Maskell R, Okubadejo O A, Payne R H, Pead L
J Med Microbiol. 1978 Feb;11(1):33-45. doi: 10.1099/00222615-11-1-33.
Clinical details are presented of 16 patients from whom thymine-requiring (thy-) mutants of pathogenic organisms were isolated; all had been treated with co-trimoxazole. The urine of six patients infected with thy- mutants contained levels of a thymine-like compound sufficient to support their growth. This might be the result either of the breakdown of pus cells or of thymine production by living bacteria that persist in stones or scar tissue, a suggestion supported by the observation of mutant growth "in satellitism" in vitro. Since 1975 we have isolated mutants from patients who have had short courses of co-trimoxazole, in contrast to those we reported upon previously, all except one of whom had had long courses. We are now isolating thy- mutants more frequently than hitherto. Secondary mutations to a low thymine requirement may now be occurring more rapidly, thereby allowing more mutant organisms to survive. The clinical significance of infection with thy- mutants is not yet clear, but evidence is accumulating that they are pathogenic. Alternative chemotherapy is suggested for patients from whom such mutants have been isolated.
本文介绍了16例患者的临床详情，这些患者体内分离出了致病生物体的胸腺嘧啶需求型（thy-）突变体；所有患者均接受过复方新诺明治疗。6例感染thy-突变体的患者尿液中，一种类似胸腺嘧啶的化合物含量足以支持其生长。这可能是脓细胞分解的结果，也可能是存在于结石或瘢痕组织中的活细菌产生胸腺嘧啶的结果，体外“卫星现象”中突变体生长的观察结果支持了这一推测。自1975年以来，我们从接受过短期复方新诺明治疗的患者中分离出了突变体，这与我们之前报告的患者不同，之前报告的患者除1例之外均接受过长期治疗。我们现在比以往更频繁地分离出thy-突变体。现在，向低胸腺嘧啶需求的二次突变可能发生得更快，从而使更多的突变生物体得以存活。感染thy-突变体的临床意义尚不清楚，但越来越多的证据表明它们具有致病性。对于分离出此类突变体的患者，建议采用替代化疗方法。
