臺灣博碩士論文加值系統

類鼻疽是相當嚴重且容易致命的感染性疾病，是由類鼻疽伯克氏菌感染所引起。此疾病流行於東南亞及北澳洲地區，病原菌主要存在流行地區的潮濕土壤中以及水池表面，其地理位置大約分佈在南、北緯20度之間的熱帶及亞熱帶區域。台灣的地理位置相當接近流行地區，首例類鼻疽的病例報告發表於1985年，在2005年之前，台灣持續有類鼻疽的境外及本土病例報告，並且都屬於散發性病例，病例大多分佈在南台灣。在2005年7月，因颱風侵襲造成南台灣多處地區淹水，接著爆發了台灣首例類鼻疽的群突發疫情，這些病例主要集中在台南縣仁德鄉、台南市南區及高雄縣茄萣鄉等地區。本研究收集了群突發期間30株由臨床分離的類鼻疽伯克氏菌菌株，同時包括2株在2004年收集的菌株，進行細菌的生化特性及抗藥性的表現型分析，再配合脈衝式電泳法，利用XbaI 限制酵素將菌株的染色體DNA分子切成片段，來分析菌株基因型的特徵。根據生化特性結果分析，利用API 20 NE套組鑑定系統，可以提供準確的菌種鑑定結果。脈衝式電泳模式結果分析，證實本次群突發菌株分屬於二種不同型別的基因遺傳體系。儘管，本次群突發疫情之病例大多來自二仁溪流域，分析二種基因型在地理分佈的結果，位於二仁溪上游之仁德地區菌株之基因型，相異於其它地區，顯示南台灣環境中可能存在二種基因型的類鼻疽伯克氏菌。我們認為類鼻疽在南台灣是一種地方性流行的新興感染疾病，特別是在大雨及颱風過後，臨床醫師診療病患時必須考慮到這項來自社區的感染症。

Melioidosis is a serious, fatal and infectious disease, caused by the bacteria of Burkholderia pseudomallei. The disease is endemic in northern Australia and Southeast Asia where the pathogen can be found in wet soil and pooled surface water. The geographical distribution is between the latitudes of 20 degrees North and 20 degrees South. Taiwan is geographically close to this endemic area, and the first case of melioidosis was reported in 1985. The sporadic cases of this disease were increased in Taiwan before 2005, and these cases were imported and indigenous. In July of 2005, owing to the flood caused by a typhoon, the first outbreak event of melioidosis was found in southern Taiwan. The cases of melioidosis which distributed over Rende township, south district of Tainan city and Qieding township. Clinical isolation of 30 B. pseudomallei were performed phenotypic identification and antimicrobial susceptibility testing, and two isolates were recovered from 2004. Isolates were analyzed by biochemical characteristics, antimicrobial susceptibility patterns, and DNA macrorestiction analysis was performed using XbaI restriction enzyme. We define the API 20NE system can provide correctly identified isolate of B. pseudomallei. The result of pulsed-field gel electrophoresis（PFGE) shows two different restriction patterns in these cases, although case-clusters of melioidosis came from the Er-Ren River Basin. The Rende area is located on upstream of the Er-Ren Rriver Basin, which shows distinct pattern from other areas. Thus, two genotypic strains were present in southern Taiwan. However, melioidosis is an endemic and emerging infectious disease in southern Taiwan. The physicians managing patients should be alert to this disease, and especially after heavy rains or typhoon.

中文摘要 I
英文摘要 III
誌謝 V
一、前言與文獻資料回顧 1
二、材料與方法 16
三、結果 23
四、討論 26
五、結論 32
六、參考文獻 33
七、附錄 44

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