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Clinical and laboratory features of severe cases of hand, foot and mouth diseases in Wenzhou

Suhua LI ; Jie CHEN ; Hongjiao WANG ; Junya CHEN ; Zhiwei XU ; Yiping CHEN

Chinese Journal of Clinical Infectious Diseases.2010;03(6):337-339. doi:10.3760/cma.j.issn.1674-2397.2010.06.005

Objective To investigate the clinical and laboratory features of severe cases of hand,foot and mouth disease (HFMD) in Wenzhou, Zhejiang Province. Methods Clinical data of 107 children with HFMD, including 97 severe and 10 critical cases treated in Children' s Hospital Affiliated to Wenzhou Medical College during January and May 2010 were retrospectively analyzed. One hundred and fifty children with mild HFMD were also selected as the controls. Clinical features and laboratory results were compared between the two groups. Results Fever, rash and infection in central nervous system were observed in all patients with severe HFMD, and symptoms on respiratory, digestive and cardiovascular systems were more serious than those of mild HFMD cases. White blood cell counts (WBC) were higher in severe group than those in controls (t = 12.72, P ＜0.01). Hyperglycemia (9. 2 mmol/L) and abnormal troponin (0. 3 -9. 0 ng/mL) were presented in all the critical patients. Cerebrospinal fluid WBC counts were raised in 97 severe HFMD patients (98.5 × 106/L for average) with predominance of lymphocytes. Among 107 severe patients, EV71 was positive in 70, including all 10 critical cases. Conclusion Involvement of nervous,respiratory and digestive symptoms is common in severe cases of HFMD, and EV71 is the predominant pathogen.

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Drug-resistance and genotyping of methicillin-resistant Staphylococcus aureus isolated from intensive care unit

Zhijun ZHAO ; Wei JIA ; Zhiyun SHI ; Gang LI ; Nan ZHANG ; Shuai ZONG ; Jun WEI

Chinese Journal of Clinical Infectious Diseases.2010;03(6):321-324. doi:10.3760/cma.j.issn.1674-2397.2010.06.001

Objective To investigate drug resistance and genotypes of methicillin-resistant Staphylococcus aureus (MRSA) isolated from intensive care unit (ICU). Methods MRSA strains were isolated from patients, medical staff and environment of hospital ICUs. Disk diffusion (K-B method) was used for drug resistance testing; Staphylococcal cassette chromosome mec (SCCmec) and Staphylococcal protein A (spa) typing methods were used for genotyping and identifying the homology. Results There were 78 strains of Staphylococcus aureus isolated including 62 isolates of MRSA, which were mainly from the burn ICU (22, 35.48%). Among 62 MRSA strains, 50 were hospital acquired strains, in which 43 isolates were of SCCmec Ⅲ, 4 of SCCmec Ⅰ and 3 of SCCmec Ⅱ. Twelve isolates could not be typed. Twenty-eight out of 37 hospital acquired isolates were typed by spa typing as SCCmec Ⅲ-t030, which belonged to the same clone. Conclusion MRSA in ICU is multi-drug resistant and SCCmec Ⅲ-t030 is the most prevalent genotype, which indicates that clinical MRSA strains and environmental MRSA strains may be homologous.

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Correlation of T-lymphocytes expressing HLA-DR antigen with serum HBV DNA and HBeAg levels in chronic hepatitis B

Songping ZHANG ; Yongle ZHANG ; Mingli ZHU ; Yijian PAN ; Ying WANG ; Gongying CHENG

Chinese Journal of Clinical Infectious Diseases.2010;03(6):333-336. doi:10.3760/cma.j.issn.1674-2397.2010.06.004

