Baker L R, Brown A L, Stephenson J R, Tabaqchali S, Zatouroff M, Parkin J M, Pinching A J
Department of Nephrology, St Bartholomew's Hospital, London.
J Clin Pathol. 1993 May;46(5):398-402. doi: 10.1136/jcp.46.5.398.
To differentiate between reinfection and relapsing infection with Staphylococcus epidermidis in a middle-aged woman with defective opsonisation and procidin function in serum.
Microbiological typing was done by biotyping, phage typing, and polyacrylamide gel electrophoresis of radiolabelled bacterial proteins (radioPAGE method). Polymorphonuclear cell function was assessed in vitro by phagocytosis and killing of Candida albicans; measurement of neutrophil random locomotion and chemotaxis; reduction of nitroblue tetrazolium after stimulation by opsonised Candida and a radiometric saccharomyces opsonisation assay. The effect of plasma infusions on opsonic activity was assessed by chemiluminescence using control polymorphonuclear leucocytes with a laboratory strain of S epidermidis opsonised with either patient or control serum.
Recurrent reinfection with different strains of Staphylococcus epidermidis rather than relapsing infection was confirmed as having occurred by typing bacterial strains. The RadioPAGE method detected all the S epidermidis strains involved in this patient's illness. The patient's serum was shown to be defective in both opsonin and procidin function. The defects were correctable in vitro by the addition of normal serum. Clinical recovery occurred after repeated infusions of normal fresh frozen plasma and prolonged antibacterial treatment; antibacterial treatment alone was insufficient.
The radioPAGE method is useful in distinguishing recurrent reinfection with S epidermidis from relapsing infection with this organism. Elucidation of the nature of, and underlying predisposition to, infection in the patient studied allowed a rational treatment plan of plasma infusion combined with antibacterial treatment to be devised which ultimately proved successful.
鉴别一名中年女性血清中调理素和脯杀菌素功能缺陷时表皮葡萄球菌的再感染和复发感染。
通过生物分型、噬菌体分型以及放射性标记细菌蛋白的聚丙烯酰胺凝胶电泳（放射性聚丙烯酰胺凝胶电泳法）进行微生物分型。通过吞噬和杀灭白色念珠菌在体外评估多形核细胞功能；测量中性粒细胞随机运动和趋化性；经调理的念珠菌刺激后硝基蓝四氮唑的还原以及放射性酿酒酵母调理素测定。使用对照多形核白细胞和用患者或对照血清调理的表皮葡萄球菌实验室菌株，通过化学发光评估血浆输注对调理活性的影响。
通过对细菌菌株进行分型，确认该患者发生的是不同菌株的表皮葡萄球菌反复再感染而非复发感染。放射性聚丙烯酰胺凝胶电泳法检测到了该患者疾病中涉及的所有表皮葡萄球菌菌株。患者血清在调理素和脯杀菌素功能方面均存在缺陷。通过添加正常血清，这些缺陷在体外可得到纠正。在反复输注正常新鲜冰冻血浆并延长抗菌治疗后实现了临床康复；单独的抗菌治疗是不够的。
放射性聚丙烯酰胺凝胶电泳法有助于区分表皮葡萄球菌的反复再感染和该菌的复发感染。对所研究患者感染的性质及潜在易感性的阐明，使得能够制定出血浆输注联合抗菌治疗的合理治疗方案，最终证明该方案是成功的。
