安徽省阜阳市首例W群流行性脑脊髓膜炎死亡病例病原学分析

孟昭倩; 郭国侠; 郭靓子; 段然; 徐海洋; 卜戈

doi:10.3784/jbjc.202211100485

安徽省阜阳市首例W群流行性脑脊髓膜炎死亡病例病原学分析

doi: 10.3784/jbjc.202211100485

1.
阜阳市疾病预防控制中心, 安徽阜阳 236000
2.
中国疾病预防控制中心传染病预防控制所, 北京 102206

基金项目: 安徽省医疗卫生重点专科建设项目；阜阳市卫生健康委员会科研立项课题（No. FY2019079）

详细信息

作者简介:
孟昭倩，女，安徽省阜南县人，主任技师，主要从事病原微生物检测工作，Email：408423362@qq.com

通讯作者:
卜戈，Tel：0558−2560321，Email：865202817@qq.com

中图分类号: R211; R515.2
计量
- 文章访问数: 56
- HTML全文浏览量: 29
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2022-11-10
- 网络出版日期: 2023-03-29
- 刊出日期: 2023-04-30

Etiological analysis on the first death of meningococcal meningitis caused by Neisseria meningitidis serogroup W in Fuyang, Anhui

1.
Fuyang Center for Disease Control and Prevention, Fuyang 236000, Anhui, China
2.
National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China

Funds: This study was supported by the fund of Medical and Health Key Specialty Construction Project of Anhui Province, Scientific Research Project of Fuyang Health Commission (No. FY2019079)

More Information

Corresponding author: Bu Ge, Email: 865202817@qq.com

摘要

摘要: 目的对安徽省阜阳市2020年1月某寄宿学校1例疑似流行性脑脊髓膜炎（流脑）死亡病例开展流行病学调查与病原学分析，了解其传播途径和传染源，为及时有效阻止疫情扩散提供科学依据。方法依据WS 295—2019《流行性脑脊髓膜炎诊断》，采集病例血液和密切接触者咽拭子，现场接种，及时保温运送至实验室进行分离培养，同时用聚合酶链式反应方法开展种特异性鉴定，对分离出的菌株进行分群鉴定、采用K-B纸片扩散法和E-test试纸条法进行药敏试验，用脉冲场凝胶电泳（PFGE）技术分析其同源性。结果从病例血液和密切接触者咽拭子中共分离出13株脑膜炎奈瑟菌，均为W群，密切接触者菌株携带率为66.67%（12/18），PFGE分型显示病例和密切接触者菌株高度相似，相似度为92.60%～100.00%。所有菌株对头孢曲松、头孢噻肟、氯霉素、利福平、美罗培南、阿奇霉素、米诺环素敏感，对青霉素、氨苄西林中介，对环丙沙星、复方新诺明、左氧氟沙星耐药。结论密切接触者和病例均检出W群脑膜炎奈瑟菌，流行病学调查发现，本病例为阜阳市首例W群流脑病例。密切接触者病原菌携带率较高，W群流脑存在流行趋势，应加强对其监测，及时采取干预措施，同时应注意抗菌药物的合理使用。
- 脑膜炎奈瑟菌 /
- W群 /
- 药敏试验 /
- 脉冲场凝胶电泳
Abstract: Objective To understand the etiological characteristics of a death of suspected meningococcal meningitis in a boarding school in Fuyang, Anhui province, in January 2020, identify its transmission route and source of infection, and provide scientific evidence for the timely and effective control of the spread of the epidemic. Methods On the basis of the diagnosis criteria for meningococcal meningitis (WS 295—2019), blood samples of the cases and throat swabs of close contacts were collected, and field inoculation, heat preservation and timely transfer of the samples were conducted for pathogen culture in laboratory, at the same time polymerase chain reaction (PCR) was used for specific identification of serogroup. K-B disk diffusion method and E-test strip method were used for antimicrobial susceptibility test. The homology of the strains was analyzed by pulsed field gel electrophoresis (PFGE). Results A total of 13 strains of Neisseria meningitidis were isolated from the blood samples of cases and throat swabs of close contacts. All the strains belonged to serogroup W. The carriage rate of N. meningitidis W in close contacts was 66.67% (12/18). PFGE showed that the patterns of the strains isolated from the cases and close contacts were highly similar, and the similarity was 92.59%−100.00%. All the strains were sensitive to ceftriaxone, cefotaxime, chloramphenicol, rifampicin, meropenem, azithromycin, minocycline, intermediate to penicillin and ampicillin, and resistant to ciprofloxacin, compound sulfamethoxazole and levofloxacin. Conclusion N. meningitidis W was detected in both the cases and the close contacts. Epidemiological investigation revealed that the death was the first case caused by infection of N. meningitidis W in Fuyang. The pathogen carriage rate in close contacts was high, suggesting the risk of epidemic caused by N. meningitidis W. It is necessary to strengthen the surveillance for N. meningitidis W, take timely intervention measures, and pay attention to the rational use of antibiotics.
- Neisseria meningitidis /
- Serogroup W /
- Drug susceptibility test /
- Pulsed field gel electrophoresis