Objective To investigate the correlation of T-lymphocyte expressing HLA-DR with serum HBV DNA and HBeAg contents in chronic hepatitis B. Methods Totally 134 chronic hepatitis B patients and 36 healthy blood donors were enrolled in the study. The T-lymphocytes (CD3 + HLA-DR + ,CD4 + HLA-DR+ and CD8 + HLA-DR+ T) expressing HLA-DR were detected by flow cytometry, the serum HBV viral loads were detected by the real-time quantitative PCR and HBeAg was detected by chemiluminescence method. According to serum HBV DNA viral loads patients were defined as HBV DNA negative (≤ 103 copies/mL), low (＞ 103 - 105 copies/mL), medium (＞ 105 - 107 copies/mL) and high groups (＞ 107 - 109 copies/mL) ; according to serum HBeAg levels, patients were defined as HBeAg negative (≤1 PEIU/mL), low (＞ 1 - 100 PEIU/mL), medium (＞ 100-1 000 PEIU/mL) and high groups (＞ 1 000-10 000 PEIU/mL). T test and one-way ANOVA were performed. Results With HBV DNA loads, HBeAg levels increased, the percentage of CD3 + HLA-DR + , CD4 + HLA-DR + and CD8 + HLA-DR +decreased, especially CD8 + HLA-DR +. Compared with HBV DNA negative group, the percentages of CD3 +HLA-DR + , CD4 + HLA-DR + and CD8 + HLA-DR + were significantly reduced in high group (t = 3. 686,4. 592 and 3. 216, P ＜ 0. 0l); the percentages of CD4 + HLA-DR + and CD8 + HLA-DR + were also reduced in medium group (t = 3. 761 and 2.862, P ＜ 0.01); while in low group, only the percentage of CD8 + HLA-DR + was reduced (t = 2.215, P ＜ 0.05). Compared with HBeAg negative group, the percentages of CD3 +HLA-DR+, CD4 + HLA-DR+ and CD8 + HLA-DR+ were significantly reduced in medium and high groups (thigher =3. 144, 2.222 and 4.035; tmiddle =3.311, 2.362 and 3.374, P ＜0.05), while in the low group,only the percentage of CD8+HLA-DR+ was reduced (t=2.029, P＜0. 05). Conclusion The combined measurement of HBV DNA, HBeAg and T-lymphocytes expressing HLA-DR in chronic hepatitis B patients may not only help to evaluate the immune status of patients, but also can predict the disease progression and clinical outcomes.

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Drug resistance and genotype of methicillin-resistant Staphylococcus in Tianjin

Shujiong CHEN ; Shangwei WU ; Rong WANG ; Wei GAO ; Jie XIA ; Wei GUAN ; Yunde LIU

Chinese Journal of Clinical Infectious Diseases.2010;03(6):328-332. doi:10.3760/cma.j.issn.1674-2397.2010.06.003

Objective To investigate the drug resistance and genotype of methicillin-resistant Staphylococcus (MRS), and to study the epidemiology of drug resistance in Staphylococcus. Methods Drug susceptibility tests were performed for 138 Staphylococcus strains clinically isolated, and mecA gene was detected with PCR. For mecA positive strains, Staphylococcal cassette chromosome mec (SCCmec) gene was detected by two multiplex PCR assays. Results Seven (10.8%) out of 65 Staphylococcus aureus strains were methicillin-resistant Staphylococcus aureus (MRSA) strains, and 44 (60.3%) out of 73 coagulase negative Staphylococcus strains were methicillin-resistant coagulase negative Staphylococcus (MRCNS)strains. There was statistical significance on the difference of isolation rates (x2 = 37. 05, P ＜0.01). No vancomycin or nitrofurantoin resistant strain was found. There were 52 (52/138, 37.7%) mecA positive strains, including 16 SCCmec type Ⅰ strains, 1 type Ⅱ strain, 13 type Ⅲ strains, 9 type Ⅳ strains and 4 type Ⅴ strains. Conclusions Drug resistance in MRS is increasingly serious. MRCNS strains are more popular than MRSA in clinic, and SCCmec Ⅰ and Ⅲ may account for most infections.

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Smac/DIABLO and cytochrome c mRNA levels in liver tissue of rats with acute hepatic failure treated by microencapsulated hepatocytes

Hongjiao WANG ; Zhiwei XU ; Junya CHEN ; Hailong LIN ; Yiping CHEN ; Yongping CHEN

Chinese Journal of Clinical Infectious Diseases.2009;02(6):341-344. doi:10.3760/cma.j.issn.1674-2397.2009.06.006

Objective To investigate Smac/DIABLO and cytochrome c(cyt-c)mRNA levels in liver tissue of rats with acute hepatic failure treated by microencapsulated hepatocyte.Methods Acute hepatic failure were induced by intraperitoneal injection of D-galactosamine in rats.and the rats were treated with microencapsulated hepatocytes,free hepatocytes and physical saline(contr01),respectively.Smac/DIABLO and cyt-c mRNA in liver tissue was detected by RT-PCR and the mRNA expression levels among three groups were compared.Results Smac/DIABLO and cyt-c mRNA levels in liver tissues of rats with acute hepatic failure were higher than those of normal rata(F=4.345,14.821,47.565,42.178 and 62.961,P<0.05).The peak values of Smac/DIABLO and cyt-C mRNA expressions in free hepatocytes and control groups were at 48 h.while that in microencapsulated hepatoeytes group was at 24 h.Conclusion Smac/DIABLO and cyt-c mRNA expression is an indicator of apoptosis of hepatocytes.

