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Post. Mikro 3-2013.Indb POLSKIE TOWARZYSTWO MIKROBIOLOGÓW Kwartalnik Tom 52 Zeszyt 2•2013 KWIECIE¡ – CZERWIEC CODEN: PMKMAV 52 (2) Advances in Microbiology 2013 POLSKIE TOWARZYSTWO MIKROBIOLOGÓW Kwartalnik Tom 52 Zeszyt 3•2013 LIPIEC – WRZESIE¡ CODEN: PMKMAV 52 (3) Advances in Microbiology 2013 POLSKIE TOWARZYSTWO MIKROBIOLOGÓW Kwartalnik Tom 52 Zeszyt 4•2013 PAèDZIERNIK – GRUDZIE¡ CODEN: PMKMAV 52 (4) AdvancesIndex Copernicus in ICV Microbiology = 9,52 (2012) 2013 Impact Factor ISI = 0,151 (2012) Punktacja MNiSW = 15,00 (2012) http://www.pm.microbiology.pl RADA REDAKCYJNA JACEK BIELECKI (Uniwersytet Warszawski), RYSZARD CHRÓST (Uniwersytet Warszawski), JERZY DŁUGOŃSKI (Uniwersytet Łódzki), DANUTA DZIERŻANOWSKA (Centrum Zdrowia Dziecka), EUGENIA GOSPODAREK (Collegium Medicum UMK w Bydgoszczy), JERZY HREBENDA (Uniwersytet Warszawski), WALERIA HRYNIEWICZ (Narodowy Instytut Leków), MAREK JAKÓBISIAK (Warszawski Uniwersytet Medyczny), ANDRZEJ PASZEWSKI (Instytut Biochemii i Biofizyki PAN), ANDRZEJ PIEKAROWICZ (Uniwersytet Warszawski), ANTONI RÓŻALSKI (Uniwersytet Łódzki), ALEKSANDRA SKŁODOWSKA (Uniwersytet Warszawski), BOHDAN STAROŚCIAK (Warszawski Uniwersytet Medyczny), BOGUSŁAW SZEWCZYK (Uniwersytet Gdański), ELŻBIETA TRAFNY (Wojskowy Instytut Higieny i Epidemiologii), STANISŁAWA TYLEWSKA-WIERZBANOWSKA (Państwowy Zakład Higieny), GRZEGORZ WĘGRZYN (Uniwersytet Gdański), PIOTR ZIELENKIEWICZ (Uniwersytet Warszawski) REDAKCJA JACEK BIELECKI (redaktor naczelny), JERZY HREBENDA (zastępca), BOHDAN STAROŚCIAK (sekretarz), MARTA BRZÓSTKOWSKA (korekta tekstów angielskich) ADRESY REDAKCJI Redaktorzy: Instytut Mikrobiologii, Wydział Biologii, Uniwersytet Warszawski ul. Miecznikowa 1, 02-096 Warszawa, tel. (22) 554 13 04, fax (22) 554 14 04 e-mail: [email protected]; [email protected] Sekretarz Zakład Mikrobiologii Farmaceutycznej, Warszawski Uniwersytet Medyczny ul. Oczki 3 (parter), 02-007 Warszawa, tel. (22) 628 08 22, (22) 621 13 51 e-mail: [email protected] PUBLIKACJE METODYCZNE I STANDARDY Redaktor odpowiedzialny: STEFANIA GIEDRYS-KALEMBA (Pomorska Akademia Medyczna w Szczecinie) Adres Redaktora działu Publikacje Metodyczne i Standardy Katedra i Zakład Mikrobiologii i Immunologii Pomorskiej Akademii Medycznej, Al. Powstańców Wlkp. 72, 70-111 Szczecin, tel./fax: (91) 46 616 51, 52, lub fax: (91) 46 616 59, e-mail: [email protected] lub [email protected] Stali recenzenci: JERZY DŁUGOŃSKI (Uniwersytet Łódzki), WALERIA HRYNIEWICZ (Narodowy Instytut Leków), JÓZEF KUR (Politechnika Gdańska), EUGENIUSZ MAŁAFIEJ (Instytut Centrum Zdrowia Matki Polki), ANNA PRZONDO-MORDARSKA (Akademia Medyczna we Wrocławiu) CZASOPISMO WYDAWANE Z FINANSOWĄ POMOCĄ MINISTERSTWA NAUKI I SZKOLNICTWA WYŻSZEGO ISBN 978 - 83 - 923731 - 3 - 1 Informacja o zdjęciu na okładce: Fonsecaea monophora – szczegóły morfologii (widoczny konidiofor i układ konidiów). SEM, pow. 4 000 x. Autor zdjęcia: dr n. med. Tomasz Jagielski; Zakład Mikrobiologii Stosowanej, Instytut Mikrobiologii Wydział Biologii Uniwersytetu Warszawskiego ul. I. Miecznikowa 1; 02-096 Warszawa; e-mail: [email protected]. Szanowni Państwo! Autorzy i Czytelnicy Postępów Mikrobiologii: Informujemy Państwa, że