成人肠热病的临床微生物学特征

Rishikesh Dessai, A. Yadav, A. Garg
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引用次数: 0

摘要

背景:肠热是一个重大的公共卫生问题;全世界每年的疾病负担约为1190万至2690万例,死亡12.9万至21.7万例。印度每年的疾病负担约为600万人。肠热是由革兰氏阴性菌伤寒沙门氏菌或副伤寒沙门氏菌A、B或C引起的,这是一种血液感染。观察到伤寒沙门氏菌对氨苄西林、复方新诺明、氯霉素等旧抗生素的敏感性重新出现。目的:研究伤寒沙门氏菌、甲型副伤寒沙门氏菌和乙型副伤寒沙门氏菌的抗生素敏感性模式,以及成年肠炎患者的血球计数、肝功能检查和伤寒血清学的临床和实验室概况。材料和方法:研究在Sir Ganga Ram医院内科和微生物科进行,研究对象为76例血培养阳性肠热成年患者。记录患者的临床和实验室资料。研究了所有病例的抗生素敏感性模式和多重耐药菌株的流行情况,如果目前是确定的。结果:本组患者平均年龄31.46 + 11.29岁。男46例,女30例。所有患者均有发热(100%)。大多数患者(98.7%)存在肌痛/头痛。腹部疼痛(57.9%)。白细胞减少和白细胞增多分别出现在25%和2.6%的患者中。血清谷草转氨酶和谷丙转氨酶异常分别为36.8%和38.2%。本研究未见肠热患者出现回肠穿孔和胃肠道出血等并发症。50%的患者IgM阳性。半数以上患者感染伤寒沙门氏菌(血培养),占69.7%;甲型副伤寒沙门氏菌占30.3%。氨苄西林耐药5.3%,氯霉素和复方新诺明各耐药2.6%。左氧氟沙星耐药率为38.2%。头孢曲松、阿奇霉素和头孢克肟的敏感性为100%。2.6%的病例出现多药耐药(对氨苄西林、氯霉素和复方新诺明耐药),这与伤寒沙门氏菌有关。结论:本研究显示发热、肌痛/头痛、腹痛、恶心/呕吐和腹泻是肠炎热的常见临床表现。其他重要结论是合并症发生率低,白细胞增多症发生率低,伤寒IgM阳性高,耐多药率低,大多数药物100%敏感。本研究未发现任何一例肠热患者出现回肠穿孔和胃肠道出血。
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Clinico-microbiological profile of adults with enteric fever
Background: Enteric fever is a major public health problem; the burden of disease worldwide is approximately 11.9–26.9 million cases and 129,000–217,000 deaths each year. The burden of disease in India is approximately 6 million per year. Enteric fever is caused by Gram-negative bacteria Salmonella typhi or Salmonella paratyphi A, B or C, which is a bloodstream infection. The re-emergence of susceptibility of old antibiotics such as ampicillin, co-trimoxazole, and chloramphenicol in S. typhi has been observed. Aims: The objective of the study was to study the antibiotic sensitivity pattern of S. typhi, S. paratyphi A and S. paratyphi B and also the clinical and laboratory profile of enteric fever with respect to blood counts, liver function tests and typhoid serology in adult patients with enteric fever. Materials and Methods: The study was conducted in the Department of Internal Medicine and Microbiology at Sir Ganga Ram Hospital in 76 adult patients of blood culture-positive enteric fever. Clinical and laboratory profile of patients was recorded. Antibiotic sensitivity patterns were studied in all cases and the prevalence of multidrug-resistant strains, if the present was established. Results: The mean age in this study was 31.46 + 11.29 years. There were 46 male patients and 30 female patients. Fever was present amongst all patients (100%). Myalgia/headache was present amongst the majority of patients (98.7%). Pain in the abdomen (57.9%) was present. Leucopenia and leucocytosis were present in 25% and 2.6% of patients, respectively. Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase were abnormal amongst 36.8% and 38.2% of patients, respectively. Complications, such as ileal perforation and gastrointestinal (GI) bleed, were not seen in the patients of enteric fever in this study. Typhidot IgM was positive in 50% of patients. S. typhi (blood culture) was amongst more than half of the patients (69.7%) and S. paratyphi A was 30.3%. Ampicillin was resistant to 5.3% and chloramphenicol and cotrimoxazole each were resistant to 2.6%. Levofloxacin was resistant to 38.2%. Ceftriaxone, azithromycin and cefixime were sensitive to 100%. Multidrug resistance (resistance to ampicillin, chloramphenicol and cotrimoxazole) was seen in 2.6% of cases, which was associated with S. typhi. There was no multidrug resistant (MDR) strain seen with S. paratyphi A. Conclusions: This study showed that fever, myalgia/headache, pain in the abdomen, nausea/vomiting and diarrhoea were the common clinical manifestations of enteric fever. Other important conclusions were low percentages of comorbidities, low occurrence of leucocytosis, high typhidot IgM positivity, low MDR and most of the drugs were 100% sensitive. Ileal perforation and GI bleeding were not found in any case of enteric fever in this study.
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