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The genetic feature of a strain of pan-drug resistant Acinetobacter baumannii

Ganzhu FENG ; Yang ZHANG ; Shuidi ZHAO

Chinese Journal of Clinical Infectious Diseases.2009;2(5):288-292. doi:10.3760/cma.j.issn.1674-2397.2009.05.008

Objective To investigate the genetic features related to drug-resistance of a strain of pan-drug resistant Acinetobacter baumannii. Methods The susceptibilities to 15 antibacterial agents were detected in Acinetobacter baumannii by K-B paper diffusing method. A strain of pan-drug resistant Acinetobacter baumannii was selected. The drug-resistant genes of the selected strain were amplified by polymerase chain reaction (PCR) , including 15 extended-spectrum β-lactamase genes, 3 metal β-lactamase genes, 2 AmpC enzyme genes, 7 aminoglycoside modifying enzyme genes and the genetic markers of integron I and transposons. Results The strain was resistant to 14 antibacterial agents except cefoperazone sodium/ sulbactam. β-lactamases genes ( TEM, OXA-23 and ADC) , aminoglycosides modification enzyme genes [aac(3)- I , aac(6')- I b and ant(3")- I ] , integron I qacEAi-sull and transposon tnpU were positive in PCR amplification. A new subtype of AmpC (chromosome) desoxyribonucleic acid ( DNA) was detected. Conclusion Acinetobacter baumannii is of high resistance to most antibacterial agents, and the mechanisms of the resistance are complex.

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Detection of 22 beta-lactamase genes and enzyme activities in multi-drug resistant Acinetobacter baumannii

Jianming ZHU ; Jinlan WU ; Rujin JIANG ; Kangle WU ; Jianmin WANG ; Haishen KONG

Chinese Journal of Clinical Infectious Diseases.2009;2(5):281-287. doi:10.3760/cma.j.issn.1674-2397.2009.05.007

Objective To investigate the distribution of 22 beta-lactamase genes and enzyme activities in multi-drug resistant Acinetobacter baumannii (MDRAB). Methods Sixty-two MDRAB strains were isolated from the First Affiliated Hospital, College of Medicine, Zhejiang University. Twenty-two beta-lactamase genes were analyzed by PCR and verified by DNA sequencing. Enzyme activities of extended spectrum beta-lactamases (ESBLs) , cephalosporinase ( AmpC) and metallo-beta-lactamases ( MBL) were detected by the modified three-dimensional method using enzyme extraction. Results In 62 MDRABs, 51 (82.3% ) , 50 (80.6% ) and 36 (58.1% ) isolates were found to carry blaTEM, blaOXA-23 cluster, and blaADC, respectively. The rest 19 genes were not detected in this study. DNA sequencing and genomic comparison showed that 5 isolates carrying blaTEM had the same genotype as blaTEM-l , 6 isolates carrying blaOXA-23 cluster had the same genotype as blaOXA-23 carbapenemases (accession; CAB69042. 1) , and 2 isolates carrying blaADC had the same genotype as blaADC-like (accession: EU081908). Thirty-two isolates (51.6% ) produced ESBLs and AmpC, 19 isolates (30.6% ) produced ESBLs only, and 1 isolate (1.6%) produced AmpC only; and no isolate produced MBL. Conclusion MDRAB carrying blaOXA-23 carbapenemase and blaADC AmpC in this study are of high drug resistance.

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Combination of interferon α with mannan peptide in treatment of HBeAg-positive chronic hepatitis B

Xiao LING ; Zhenxiang TANG ; Shuquan CHENG ; Yongchao XIAN ; Xin YE ; Yifeng CAI ; Chengjun HUANG ; Hui NI

Chinese Journal of Clinical Infectious Diseases.2009;2(5):268-272. doi:10.3760/cma.j.issn.1674-3397.2009.05.004

