臺灣博碩士論文加值系統

近幾十年來，黴菌（fungi）感染在臨床上的重要性已逐漸昇高，尤其在1980年代AIDS（acquired immunodeficiency syndrome）出現以後，免疫抑制（immunocompromised）病人逐年增多，使得伺機性黴菌或其他少見黴菌之感染病例明顯增加，且有許多造成了院內感染與侵入性（invasive）的疾病，在免疫抑制病人的治療方面是嚴重的問題。
為獲得感染原的初步訊息，可利用各種菌株分型法（strain typing），例如生化分型、血清分型、染色體DNA分型、PCR fingerprinting等，做流行病學調查並分析菌體間的相關性，提供感染管制及研究的參考。
本實驗主要利用RAPD（Random amplified polymorphic DNA）分型法分析台大醫院近年來分離報告增多的兩種黴菌臨床菌株：Exophiala jeanselmeie共11株（來自9位病人），和Penicillium marneffei共20株（來自12位病人）；並做部分菌株的醣類同化試驗、藥物感受性試驗、菌體脂肪酸分析和染色體DNA限制酵素分析。
醣類同化試驗、藥物感受性試驗和RAPD分型結果都一致可將11株E. jeanselmei區分成兩種型，八名在超音波室抽取胸水病人之8株菌株應是相同之來源，另一位傷口感染病人之3株菌株則與前述病人明顯不同。由結果推測，前8株檢體可能都只是超音波室抽取胸水之過程受到污染，台大醫院分離報告增加的情形應屬假性群突發（pseudo-outbreak），與真正造成傷口感染的菌株有很大的差異。
Penicillium marneffei臨床菌株的分型結果，不像E. jeanselmei能明顯分為兩型，藥物感受性試驗、菌體脂肪酸分析、限制酵素分析和RAPD方法的結果各有不同，不易歸納分型。菌體脂肪酸分析可分為三群；採用HaeⅢ限制酵素分析P. marneffei的DNA，結果與之前的報告同樣可將P. marneffei分成兩種型；RAPD分型綜合二到三種引子的結果則能夠將P. marneffei分成八種基因型。
研究結果顯示，醣類同化試驗、藥物感受性試驗、菌體脂肪酸分析、限制酵素分析和RAPD方法，對這些研究較少的黴菌之流行病學調查應具可行性。合併藥物感受性試驗與RAPD二到三種引子的結果作分型，應可兼顧臨床治療的應用與分型的能力，進一步作黴菌感染管制的參考。

Fungal infections have become a growing threat during the past decade. Frequent and prolonged exposure of immunocompromised patient to a variety of environmental conditions has resulted in the emergence of newly identified fungal pathogens and the reemergence of previously uncommon fungal diseases. Nosocomial infections due to opportunistic fungi are an important cause of morbidity and mortality among hospitalized patients.
Strain typing methods, such as biotyping, serotyping, ribotyping, chromosomal DNA typing, and PCR fingerprinting, have been useful for epidemiological investigation and control of nosocomial infections. The present study demonstrates phenotypic and genotypic characteristics of 11 strains of Exophiala jeanselmei from 9 patients and 20 strains of Penicillium marneffei from 12 patients.
The results of carbohydrate assimilation, antifungl susceptibility, cellular fatty acid analysis and random amplified polymorphic DNA patterns indicate two distinct types of E. jeanselmei and suggest that peudo-outbreak of E. jeanselmei might occur in NTU hospital.
The isolates of P. marneffei were divided into two DNA types according to their restriction fragment length polymorphism. Analysis of random amplified polymorphic DNA patterns obtained by two arbitrary primers showed eight genotypes of P. marneffei. Antifungal susceptibility test and cluster analysis of cellular fatty acid revealed some discrepancies between phenotypic and genotypic methods.
These data suggest that both antifungal susceptibility test and RAPD analysis can be use to investigate the epidemiology of the opportunistic or rare fungal pathogens.

英文摘要-------------------------1
中文摘要-------------------------3
緒論--------------------------------5
材料與方法---------------------10
結果-------------------------------21
討論-------------------------------25
實驗結果之圖表---------------32
參考文獻------------------------ 49

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