呼吸道和男性泌尿生殖道非脑膜炎球菌与非淋球菌奈瑟菌感染的实验诊断与临床研究

Studies on the laboratory diagnosis and clinical significance for respiratory tract and male genitourinary tract infection with the non-meningococci and non-gonococci Neisseria species

目的探讨非淋球菌与非脑膜炎球菌奈瑟菌引起呼吸道及男性泌尿生殖道感染的病原学诊断及其临床意义。方法采集8例急性尿道炎和慢性前列腺炎患者的前列腺按摩液或/和精液标本以及19例慢性支气管炎或肺炎等呼吸道感染疾病患者的痰标本,分别接种血琼脂培养基或/和淋球菌琼脂培养基,置5%CO2培养箱内37℃培养18-24h。分离的革兰阴性双球菌分别进行氧化酶与生化反应鉴定、药物敏感试验以及淋球菌隐蔽性质粒pJD1基因聚合酶链反应(PCR)检测。结果从27例患者的前列腺液、精液及痰标本分别分离到28株革兰阴性双球菌,其中8例男性泌尿生殖道感染患者的前列腺液与精液标本分离8株,包括粘液奈瑟菌3株、灰色奈瑟菌4株、嗜乳糖奈瑟菌1株;19例呼吸道感染患者的痰标本分离20株,包括嗜乳糖奈瑟菌7株、微黄奈瑟菌4株、粘液奈瑟菌4株、灰色奈瑟菌2株、干燥奈瑟菌2株、多糖奈瑟菌1株。分离菌株的淋球菌隐蔽性质粒Pjd1基因PCR检测结果显示:26株(92.6%)形成与淋病奈瑟菌一致的阳性反应。获自泌尿生殖道及呼吸道感染患者的28株非淋球菌和非脑膜炎球菌奈瑟菌对头孢菌素类、奎诺酮类和磷霉素等临床常用抗菌药物具有明显的耐药性(23.1%～100%)以及多重耐药性。结论人体上呼吸道的某些正常菌群奈瑟菌也可感染人类呼吸道和男性泌尿生殖道,引起淋病样尿道炎、慢性前列腺炎、慢性支气管炎以及肺炎等疾病。常规细菌学的形态检查、氧化酶试验甚至检测隐蔽性质粒以及其他淋球菌非特异性基因的方法,可导致对于非淋球菌和非脑膜炎球菌奈瑟菌感染的误诊与漏诊。感染泌尿生殖道和呼吸道的非淋球菌和非脑膜炎球菌奈瑟菌对临床常用的许多抗菌药物具有耐药性甚至多重耐药性,是导致呼吸道和泌尿生殖道感染治疗困难的一个重要因素。

Ohjective To probe the diagnosis and clinical significance for infection of respiratory tract and the male genitourinary tract caused by the non-gonococci and non-meningococci Neisseria species. Methods The samples of prostatic secretion or/and sperm were collected from the 8 cases of male patients with the acute urethritis and chronic prostatitis and the samples of sputum from the 19 cases of patient with the chronic bronchitis or pneumonia and other respiratory infectious diseases, then inoculated into the blood agar medium or/and gonococcal agar medium respectively and incubated in 5% CO2 at 37℃ for 18-24h. The Gram-negative diplococci from the samples were identified by oxidase test, biochemical examinations, drug sensitivity tests. PCR products of cryptic plasmid pJD1 gene of the isolated strains were amplified for the identification of N. Gonorrhoeae. Results 28 strains of Gramnegative diplococci were isolated from the 27 patients, which were identified as three of N. mucosa （3 strains）, N. cinerea （4 strains） and N. lactamica （1 strains） from 8 cases of male genitourinary infection, and N. lactamica （7 strains）, N. subflava （4 strains）, N. mucosa （4 strains）, N. cinerea （2 strains）, N. sicca （2 strains） and N. polysaccharea （1 strains） from 19 cases of respiratory infection respectively. In the PCR identification test of cryptic plasmid pJD1 gene, 26 strains of the non-gonococci and non-meningococci Neisseria species showed the same positive results （92. 6% %） as that of N. Gonorrhoeae. The non-gonococci and non-meningococci Neisseria species isolated from the patients displayed obviously resistance （23. 1%-100%） to the drugs most in use on clinical and multidrug resistance, especially to Qinolones, Cephaloporins and Fosfomycine Conclusion Some Neisseria species that are the normal inhabitants of the upper respiratory tract can also cause infection of male genitourinary and respiratory tract such as gonorrhoea-like urethritis, chronic prostatitis, chronic bronchitis or pneumonia and others. The routine identification methods including morphological examinations, oxidase tests and even the PCR identification test of cryptic plasmid and other nonspecific genes for N. Gonorrhoeae, may lead to the clinical and etiological diagnostic errors and misdiagnosis of infection caused by non-gonococci and non-meningococci Neisseria species. Drug resistance in non-gonococci and non-meningococci Neisseria species can directly affect the success of treatment to the patients with these bacteria.