , Bordetella pertussis , Genetics , Erythromycin , Genotype , Microbial Sensitivity Tests , Whooping CoughABSTRACT
OBJECTIVE: To summarize the clinical characteristics of children with pertussis and investigate the distribution of virulence-related genotypes and antimicrobial susceptibility among the Bordetella pertussis isolates. METHODS: The clinical information of 224 culture-positive pertussis cases in Beijing Children's Hospital,Capital Medical University from 2015 to 2016 was collected. Antimicrobial susceptibility was determined by E-test and Kirby-Bauer(KB)disk diffusion methods. A fragment of the 23 S rDNA genes was detected for drug-resistance mutation and antigen genotypes.RESULTS: The 224 culture-positive pertussis cases were from 14 provinces or municipalities. Among the 224 subjects,150 patients(67.0%)were younger than 6 months old and 176 patients(78.6%)were unvaccinated or not fully vaccinated individuals. The commonest virulence-associated genotype was ptx A1/ptx C1/ptx P1/prn1/fim2-1/fim3-1/tcfA2,with frequencies of 90.6%(203/224). All erythromycin-resistant strains were determined A2047 G mutation in 23 S r DNA sequences,and the strains were the ptx P1 genotype(203/224). Eighteen ptx P3 strains were identified in the present study and all ptx P3 strains were sensitive to erythromycin. All isolates were determined low MIC against sulphamethoxazole/trimethoprim(0.004-0.500 mg/L). CONCLUSION: The culture-positive pertussis cases are mostly infants and young children unvaccinated or not-fully vaccinated. The isolates genotyped as ptx A1/ptx C1/ptx P1/prn1/fim2-1/fim3-1/tcfA2 are widespread,which are highly resistant to erythromycin. The high-virulent strains harboring ptxP3 are rare,and are sensitive to erythromycin. Sulphamethoxazole/trimethoprim is effective to treat pertussis caused by erythromycin-resistant isolates.
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Objective To investigate the changes of brain CT imaging in patients with cerebral cysticercosis during the period of anti-cysticercus chemotherapy. Methods A total of 380 inpatients that were conformed to the practical diagnostic criteria of cerebral cysticercosis were enrolled in this study in the Third Affiliated Hospital of Shandong Academy of Medical Sciences from May 2010 to May 2015. All the patients were given anti-cysticercus chemotherapy (albendazole and praziquantel). All the patients received brain CT scan, and of which 210 received enhanced scan. The data of CT imaging were systematically reviewed. Results Before the treatment, the CT images of the patients showed single or multiple small cystic (s) with low density and small nodule-like cephalomere with high density. The re-examinations of CT showed that there were 81.58% (310/380) of the patients whose low density foci were completely absorbed, there were 16.32% (62/380) of the patients whose foci were mostly absorbed, and there were 2.11% (8/380) of the patients whose foci were calcified. Along with the prolongation of treatment time, the side effects were gradually reduced, and in the third course of treatment, the foci were absorbed or calcified in most of the patients. Conclusion CT examination can diagnose the lesion site, range and classification of cerebral cysticercosis, and can evaluate the effect of the therapy according to the changes of CT imaging during the period of anti-cysticercus chemotherapy.
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Objective To investigate the changes of brain CT imaging in patients with cerebral cysticercosis during the period of anti-cysticercus chemotherapy. Methods A total of 380 inpatients that were conformed to the practical diagnostic criteria of cerebral cysticercosis were enrolled in this study in the Third Affiliated Hospital of Shandong Academy of Medical Sciences from May 2010 to May 2015. All the patients were given anti-cysticercus chemotherapy (albendazole and praziquantel). All the patients received brain CT scan, and of which 210 received enhanced scan. The data of CT imaging were systematically reviewed. Results Before the treatment, the CT images of the patients showed single or multiple small cystic (s) with low density and small nodule-like cephalomere with high density. The re-examinations of CT showed that there were 81.58% (310/380) of the patients whose low density foci were completely absorbed, there were 16.32% (62/380) of the patients whose foci were mostly absorbed, and there were 2.11% (8/380) of the patients whose foci were calcified. Along with the prolongation of treatment time, the side effects were gradually reduced, and in the third course of treatment, the foci were absorbed or calcified in most of the patients. Conclusion CT examination can diagnose the lesion site, range and classification of cerebral cysticercosis, and can evaluate the effect of the therapy according to the changes of CT imaging during the period of anti-cysticercus chemotherapy.
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On November 3, 2017, the China Food and Drug Administration reported that the potency indexes of two batches of diphtheria-pertussis-tetanus vaccines produced by two companies did not reach the requirements. Insufficient potency could affect the protection effect of these vaccines immunization. Currently, pertussis cases have already showed an increasing trend in China and could last for several years. Such an increase could be linked to these adverse events of vaccine with insufficient potency, which could become an evidence to challenge or deny the effectiveness of vaccination, and brings a persistent inhibition of the public's acceptance for vaccination. The wider global context of pertussis resurgence, previous underestimate on the domestic pertussis, the promotion of detection methods, the change of knowledge about pertussis, the confirmation of pertussis in elder children and adults, the antigenicity variation of pertussis strains could lead to a significant increase of pertussis cases. Health researchers and clinical workers should raise awareness about these factors, and assess rationally the impact of vaccine titer deficiency on pertussis epidemiology for maintaining and promoting public confidence in vaccination.