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標題: 台灣人類貓抓熱特殊病例與小型哺乳類動物Bartonella感染之調查及分子鑑定研究
Investigation and Molecular Identification of Bartonella Infection in a Special Human Case and Small Mammals in Taiwan
作者: 林壬威
Lin, Jen-Wei
關鍵字: Bartonella species;巴東體屬菌;Molecular Identification;Cat Scratch Disease;分子鑑定;貓抓熱
出版社: 獸醫學系暨研究所
引用: 中文文獻 謝金偉。2005。臺灣中部地區小型哺乳類動物Bartonella屬菌之流行病學研究。碩士論文。臺中:國立中興大學獸醫公衛學研究所。 林昭成。2009。流浪動物體表外寄生蟲感染病媒性病原之流行病學研究。碩士論文。臺中:國立中興大學獸醫公衛學研究所。 陳宏彰。2010。蝙蝠性別與體重對於外寄生蝠蠅豐富度的相關性探討。臺灣生物多樣性研究(TW J. of Biodivers.) 12(4):341-350。 西文文獻 1. Abbot, P., A. E. Aviles, L. Eller, and L. A. Durden. 2007. Mixed infections, cryptic diversity, and vector-borne pathogens: evidence from Polygenis fleas and Bartonella species. Appl. Environ. Microbiol. 73:6045-52. 2. Anderson, B. E., and M. A. Neuman. 1997. Bartonella spp. as emerging human pathogens. Clin. Microbiol. Rev. 10:203-19. 3. Avidor, B., M. Graidy, G. Efrat, C. Leibowitz, G. Shapira, A. Schattner, O. Zimhony, and M. Giladi. 2004. Bartonella koehlerae, a new cat-associated agent of culture-negative human endocarditis. J. Clin. Microbiol. 42:3462-8. 4. Bai, Y., M. Y. Kosoy, S. Boonmar, P. Sawatwong, S. Sangmaneedet, and L. F. Peruski. 2010. Enrichment culture and molecular identification of diverse Bartonella species in stray dogs. Vet. 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結果顯示,臺灣囓齒目動物Bartonella屬菌感染研究方面,以聚合酶鏈鎖反應/限制片段長度多型性(polymerase chain reaction/restriction fragment length polymorphism;PCR/RFLP)來進行分析,發現有B. elizabethae與B. tribocorum菌種感染。此外由一溝鼠之樣本中分離出一分子型別特殊菌株,經進一步分子診斷技術,針對Bartonella菌屬的gltA、ftsZ、rpoB genes與16S-23S rRNA intergenic spacer region,進行PCR增幅與進一步的基因定序比對後顯示此特殊菌株應為與造成人類病例之B. rochalimae相近,為國際首次報告,研究結果重要的指出B. rochalimae可能以鼠科動物為傳播媒介,為潛在的人畜共通病原。
在臺灣生態共域環境中的蝙蝠族群與其他小型哺乳類Bartonella屬菌感染研究方面,為臺灣首度由蝙蝠族群中摺翅蝠(Miniopterus schreibersii)血液樣本中成功分離出Bartonella屬菌,並且經過Bartonella屬菌特定基因序列增幅與比對,確定此菌株與現今Bartonella屬菌中各標準菌種序列差距甚大,可能為一新菌種。而由相同生態環境中所收集其他小型哺乳類動物(食蟲目動物與囓齒目動物)之Bartonella屬菌感染狀況,所得菌種近似於B. queenslandensis、 B. grahamii、B. tribocorum及B. elizabethae,此結果與先前國際間針對食蟲目動物與囓齒目動物調查結果一致。但造成蝙蝠感染的Bartonella屬菌,有異於同調查中其他小型哺乳動物的感染菌種。在這個調查研究中,我們也發現在灰鼩鼱(Crocidura attenuata tanakae)這動物族群中有Bartonella屬菌感染的情形。根據相關資料的搜查,就我們所知這是全球首度發現此物種有Bartonella屬菌的感染情形。另外目前由M. schreibersii所分離出之菌種雖無任何感染人的病例報告。但由於在臺灣蝙蝠與人類具有交集的生活範圍,因此仍須注意人類可能意外感染。
在人類貓抓熱特殊病例的探討方面,此病例在發病期間有持續背痛的症狀,非貓抓熱病感染之典型特徵,藉由本研究之回溯調查與利用分子診斷,結果顯示此病患可能為意外遭受針刺傷後,傷口未經包紮而進一步於醫療過程受到污染而導致B. henselae感染。因此建議在高度危險職業族群中(如:獸醫等),傷口的妥善處理與包紮應加以重視,以避免接觸貓抓熱病原機會。此外,若有因不明發燒並伴隨背痛的症狀病例出現時,當排除了其他可能細菌病原感染之後,建議須將B. henselae的感染列入鑑別診斷。

Recent studies have shown that small mammals are important reservoirs for most of the Bartonella species. Among them, some of which can cause human diseases. In Taiwan, limited information with regard to the epidemiology of Bartonella infections in small mammals is available. It is of major importance to understand the potential threat to human health through contact of these animals. The objectives of this study were: a) to understand the epidemiology of Bartonella infections in rodents in Taiwan; b) to determine if the co-circulation of Bartonella infections could occur among bats and small mammals while sharing the same ecological environment; c) identification of an unusual Cat Scratch Disease (CSD) case and determination of the possible transmission route through retrospective investigation.