Objective To investigate the clinical effect of IFNα combined with mannan peptide in treatment of patients with HBeAg-positive chronic hepatitis B ( CHB ). Methods Eighty HBeAg-positive CHB patients with HBV DNA quantity ranging from 10 to 10 eopies/mL were enrolled and randomized into the treatment group and the control group ( n = 40 for each ). Patients in treatment group were given daily subcutaneous injection of IFNα-2b 5,000,000 U for 52 weeks, and received mannan peptide 10 mg per intravenous injection or 2. 5 mg per intramuscular injection for a total of 2 to 3 treatment courses (12 weeks for each). The control group received only IFNα-2b treatment. Liver function, serum markers of hepatitis B, HBV DNA quantity and blood tests were performed before the treatment and at 2, 4, 8, 16, 26 and 52-week during the treatment; and the adverse effects were recorded. Results The rates for ALT normalization, negative HBsAg, negative HBeAg, HBeAg seroconversion and negative HBV DNA were 91. 8% , 17. 5% , 52. 5% , 27. 5 % and 47. 5% at 52nd week in the treatment group, while those in the control group were 80. 0% , 12. 5% , 30. 0% , 10. 0 % and 25. 0% , respectively. There were significant differences in HBeAg-negative, HBeAg-seroeonversion and HBV DNA-negative rates between two groups (χ2 = 4. 178, 4.021 and 4.381, P < 0. 05 ) , and these indexes in the treatment group were increased to 57. 5% , 30. 0% and 50. 0 respectively at 52nd week after drug withdraw. White blood cells began to be elevated at 4th week and were restored to the normal levels at 8th week in the treatment group, while the count in the control was lower than the normal value even at 52nd week of the treatment with the average of (3.45±1. 18)×109/L. Conclusion Alpha-interferon combined with mannan peptide therapy is effective for patients with HBeAg-positive CHB, which may restore the declined peripheral WBC counts induced by interferon and improve the compliance.

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Vibrio vulnificus: cultivation, identification and antimicrobial susceptibility

Zhigang WANG ; Pingyang SHAO ; Xiaoyan WU ; Kanxiang NI ; Hongxia LU

Chinese Journal of Clinical Infectious Diseases.2009;2(5):293-296. doi:10.3760/cma.j.issn.1674-2397.2009.05.009

Objective To investigate the cultivation, biochemical features and drug susceptibilities of Vibrio vulnificus. Methods Three strains of Vibrio vulnificus were isolated from fatal patients in the Second Hospital of Jiaxing, Zhejiang province. Cultivation, identification and antibacterial susceptibility test were performed. Results Vibrio vulnificus grew on blood agar as dull-gray, opaque colonies with β-hemolysis. The organism presented positive in lactose, cellobiose fermentation and O/129 (10 μg) tests, but lack of inositol and rhamnus. The antibacterial susceptibility tests showed that Vibrio vulnificus strains were sensitive to ciprofloxacin, levofloxacin, imipenem, cefepime, ceftazidime, ceftriaxone, compound sulfamethoxazole and nitrofurantoin, however, resistant to gentamicin, tobramycin, aztreonam and cefazolin. Conclusions Vibrio vulnificus can be isolated from blood, bubbles fluid, and stool. Rapid identification, early diagnosis, and prompt empirical antibacterial therapy are important for reducing the mortality.

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IL-1βand IL-1ra contents in cerebrospinal fluid of children with Japanese encephalitis

Wei LI ; Haifan SHI ; Hongjiao WANG ; Yiping CHEN ; Guangqian LI

Chinese Journal of Clinical Infectious Diseases.2009;2(5):277-280. doi:10.3760/cma.j.issn.1674-2397.2009.05.006

Objective To investigate the contents of IL-1β and IL-1ra in cerebrospinal fluid of children with Japanese encephalitis, and their clinical significance. Methods Enzyme linked immunosorbent assay (ELISA) was employed to detect IL-lβ and IL-lra contents in 50 children with Japanese encephalitis and 20 children without nervous system disease (controls). Results IL-1β contents in climax stage, convalescent stage and the controls were (49. 43±14. 59) , (24. 73±14. 50) and (8. 98± 1.26)μg/L (F = 79.88, P<0.01); IL-lra contents in climax stage, convalescent stage and the controls were (177. 39±60. 19), (78. 24±44. 63) and (21. 09±3. 10) μg/L (F = 91. 53, P <0. 01). There were significant differences on IL-lβ and IL-lra contents among children with mild, moderate and severe encephalitis (climax: F = 82.36 and 66.50, P<0.01; convalescence; F = 55. 17 and 79.50, P<0.01). IL-1β content was positively correlated with IL-lra in both climax and convalescent stages (climax; r = 0. 815, P < 0.01; convalescent; r= 0.728, P < 0.01). Conclusions IL-lβ and IL-lra contents in cerebrospinal fluid are significantly increased in children with Japanese encephalitis in climax stage, which are closely correlated with the disease severity. The two indicators may participate in the pathological process of brain damages with Japaness encephalitis.

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