HTML全文

图 1 13 株脑膜炎奈瑟菌siaD基因PCR扩增产物电泳图谱

注：M. 分子量标准；1～13为分离的菌株；N. 阴性对照；S. 阳性对照

Figure 1. Electrophoretic map of siaD gene of N. meningitidis group W

下载: 全尺寸图片幻灯片

图 2 13 株脑膜炎奈瑟菌的脉冲场凝胶电泳图谱聚类分析

Figure 2. PFGE results of 13 strains of N. meningitidis

下载: 全尺寸图片幻灯片

表 1 用于脑膜炎奈瑟菌种属及群鉴定的引物

Table 1. Primers used for species and groups identification of N. meningitidis

扩增基因	种属/血清群	引物序列（5′～3′）	产物长度（bp）
crgA	脑膜炎奈瑟菌	F：GCTGGCGCCGCTGGCAACAAAATTC	230
crgA	脑膜炎奈瑟菌	R：CTTCTGCAGATTGCGGCGTGCCGT	230
orf-2	A	F：CGCAATAGGTGTATATATTCTTCC	400
orf-2	A	R：CGTAATAGTTTCGTATGCCTTCTT	400
siaD	B	F：GGATCATTTCAGTGTTTTCCACCA	450
siaD	B	R：GCATGCTGGAGGAATAAGCATTAA	450
siaD	C	F：TCAAATGAGTTTGCGAATAGAAGGT	250
siaD	C	R：CAATCACGATTTGCCCAATTGAC	250
siaD	Y	F：CTCAAAGCGAAGGCTTTGGTTA	120
siaD	Y	R：CTGAAGCGTTTTCATTATAATTGCTA	120
siaD	W	F：CAGAAAGTGAGGGATTTCCATA	120
siaD	W	R：CACAACCATTTTCATTATAGTTACTGT	120
注：F. 正向引物；R. 反向引物

下载: 导出CSV

表 2 样品的脑膜炎奈瑟菌培养及核酸检测结果

Table 2. Results of N. meningitidis culture and nucleic acid detection

样品	标本数（份）	培养阳性数（份）	培养阳性率（%）	crgA基因阳性数（份）	crgA基因阳性率（%）
病例血液	1	1	100.00	1	100.00
密切接触者咽拭子	18	12	66.67	12	66.67
合计	19	13	68.42	13	68.42

下载: 导出CSV

参考文献(14)