The results indicated that B. elizabethae and B. tribocorum were identified in rodents in Taiwan by polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) analysis. However, one isolate with unique molecular pattern was isolated from Rattus norvegicus. Through further molecular identifications of gltA, ftsZ, rpoB genes and 16S-23S rRNA intergenic spacer region, the sequencing results indicated that this specific isolate was closely related to human pathogenic ‘Bartonella rochalimae', originally found in an female American who got sick after traveling to South America. Up to date, this is the first report showing that B. rochalimae could be a zoonotic agent and rats could be the reservoir of it.
In the investigation of Bartonellae infections in bats and other small mammals in the same ecological environment in Taiwan, Bartonella species were successfully isolated from bats using whole blood culture on chocolate agar plates. After sequence and phylogenetic analyses of various genes, the results indicated that the isolates from Miniopterus schreibersii were not similar to the known Bartonella species. The bat isolate could be new Bartonella species and warrant further studies. However, Bartonella spp. isolated from small mammals, which were closely related to B. queenslandensis, B. elizabethae, B. tribocorum and B. grahamii, were similar to the findings in previous studies worldwide. Therefore, it suggested that the species of Bartonella strains isolated from small mammals were different from those identified in bats; no co-circulation of Bartonella was observed among these two animal populations. In this study, we also found that Bartonella infections could occur among Asian gray shrew (Crocidura attenuata tanakae). To the best of our knowledge, this is the first study to demonstrate the Bartonella infection in Crocidura attenuata tanakae. At present, no bat-associated Bartonella infection in humans has been reported either in Taiwan or in any other parts of the world. As bats play important roles for the transmission of certain zoonoses, humans must be aware of accidental Bartonella infection when sharing common living environment with bats.
In this study, we reported a CSD case with unusual and persistent back pains through serological and molecular diagnoses. Through retrospective investigation, this case was related to his occupation as a veterinarian, and possibly acquired the infection through the contamination of wound made by a needle puncture. This case event highlights the importance of wound management for CSD prevention, especially in a high-risk population such as veterinarians. Furthermore, after ruling out other suspected infections, patients having unknown fever and back pain but with cat exposure and/or participating veterinary-associated professions should be considered for B. henselae infection.
The main contributions of this study are to identify new reservoirs of emerging Bartonella infections, to molecularly characterize Bartonella isolates in bats that are more likely to be new Bartonella species, and to find a new potential route for CSD transmission in humans. The information will be helpful to understand the transmission cycle of Bartonella organisms in animals and humans, as well as to develop effective strategies for control of the infection.
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