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首页> 外文期刊>Journal of Clinical Microbiology >Preliminary Laboratory Report of Fungal Infections Associated with Contaminated Methylprednisolone Injections
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Preliminary Laboratory Report of Fungal Infections Associated with Contaminated Methylprednisolone Injections

机译：与污染的甲基己酮胺注射相关的真菌感染初步实验室报告

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In September 2012, the Centers for Disease Control and Prevention (CDC) initiated an outbreak investigation of fungal infections linked to injection of contaminated methylprednisolone acetate (MPA). Between 2 October 2012 and 14 February 2013, the CDC laboratory received 799 fungal isolates or human specimens, including cerebrospinal fluid (CSF), synovial fluid, and abscess tissue, from 469 case patients in 19 states. A novel broad-range PCR assay and DNA sequencing were used to evaluate these specimens. Although Aspergillus fumigatus was recovered from the index case, Exserohilum rostratum was the primary pathogen in this outbreak and was also confirmed from unopened MPA vials. Exserohilum rostratum was detected or confirmed in 191 specimens or isolates from 150 case patients, primarily from Michigan (n = 67 patients), Tennessee (n = 26), Virginia (n = 20), and Indiana (n = 16). Positive specimens from Michigan were primarily abscess tissues, while positive specimens from Tennessee, Virginia, and Indiana were primarily CSF. E. rostratum antifungal susceptibility MIC50 and MIC90 values were determined for voriconazole (1 and 2 μg/ml, respectively), itraconazole (0.5 and 1 μg/ml), posaconazole (0.5 and 1 μg/ml), isavuconazole (4 and 4 μg/ml), and amphotericin B (0.25 and 0.5 μg/ml). Thirteen other mold species were identified among case patients, and four other fungal genera were isolated from the implicated MPA vials. The clinical significance of these other fungal species remains under investigation. The laboratory response provided significant support to case confirmation, enabled linkage between clinical isolates and injected vials of MPA, and described significant features of the fungal agents involved in this large multistate outbreak.
机译：2012年9月，疾病控制和预防中心（CDC）启动了与注射污染的甲基己酮醋酸甲酯（MPa）相关的真菌感染的爆发调查。 2012年10月2日至2013年2月14日期间，CDC实验室从19个州的469例患者中获得了799个真菌分离物或人类标本，包括脑脊液（CSF），滑膜液和脓肿组织。新颖的宽范围PCR测定和DNA测序用于评估这些样本。虽然从指数案例中回收曲霉菌，但埃斯洛希尔·罗斯特拉特在该爆发中是主要病原体，并且还从未开封的MPa小瓶中确认。在191个标本或从150例患者分离出来的exserohilum rostratum，主要来自密歇根州（ n = 67名患者），田纳西州（ n = 26），弗吉尼亚州（< EM> n = 20）和印第安纳（ N = 16）。来自密歇根的阳性标本主要是脓肿组织，而来自田纳西州，弗吉尼亚州和印第安纳州的阳性标本主要是CSF。 E.测定voriconazole（分别为0.5和1μg/ ml）测定voriconazole（分别为1和2μg/ ml）的升温抗真菌敏感性MIC 50 和MIC 90 值。唑烷唑（0.5和1μg/ mL），异戊基唑（4和4μg/ ml），以及两性蛋白B（0.25和0.5μg/ ml）。在病例患者之间鉴定了13种其他模具物种，并从暗示的MPA小瓶中分离了另外四个真菌属。这些其他真菌物种的临床意义仍在调查中。实验室反应提供了案例确认的显着支持，临床分离株与MPa的注射小瓶之间的能够联系，并描述了涉及该大型多态爆发的真菌剂的显着特征。

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