一例Y群ST-23克隆群脑膜炎球菌肺炎病例报告

A pneumonia case caused by Neisseria meningitides serogroup Y ST-23 clonal complex

目的了解广东省广州市1例脑膜炎奈瑟菌引起的肺炎病例的流行病学、病原学以及临床特征。方法收集病例的临床诊疗经过及流行病学调查资料,对医院分离的菌株进行生化鉴定、乳胶凝集、血清分群、PCR分型、全基因组测序及体外药敏试验,确定脑膜炎奈瑟菌的分群及基因型。结果患者临床症状为咽痛、发热、气促、精神疲倦等,无头痛、恶心、意识障碍,无脑膜炎刺激征,全身未见出血点、皮疹。胸部计算机体层摄影术显示肺部感染。从病例血培养中分离到的菌株经鉴定为Y群脑膜炎奈瑟菌,基因组测序显示其序列型为ST-1655(属于ST-23克隆群)。该菌株对青霉素、头孢噻肟、头孢曲松等10种抗生素敏感。结论该病例是广州市首例Y群脑膜炎奈瑟菌引起的肺炎病例,基因分型与广东省分离到的境外流行株一致,应警惕ST-23克隆群的潜在危害,同时应加强对其他脑膜炎球菌性疾病的监测工作。

Objective To investigate the epidemiologic,etiologic and clinical characteristics of a meningococcal pneumonia case in Guangzhou.Methods Clinical diagnosis and epidemiological investigation data were collected,the Neisseria meningitides strains isolated by hospital were used for biochemical identification,latex agglutination,PCR,whole genome sequencing and drug susceptibility test in vitro.Results The patient had symptoms such as sore throat,fever,anhelation,mental fatigue,etc.,but had no headache,nausea,disturbance of consciousness,meningitis irritation and petechia.Chest CT showed a pulmonary infection.The N.meningitides Y strain isolated from the pneumonia patient’s blood was identified as ST-1655,belonging to ST-23 clonal complex.The strain was sensitive to penicillin,cefotaxime,ceftriaxone,etc.Conclusion The meningococcal pneumonia was caused by N.meningitides Y ST-23 clonal complex,which was consistent with the imported strain isolated in Guangdong.We should keep vigilance to the ST-23 clonal complex.Further surveillance for other meningococcal disease is needed.