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目的对一起食源性疾病暴发中检出多种致病菌的情况进行探讨分析,找出真正的致病菌,为研究类似的食源性疾病病因提供参考。方法利用标准化的食源性疾病暴发个案调查表收集信息,采用描述流行病学描述事件特征、分析流行病学探索危险食物,采集的样本按照GB 4789系列食品卫生微生物学检验标准进行可疑致病菌分离培养,分离出的副溶血性弧菌按照DNA指纹图谱分析方法进行基因分型。结果搜索到共同进餐者30例,失访5例,其中符合病例定义的17例,罹患率为56.67%(17/30);临床表现主要以腹泻(17/17)、腹痛(16/17)为主,腹痛以上腹部疼痛为主(10/16);发病潜伏期为11~25 h;回顾性队列研究未发现可疑食物。在病例肛拭子中检出9株副溶血性弧菌,8株奇异变形杆菌,1株沙门菌混合副溶血性弧菌,1株空肠弯曲菌;在从业人员肛拭子中检出1株奇异变形杆菌;在环境涂抹拭子中检出1株副溶血性弧菌,4株奇异变形杆菌;在食品样品中检出1株副溶血性弧菌,4株奇异变形杆菌。对从9例病例检测到的副溶血性弧菌进行脉冲场凝胶电泳分子分型,结果发现其遗传相似性达97%以上。结论综合现场流行病学调查和食品卫生学以及实验室检测结果分析,排除其他致病因子引起该起事件暴发的可能,认为这是一起由副溶血性弧菌引起的食源性疾病暴发事件。
OBJECTIVE To investigate and analyze a variety of pathogenic bacteria detected in an outbreak of foodborne diseases and find out the real pathogenic bacteria for reference to study the causes of similar foodborne diseases. Methods The standardized questionnaire of foodborne disease outbreaks was used to collect information. Epidemiology was used to describe the characteristics of the incidents and the epidemiology was used to explore the dangerous foods. The collected samples were tested for pathogenic bacteria according to GB 4789 series of food hygiene microbiology test Isolation and culture, isolated Vibrio parahaemolyticus according to DNA fingerprinting method for genotyping. Results There were 30 co-diners and 5 patients lost to follow-up, of which 17 cases met the definition of the disease and the rate of attack was 56.67% (17/30). The main clinical manifestations were diarrhea (17/17), abdominal pain (16/17) Mainly abdominal pain over abdominal pain (10/16); incidence of incubation period of 11 ~ 25 h; retrospective cohort study found no suspicious food. Nine strains of Vibrio parahaemolyticus, eight strains of Proteus mirabilis, one strain of Salmonella mixed with Vibrio parahaemolyticus and one strain of Campylobacter jejuni were detected in the cases of anal swab. One strain was detected in the rectal swab 1 strain of Vibrio parahaemolyticus and 4 strains of Proteus mirabilis were detected in the environment-smear swabs. One strain of Vibrio parahaemolyticus and 4 strains of Proteus mirabilis were detected in food samples. The molecular typing of Vibrio parahaemolyticus detected in 9 cases by pulsed-field gel electrophoresis showed that the genetic similarity was over 97%. Conclusion Based on the epidemiological investigation in the field and the analysis of food hygiene and laboratory test results, it is possible to exclude the possibility of other pathogenic factors causing the outbreak of this incident. This is considered to be an outbreak of foodborne disease caused by Vibrio parahaemolyticus.