The Microbiological and Clinical Characteristics of Invasive Salmonella in Gallbladders from Cholecystectomy Patients in Kathmandu, Nepal
The Microbiological and Clinical Characteristics of Invasive Salmonella in Gallbladders from Cholecystectomy Patients in Kathmandu, Nepal
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DOI：
10.1371/journal.pone.0047342
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发表时间：
2012-10-15
期刊：
影响因子：
3.7
通讯作者：
Baker, Stephen
中科院分区：
文献类型：
--
作者：
Dongol, Sabina;Thompson, Corinne N.;Baker, Stephen
胆囊携带侵袭性沙门氏菌被认为是维持伤寒传播的基础。从加德满都接受胆囊切除术的1377例患者中采集胆汁和组织，以调查该流行地区胆囊侵袭性沙门氏菌的患病率、特征及其相关性。20%的胆汁样本含有革兰氏阴性菌，分别从24人和22人身上分离出伤寒沙门氏菌和甲型副伤寒沙门氏菌。与不含沙门氏菌的胆囊相比，含沙门氏菌的胆囊更容易出现急性炎症和广泛的中性粒细胞浸润，这与沙门氏菌阳性个体血液中中性粒细胞较高和淋巴细胞计数较低相对应。侵袭性沙门氏菌分离株的抗菌素耐药性有限，表明胆囊定植不太可能由抗菌素耐药性驱动。侵入性沙门氏菌在胆囊中的整体作用尚不清楚；在此，我们发现3.5%接受胆囊切除术的患者在其胆汁中有高浓度的抗微生物敏感的侵袭性沙门氏菌。我们预测，如果目前的传播机制受到干扰，这些个体将变得越来越重要；因此，前瞻性地识别这些个体对于快速地在当地和区域消灭是至关重要的。
Gallbladder carriage of invasive Salmonella is considered fundamental in sustaining typhoid fever transmission. Bile and tissue was obtained from 1,377 individuals undergoing cholecystectomy in Kathmandu to investigate the prevalence, characteristics and relevance of invasive Salmonella in the gallbladder in an endemic area. Twenty percent of bile samples contained a Gram-negative organism, with Salmonella Typhi and Salmonella Paratyphi A isolated from 24 and 22 individuals, respectively. Gallbladders that contained Salmonella were more likely to show evidence of acute inflammation with extensive neutrophil infiltrate than those without Salmonella, corresponding with higher neutrophil and lower lymphocyte counts in the blood of Salmonella positive individuals. Antimicrobial resistance in the invasive Salmonella isolates was limited, indicating that gallbladder colonization is unlikely to be driven by antimicrobial resistance. The overall role of invasive Salmonella carriage in the gallbladder is not understood; here we show that 3.5% of individuals undergoing cholecystectomy in this setting have a high concentration of antimicrobial sensitive, invasive Salmonella in their bile. We predict that such individuals will become increasingly important if current transmission mechanisms are disturbed; prospectively identifying these individuals is, therefore, paramount for rapid local and regional elimination.