uległ zmianie numer konta bankowego Zarządu Głównego Polskiego Towarzystwa Mikrobiologów. Aktualny numer konta: BGŻ SA 57 2030 0045 1110 0000 0261 2550 POLSKIE TOWARZYSTWO MIKROBIOLOGÓW Nakład 1150, Objętość 15 arkuszy wyd., Papier offset 80 g Skład i druk: Zakład Wydawniczy Letter Quality, tel. 22 115 38 10, 607 217 879 e-mail: [email protected]; projekt okładki: Jerzy Grzegorkiewicz POST. MIKROBIOL., EPIDEMIOLOGIA ZAKAŻEŃ STREPTOCOCCUS PYOGENES, 2013, 52, 3, 223–232 http://www.pm.microbiology.pl STRUKTURA KLONALNA POPULACJI I ANTYBIOTYKOOPORNOŚĆ Katarzyna Szczypa1, Joanna Wilemska2, Waleria Hryniewicz3, Izabela Sitkiewicz3* 1 ALAB Laboratoria, ul Stępińska 22/30, 00-739 Warszawa 2 Zakład Cytologii Klinicznej, Centrum Medyczne Kształcenia Podyplomowego, ul Marymoncka 99/103, 01-813 Warszawa 3 Zakład Epidemiologii i Mikrobiologii Klinicznej, Narodowy Instytut Leków, Chełmska 30/34, 00-725 Warszawa Wpłynęło w marcu 2013 r. Spis treści: 1. Wstęp. 2. Zakażenia wywoływane przez S. pyogenes. 3. Nosicielstwo i drogi szerzenia się zakażeń S. pyogenes. 4. Ustalanie pokrewieństwa genetycznego pomiędzy szczepami S. pyogenes. 5. Oporność S. pyogenes na antybiotyki. 6. Profilaktyka zakażeń S. pyogenes. 7. Podsumowanie Epidemiology of Streptococcus pyogenes infections, clonal structure population and antibiotic resistance Abstract: Streptococcus pyogenes (GAS) is one of the major human pathogens responsible for infections worldwide. It may cause mild infections of the skin and mucosal surfaces, as well as severe invasive infections. It has been estimated that S. pyogenes is responsible for half a million deaths a year, and is considered as one of the most important pathogens. Many clinical investigations on S. pyogenes focus on characterization of pathogenic strains, heterogeneity/homogeneity of the population clonal spread, transfer between patients and tracing sources of antibiotic resistance. Advanced studies on vaccines that prevent GAS infections are in progress. Contents: 1. Introduction. 2. S. pyogenes infections. 3. Carrier state and epidemiology of infections. 4. S. pyogenes strains genetic affinity. 5. S. pyogenes resistance to antibiotics. 6. The prophylactics ofS. pyogenes infections. 7. Summary Słowa kluczowe: Streptococcus pyogenes, GAS, oporność na antybiotyki, erm, struktura klonalna Key words: Streptococcus pyogenes, GAS, antibiotic resistance, erm, clonal structure 1. Wstęp S. pyogenes pośród dziesięciu najważniejszych pato- genów człowieka [15]. Globalny charakter zakażeń, Streptococcus pyogenes (paciorkowiec β-hemolizujący oporność na niektóre klasy antybiotyków czy obecność grupy A, ang. group A Streptococcus, GAS) jest Gram- wysoce zjadliwych klonów wśród szczepów inwazyjnych -dodatnim, katalazo-ujemnym ziarniakiem, należącym powoduje, że S. pyogenes jest przedmiotem ciągłego zain- do liczącego ponad 50 gatunków rodzaju Streptococcus. teresowania lekarzy, mikrobiologów i epidemiologów. Rodzaj ten skupia bakterie, które powodują infekcje sze- Jednym z głównych celów prowadzonych nad tym rokiej grupy gospodarzy, począwszy od człowieka po drobnoustrojem badań jest śledzenie zmian w patogen- wiele gatunków zwierząt domowych i dzikich. Pacior- ności i we wrażliwości