懒惰狡诈球菌临床感染病例1例及文献资料分析

One case report of Dolosigranulum pigrum infection and literature review

目的对我国大陆地区首例懒惰狡诈球菌临床感染病例进行描述,并对分离的细菌进行病原学和耐药性分析,同时结合文献资料描述懒惰狡诈球菌引起病例的情况。方法查询该病例的临床信息以及该菌相关的文献信息进行病例描述,应用BD Phoenix?-100全自动细菌鉴定/药敏系统、Vitek 2 Compact全自动细菌鉴定药敏分析仪、布鲁克基质辅助激光解吸电离飞行时间质谱仪、16S r RNA基因测序对分离的细菌进行鉴定,应用纸片扩散法对该菌进行耐药性检测。结果该病例为头面部带状疱疹合并右眼带状疱疹性结膜炎患者,从其送检疱疹脓性分泌物中分离到大小两种菌落形态的革兰氏阳性球菌,通过两种全自动细菌鉴定/药敏系统鉴定分别鉴定为耳炎差异球菌(Alloiococcusotitis)和克氏库克菌(Micrococcus Kristinae),而质谱仪均未给出鉴定结果,通过16S r RNA基因测序和比对鉴定均为懒惰狡诈球菌(Dolosigranulum pigrum)。在检测的11种抗生素中,该菌对红霉素和克林霉素耐药。通过检索、整理和分析文献信息,我们揭示该菌感染与性别无关,易于感染低年龄组儿童和老年人,而且该菌能够引起的疾病谱广泛,易于引起脓毒血症和眼部疾病。结论懒惰狡诈球菌是一种潜在的致病菌。目前常见的商业化微生物鉴定系统均不能准确鉴定该菌,该菌鉴定需要依赖16S r RNA基因测序。

Objective To report a case of Dolosigranulum pigrum（D. pigrum）infection which was found in China's Mainland for the first time,analyze the microbiology and drug resistance of the isolates,and to review the published literatures concerning the infections of D. pigrum that reported in the were also collected and analyzed. Methods The clinical data of the patient with D. pigrum infection were collected and analyzed. The obtained isolates were identified by using the BD Phoneix-100 system,VITEK 2-compact system,and matrix-assisted laser desorption/ionization time of flight（MALDI-TOF）mass spectrometry,and sequenced by 16S rDNA PCR. The drug resistance was tested by using disk diffusion method. Results The case was facial herpes zoster accompanied by herpes zoster conjunctivitis caused by D. pigrum. Two different bacterial colonies of cocci were observed from the culture plate of purulent secretion. The cocci colonies were identified as Alloiococcus otitis and Micrococcus Kristinae,and not identified by using MALDI-TOF mass spectrometry. The isolates were finally identified as D. pigrum by the 16S rDNA PCR product sequencing and differentiation. The strain was resistant to erythromycin and clindamycin among the tested 11 antibiotic drugs. By retrieval,collation and analysis of literature information,we revealed that D. pigrum was prone to infect infants and the elderly regardless of gender,and also caused a wide variety of diseases,especially sepsis and eye diseases. Conclusion D. pigrum is a potential pathogen. But common commercial microbial identification system can not accurately identify the bacterium,and sqencing of 16S rRNA is reliable for its identification.