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[采用显微镜检查、培养及分子方法对粪便样本中芽囊原虫属的检测]

[Investigation of the presence of Blastocystis spp. in stool samples with microscopic, culture and molecular methods].

作者信息

Adıyaman Korkmaz Gülcan, Doğruman Al Funda, Mumcuoğlu İpek

机构信息

Gazi University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey.

出版信息

Mikrobiyol Bul. 2015 Jan;49(1):85-97. doi: 10.5578/mb.8439.

Abstract

Blastocystis species are enteric protozoa frequently detected in human and animals. Seventeen subtypes (STs) have now been identified, nine of them isolating from humans. The pleomorphic structure and genetic diversity of Blastocystis spp. and the absence of standardized diagnostic methods complicate the evaluation of current data. Microscopic methods such as native-lugol and trichrome staining are most frequently used methods in routine diagnosis, while culture and molecular methods are preferred for research purposes. The aims of this study were to investigate the presence of Blastocystis spp. in the stool samples of patients with gastrointestinal complaints by microscopic and culture methods, and to detect the subtypes of isolates by polymerase chain reaction (PCR). A total of 350 stool samples collected from patients with diarrhea (n= 157) and without diarrhea (n= 193) were included in the study. Presence of Blastocystis spp. in the samples were investigated by native-lugol examination, trichrome staining and direct fluorescent antibody (DFA) methods. Ringer's solution containing 10% horse serum and 0.05% asparagine was used for cultivation. The cultures were evaluated after 3-4 days of incubation at 37°C by microscopic examination. The subtypes of Blastocystis spp. strains isolated from the cultures have been identified by PCR using sequence-tagged site primers. A total of 66 (19%) stool samples, of them 26 (16.6%) were from diarrheal and 40 (21%) from non-diarrheal cases, yielded Blastocystis sp. growth in culture. Among the evaluated samples, 12% (42/350) were found positive with native-lugol examination, 17% (58/350) with trichrome staining, and 19% (66/350) with DFA method. The agreement of culture and native-lugol method was estimated as strong (κ= 0.752), while it was very strong between culture with trichrome staining and DFA methods (κ= 0.922 and κ= 1.00, respectively). When the culture was accepted as reference method, the sensitivity and specificity rates of native-lugol method were 65% and 100%, trichrome staining method were 88% and 100%, and DFA method were 100% and 100%, respectively. Forty-three (65%) of Blastocystis spp. positive samples were subtyped by PCR, while 23 isolates could not be subtyped. The most frequent detected subtype was ST3 (12/43; 28%), followed by ST1 (6/43; 13.9%), ST4 (5/43; 11.6%) and ST7 (5/43; 11.6%), ST2 (3/43; 7%) and ST6 (1/43; 2.3%). ST5 was not detected in this study and 11 (25.6%) samples have been identified to have mixed subtypes. The differences of Blastocystis spp. positivity rates and the distribution of the subtypes between the patients with or without diarrhea were not found statistically significant (p> 0.05). In our study, ST3 was the most frequently identified Blastocystis spp. subtype, similar to the previous national studies, however ST6 and ST7 have been identified for the first time. In conclusion, as the sensitivity of native-lugol examination is low, culture is time-consuming and laborious and PCR methods are costly and non-standardized, rapid, practical and high sensitive DFA is considered as the favourable method in the diagnosis of Blastocystis spp. in routine laboratories.

摘要

芽囊原虫是常见于人和动物体内的肠道原生动物。目前已鉴定出17种亚型(STs),其中9种分离自人类。芽囊原虫的多形结构和遗传多样性,以及缺乏标准化的诊断方法,使得当前数据的评估变得复杂。原生卢戈氏碘液染色和三色染色等显微镜检查方法是常规诊断中最常用的方法,而培养和分子方法则更适合用于研究目的。本研究的目的是通过显微镜检查和培养方法调查胃肠道不适患者粪便样本中芽囊原虫的存在情况,并通过聚合酶链反应(PCR)检测分离株的亚型。本研究共纳入了350份粪便样本,其中腹泻患者(n = 157)和非腹泻患者(n = 193)的样本。通过原生卢戈氏碘液检查、三色染色和直接荧光抗体(DFA)方法调查样本中芽囊原虫的存在情况。使用含有10%马血清和0.05%天冬酰胺的林格氏溶液进行培养。在37°C孵育3 - 4天后,通过显微镜检查评估培养物。使用序列标签位点引物通过PCR鉴定从培养物中分离的芽囊原虫菌株的亚型。共有66份(19%)粪便样本培养出芽囊原虫,其中26份(16.6%)来自腹泻病例,40份(21%)来自非腹泻病例。在评估的样本中,原生卢戈氏碘液检查阳性率为12%(42/350),三色染色阳性率为17%(58/350),DFA方法阳性率为19%(66/350)。培养与原生卢戈氏碘液方法的一致性估计为强(κ = 0.752),而培养与三色染色和DFA方法之间的一致性非常强(分别为κ = 0.922和κ = 1.00)。以培养作为参考方法时,原生卢戈氏碘液方法的灵敏度和特异度分别为65%和100%,三色染色方法分别为88%和100%,DFA方法分别为100%和100%。43份(65%)芽囊原虫阳性样本通过PCR进行了亚型鉴定,而23株分离株无法进行亚型鉴定。最常检测到的亚型是ST3(12/43;28%),其次是ST1(6/43;13.9%)、ST4(5/43;11.6%)和ST7(5/43;11.6%)、ST2(3/43;7%)和ST6(1/43;2.3%)。本研究未检测到ST5,11份(25.6%)样本被鉴定为混合亚型。腹泻患者和非腹泻患者之间芽囊原虫阳性率和亚型分布的差异无统计学意义(p > 0.05)。在我们的研究中,ST3是最常鉴定出的芽囊原虫亚型,与之前的全国性研究相似,然而ST6和ST7是首次被鉴定出来。总之,由于原生卢戈氏碘液检查灵敏度低,培养耗时费力,PCR方法成本高且未标准化,快速、实用且高灵敏度的DFA被认为是常规实验室诊断芽囊原虫的有利方法。

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