na stosowane w terapii zakażeń kowce kolonizują różne tkanki gospodarza stanowiąc leki. Podejmowane są również próby badań epidemio- tzw. „normalną florę bakteryjną”, są też przyczyną logicznych wyjaśniających podłoże genetyczno-popu- wielu infekcji [30]. S. pyogenes jest ścisłym patogenem lacyjne obserwowanej różnorodności lub klonalności człowieka, charakteryzuje się zdolnością do całkowitej pomiędzy szczepami GAS i związek pomiędzy grupami hemolizy typu β krwinek czerwonych na podłożu sta- szczepów o określonych cechach a typami wywoływa- łym i występowaniem na powierzchni komórki grupo- nych zakażeń i ich ciężkością [11]. wego wielocukru A (grupowanie wg Lancefield) [23]. GAS jest odpowiedzialny za szeroki wachlarz zaka- żeń o różnym stopniu ciężkości. Niektóre z nich, choć 2. Zakażenia wywoływane przez S. pyogenes występują stosunkowo rzadko mają charakter inwazyjny tzn. rozwijają się w fizjologicznie jałowych miejscach Pomimo ogromnego postępu medycyny i możli- organizmu i, pomimo leczenia, obarczone są wysoką wości stosowania ciągle skutecznego wobec S. pyogenes śmiertelnością. Według Światowej Organizacji Zdrowia antybiotyku – penicyliny (patrz rozdział 5), nadal notuje (WHO) szacunkowa liczba zgonów w wyniku inwazyj- się na całym świecie wysoką zapadalność na infekcje nych infekcji GAS i powikłań po zakażeniach wynosi S. pyogenes. Są to przede wszystkim zakażenia poza- ponad 500 000 przypadków rocznie, co umiejscawia szpi talne w większości o charakterze sporadycznym. * Autor korespondencyjny: Zakład Epidemiologii i Mikrobiologii Klinicznej, Narodowy Instytut Leków, Chełmska 30/34, 00-725 War szawa; e-mail: [email protected] 224 KATARZYNA SZCZYPA, JOANNA WILEMSKA, WALERIA HRYNIEWICZ, IZABELA SITKIEWICZ Ich przeważająca liczba to zapalenie gardła i migdałków Niektórzy badacze również sugerują związek pomię- podniebiennych (angina paciorkowcowa) pojawiające dzy zaburzeniami autoimmunologicznymi i neuropsy- się szczególnie w krajach o klimacie umiarkowanym chiatrycznymi u dzieci powiązane z zakażeniem GAS oraz powierzchowne zapalenia skóry (liszajec) występu- i polegające na zaostrzeniu przez zakażenie GAS zabu- jące częściej w klimacie ciepłym i wilgotnym. Szacuje się, rzeń obsesyjno-kompulsywnych lub tików, tzw. zespół że globalnie w skali roku GAS jest przyczyną 616 milio- PANDAS [42, 51]. nów przypadków infekcji gardła a także 111 milionów Zakażenia GAS nie ograniczają się jednak tylko do przypadków infekcji skórnych (głównie liszajca) [15]. zapaleń gardła i powierzchownych infekcji skóry. Dro- Obie postacie zakażeń mają stosunkowo łagodny cha- bnoustrój ten odpowiedzialny jest również za głębokie rakter, ale nieleczone lub leczone nieprawidłowo, mogą infekcje zagrażające życiu wymagające natychmiastowej prowadzić do wystąpienia powikłań zarówno o charak- interwencji lekarza. Należą do nich poważne choroby terze ropnym, jak i nieropnym. W przypadku anginy układowe (inwazyjne) takie jak posocznica i paciorkowco- paciorkowcowej bezpośrednie ropne powikłania po wy zespół wstrząsu toksycznego (streptococcal toxic shock zakażeniu mogą przyjmować postać ropnia około- syndrome, STSS), często jako następstwo martwiczego
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