Kostyukova N N, Volkova M O, Ivanova V V, Kvetnaya A S
Gamaleya Institute of Epidemiology and Microbiology of Russian Academy of Medical Sciences, Moscow.
FEMS Immunol Med Microbiol. 1995 Jan;10(2):133-7. doi: 10.1111/j.1574-695X.1995.tb00022.x.
Pneumococcal meningitis in St. Petersburg in the period 1985-1991 occurred in 1.7-2.3 children per 100,000 annually. The most common serotypes among pneumococcal strains isolated from patients with meningitis were 19, 1, 6, 15, and 2, whereas, among the capsulated strains isolated from carriers, type 3 predominated. Only one third of strains from cases of meningitis were highly virulent for mice (types 1, 2, 3). Hyaluronidase was produced by all the 39 studied strains, 22 (84.6 +/- 7.1%) out of 26 strains from patients with otitis media, and only by 15 (11.5 +/- 2.8%) out of 130 strains isolated from carriers. Non-capsulated strains lacked this enzyme. Results of intranasal inoculation of pneumococcal strains with different hyaluronidase activity and addition of exogenous hyaluronidase to strains which did not produce the enzyme confirm the hypothesis that this enzyme plays an important role in bacterial dissemination and breaching of the blood brain barrier by pneumococci. It was concluded that high hyaluronidase activity, presence of capsule, and pneumolysin or serotype (1, 2, and 19) despite hyaluronidase titer, are the most important factors contributing to the development of pneumococcal meningitis. The role of the mouse toxic factor is unclear.
1985年至1991年期间，圣彼得堡每年每10万名儿童中发生肺炎球菌性脑膜炎的病例为1.7至2.3例。从脑膜炎患者分离出的肺炎球菌菌株中，最常见的血清型为19、1、6、15和2型，而从带菌者分离出的有荚膜菌株中，3型占主导。脑膜炎病例中只有三分之一的菌株对小鼠具有高毒力（1、2、3型）。所有39株研究菌株均产生透明质酸酶，中耳炎患者的26株菌株中有22株（84.6±7.1%）产生透明质酸酶，而从带菌者分离出的130株菌株中只有15株（11.5±2.8%）产生透明质酸酶。无荚膜菌株缺乏这种酶。对具有不同透明质酸酶活性的肺炎球菌菌株进行鼻内接种以及向不产生该酶的菌株中添加外源性透明质酸酶的结果证实了这一假设，即该酶在肺炎球菌的细菌传播和血脑屏障突破中起重要作用。得出的结论是，高透明质酸酶活性、荚膜的存在、肺炎溶血素或血清型（1、2和19型），尽管透明质酸酶滴度不同，是导致肺炎球菌性脑膜炎发生的最重要因素。小鼠毒性因子的作用尚不清楚。
