Analysis of the common opportunistic pathogens

Transcription

1 Journal of Microbes and Infection, December 2009, Vol. 4, No , 3 1, 2, 3, 1. ( ), ; 2., ; 3., :,,,,,,, ;, : ; ; Analysis of the common opportunistic pathogens SUN Fu-Yan 1, 3, LU Hong-Zhou 1, 2, 3 1. Department of Infectious Disease, Shanghai Public Health Clinical Center Affiliated to Fudan University, Shanghai , China; 2. Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai , China; 3. Department of Medical Science, Shanghai Medical College, Fudan University, Shanghai , China Abstract: Opportunistic pathogens do not cause infectious disease when the immune system is intact. However, under microdysbiosis or in an immunocompromised host, they can cause clinical infectious disease and mortality. Opportunistic infections are gradually increasing with the prolonged survival of immunocompromised patients with congenital immunodeficiency or cancer by modern medical treatment and as a result of microdysbiosis that may be caused by the abuse of antibiotics and increases in resistant strains ( single - drug or multi - drug resistant strains). Clinical manifestations of opportunistic infections appear to be more complex and atypical. Great difficulties exist in clinical treatment of this type of infection. Therefore, careful examination of common opportunistic pathogens and their characteristics has great clinical significance in the accurate diagnosis and treatment of opportunistic infections. Key words: Immunocompromise; Opportunistic infection; Opportunistic pathogen ( opportunistic infection), ( opportunistic pathogen),,,,, : ( 2008 ZX ) :, luhongzhou@ fudan. edu. cn Corresponding author: LU Hong-Zhou, luhongzhou@ fudan. edu. cn ;, ;, ( human immunodeficiency virus, HIV),, ( ) ( Pseudomonas aeruginosa),,,

2 Journal of Microbes and Infection, December 2009, Vol. 4, No. 4 1 ( 1) 1. 1, ( Escherichia coli ) ( Klebsiella), ( Staphylococcus), ( 2) 1 Tab 1. Common opportunistic pathogens Bacteria Virus Fungus Parasites Escherichia coli Cytomegalovirus Candida Toxoplasma Klebsiella EB virus Cryptococcus Cryptosporidium Pseudomonas aeruginosa Herpes simplex virus Pneumocystis jiroveci Nosema Enterobacter cloacae Varicella-zoster virus Penicillium marneffei Isospora Proteus Human parvovirus Mucor Stercoralis Mycobacterium Serratia Staphylococcus JC virus Enterococcus 2 Tab 2. Comparison of common opportunistic bacteria Opportunistic bacteria Major diseases caused by cited bacteria Potential mechanisms of resistance Resistant antimicrobial agents ( e. g. ) Escherichia coli Modifying enzymes mediated by plas- -lactams ( e. g. enicillins, cephalo- Biliary tract infections mid, outer membrane pore protein de- sporins ), fluoroquinolones, amin- Peritonitis ficiency, active drug efflux, target mu- oglycosides, chloramphenicols Wound infections tations Klebsiella Respiratory tract infections ( pneumonia) Modifying enzymes mediated by plas- -lactams ( e. g. penicillins, cepha- mid, outer membrane pore protein de- losporins ), fluoroquinolones, amin- Meningitis ficiency, active drug efflux, target mu- oglycosides, sulfonamides tations, biofilm formation Pseudomonas aeruginosa Respiratory tract infections Modifying enzymes mediated by plas- -lactams ( e. g. cephalosporins, car- mid, outer membrane pore protein de- bapenems), aminoglycosides, fluoro- ficiency, active drug efflux, target mu- quinolones Endocarditis tations, biofilm formation Soft tissue infections Serratia Lower respiratory tract infections ( pneumo- -lactamases ( extended spectrum - Piperacillin, ceftriaxone, cefopera- nia) lactamases and AmpC enzyme) zone, amikacin, gentamicin Central nervous system infections Surgical trauma infections Enterobacter cloacae Skin and soft tissue infections -lactamases, target mutations, active -lactams, fluoroquinolones, chlor- drug efflux, outer membrane pore pro- amphenicols Respiratory tract infections tein deficiency Staphylococcus Lower respiratory tract infections ( pneumo- Target mutations, modifying enzymes Fluoroquinolones, -lactams, macroli- nia) mediated by plasmid, active drug ef- des, tetracyclines, aminoglycosides Skin and soft tissue infections flux, ribosomal mutations or producing ribosomal protective proteins Endocarditis, etc.

3 Journal of Microbes and Infection, December 2009, Vol. 4, No ,, O H K,,,, Ortega 4 758, 55%,13% [ 1],,,, -,, -, [ 1] -, , 1 2 > 60%, 20%, 34. 8% 51. 4% ;, 98% [ 2], -, % [ 2 ] , ( Klebsiella pneumoniae) ( ),,, -,,,, Patel 375, 99 ( 26% ),, - [ 3 ] , 1 2 > 45%, 20%, 34. 8% 51. 4% ; % [ 2], ( Serratia), ;, - AmpC,,,, [ 4] ( Enterobacter cloacae),,,,, [ 5 ] - AmpC,,, -, 3 4 [ 5 ], ,

4 Journal of Microbes and Infection, December 2009, Vol. 4, No. 4, ; ( ),, A, 3 -,,,, ( 39. 1% ), [ 6 ] Cheong, /, 16. 3% 11. 5% 17. 0% 8. 6% [ 6 ] / 21. 3% 28. 8% [ 2 ] ( ),, ; ( ) ( ) <, ;, ;,, ( methicillin-resistant Staphylococcus aureus, MRSA), Viallon MRSA, MRSA, [ 7 ] Moran, ( 76% ), MRSA [ 8 ] Kesah 8 MRSA,, MRSA 29. 6% 27. 7% 21. 3% [ 9 ] 80% 90%, MRSA 40%, 60% MRSA,, [ 7 ], - > 80%,,,, - ( ) ( 1 ) MRSA 1. 2,,,, - ( varicella-zoster virus, VZV) ( cytomegalovirus, CMV) ( herpes simplex virus, HSV) EB, ( human parvovirus) VZV ( ), ( ),,,

5 Journal of Microbes and Infection, December 2009, Vol. 4, No ,, HSV HSV, HSV,, HSV,,,,, ;,,,,, ( ),,,,,,,,, HSV, CMV CMV HIV / ( acquired immunodeficiency syndrom, AIDS),,, CMV, ( human leucocyte antigen, HLA) HLA, Varga, HLA-DQ3 CMV, HLA-DQ3 CMV [ 10], CMV, 29% CMV, 51%, 16% CMV [ 11],, , B19( B19V) ( adeno-associated virus, AAV ) ( human Bocavirus, HBoV) PARV4 B19V,, B19V,,, HIV PARV4 DNA, HIV ; HIV, B19V DNA [ 1 2],, 1. 3,,, ( ) ; ; B( ),,,,,,,,,,,,,, ( CMV ),, ( SMZ-TMP), 3,

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