[1]	Harrison OB, Claus H, Jiang Y, et al. Description and nomenclature of Neisseria meningitidis capsule locus[J]. Emerg Infect Dis, 2013, 19(4): 566–573. DOI: 10.3201/eid1904.111799.
[2]	夏昕, 戴德芳, 湛志飞, 等. 湖南省首例W135群流行性脑脊髓膜炎病例流行病学及病原学分析[J]. 疾病监测,2013,28(9):714–716. DOI:10.3784/j.issn.1003−9961.2013.9.005. Xia X, Dai DF, Zhan ZF, et al. Epidemiology and etiology of the first serogroup W135 meningococcal disease case in Hunan[J]. Dis Surveill, 2013, 28(9): 714–716. DOI: 10.3784/j.issn.1003−9961.2013.9.005.
[3]	徐建国, 阚飙, 张建中, 等. 现场细菌学[M]. 北京: 科学出版社, 2011: 298–299. Xu JG, Kan B, Zhang JZ, et al. Field bacteriology[M]. Beijing: Science Press, 2011: 298–299.
[4]	Martinelli D, Fortunato F, Prato R. Estimates of the burden of meningococcal disease in Italy: implications for prevention and control[J]. J Prev Med Hyg, 2015, 56(3): E112–115.
[5]	邵祝军, 徐丽, 高源, 等. 中国流行性脑脊髓膜炎流行菌群变化趋势分析[J]. 中国计划免疫,2007,13(6):541–544. DOI:10.3969/j.issn.1006−916X.2007.06.008. Shao ZJ, Xu L, Gao Y, et al. Epidemiologic trend of serogroup switching of Neisseria meningitidis strains in China[J]. Chin J Vacc Immunizat, 2007, 13(6): 541–544. DOI: 10.3969/j.issn.1006−916X.2007.06.008.
[6]	李军宏, 李艺星, 吴丹, 等. 中国2006-2014年流行性脑脊髓膜炎病例菌群分布特征及变迁趋势[J]. 中国疫苗和免疫,2015,21(5):481–485. DOI: 10.19914/j.cjvi.2015.05.001. Li JH, Li YX, Wu D, et al. Epidemiological characteristics of meningococcal meningitis and switching trend of serogroups of Neisseria meningitidis in China, 2006−2014[J]. Chin J Vacc Immunol, 2015, 21(5): 481–485. DOI: 10.19914/j.cjvi.2015.05.001.
[7]	李军宏, 吴丹, 温宁, 等. 2015-2019年中国流行性脑脊髓膜炎血清群分布特征[J]. 中国疫苗和免疫,2020,26(3):241–244. DOI: 10.19914/j.cjvi.2020.03.001. Li JH, Wu D, Wen N, et al. Serogroup distribution of meningococcal meningitis in China, 2015−2019[J]. China Vacc Immunizat, 2020, 26(3): 241–244. DOI: 10.19914/j.cjvi.2020.03.001.
[8]	原灵, 詹銮峰, 林震宇. 福建省首例W135群流行性脑脊髓膜炎病例的回顾性研究[J]. 疾病监测,2010,25(3):195–196,207. DOI:10.3784/j.issn.1003−9961.2010.03.010. Yuan L, Zhan LF, Lin ZY. Retrospective study of the first case of epidemic cerebrospinal meningitis W135 in Fujian province[J]. Dis Surveill, 2010, 25(3): 195–196,207. DOI: 10.3784/j.issn.1003−9961.2010.03.010.
[9]	罗献伟, 刘丹青, 陈霞, 等. 安徽省首例W135群流行性脑脊髓膜炎病例调查[J]. 疾病监测,2013,28(2):160–161. DOI:10.3784/j.issn.1003−9961.2013.2.021. Luo XW, Liu DQ, Chen X, et al. Investigation of the first case of Neisseria meningitidis W135 infection in Anhui[J]. Dis Surveill, 2013, 28(2): 160–161. DOI: 10.3784/j.issn.1003−9961.2013.2.021.
[10]	中华人民共和国国家卫生健康委员会. WS 295－2019 流行性脑脊髓膜炎诊断[EB/OL]. (2019-01-02)[2022-11-01]. http://www.nhc.gov.cn/wjw/s9491/201905/c3dec3b7e7cc43a4ae2a6720e0dd29be/files/020125b0cc2a48f2b549e8f27da3d1a1.pdf. National Health Commission of the People's Republic of China. WS 295－2019　Diagnosis for meningococcal meningitis[EB/OL]. (2019-01-02)[2022-11-01]. http://www.nhc.gov.cn/wjw/s9491/201905/c3dec3b7e7cc43a4ae2a6720e0dd29be/files/020125b0cc2a48f2b549e8f27da3d1a1.pdf.
[11]	陈深侠, 谢锦荣, 赵中飞, 等. 健康人群W135群脑膜炎奈瑟菌免疫水平研究[J]. 浙江预防医学,2015,27(4):325–327,333. DOI:10.19485/j.cnki.issn1007−0931.2015.04.001. Chen SX, Xie JR, Zhao ZF, et al. A study on the immunity level of Neisseria meningitides serogroup W135 among healthy population[J]. Zhejiang Prev Med, 2015, 27(4): 325–327,333. DOI: 10.19485/j.cnki.issn1007−0931.2015.04.001.
[12]	骆晓艳, 张维, 陈伟, 等. 2016年天津市健康人群脑膜炎奈瑟菌W135群、Y群抗体水平调查[J]. 疾病监测,2018,33(7):569–572. DOI:10.3784/j.issn.1003−9961.2018.07.009. Luo XY, Zhang W, Chen W, et al. Investigation of antibody level against Neisseria meningitidis W135 and Y in healthy population in Tianjin, 2016[J]. Dis Surveill, 2018, 33(7): 569–572. DOI: 10.3784/j.issn.1003−9961.2018.07.009.
[13]	高景枝, 张雅婷, 何飞, 等. 2008-2017年鄂西北地区脑膜炎奈瑟菌药物敏感性及分子分型研究[J]. 疾病监测,2018,33(7):552–558. DOI:10.3784/j.issn.1003−9961.2018.07.006. Gao JZ, Zhang YT, He F, et al. Antibiotic susceptibility and molecular type of Neisseria meningitidis in northwestern Hubei[J]. Dis Surveill, 2018, 33(7): 552–558. DOI: 10.3784/j.issn.1003−9961.2018.07.006.
[14]	沈伟伟, 王连华, 邱春华, 等. 2019年浙江省台州市1例新生儿流行性脑脊髓膜炎病例病原学分析[J]. 疾病监测,2019,34(10):912–915. DOI:10.3784/j.issn.1003−9961.2019.10.011. Shen WW, Wang LH, Qiu CH, et al. Etiological analysis of a neonatal meningococcal meningitis case in Taizhou, Zhejiang, 2019[J]. Dis Surveill, 2019, 34(10): 912–915. DOI: 10.3784/j.issn.1003−9961.2019.10.011.