台灣沙門桿菌脊椎炎

研究背景:西方文獻報告在非疫區的沙門桿菌脊椎炎好發於併有鐮刀型紅血球貧血症或有免疫缺損的患者，同時以血漿型B(鼠傷寒沙門桿菌)及D型(腸炎沙門桿菌)最常見。然而在臺灣C1型(豬霍亂沙門桿菌)卻是最多見的沙門桿菌，又多侵犯健康的患者。本研究特別探討臺灣本土沙門桿菌脊椎炎並和西方的文獻做比較，以驗證臺灣沙門桿菌之血清型態與西方國家不相同。材料與方法:本篇探討十個沒有鐮刀型細胞疾患又沒有免疫缺損，但卻感染了沙門桿菌脊椎炎的病例。沙門桿菌的鑒定分析主要是使用沙門桿菌分型抗血清，並輔以PCR-ELISA方法。同時經由PubMed 從1988 到2005年找到22 個沒有鐮刀型紅血球症的沙門桿菌脊椎炎病歷報告。這22位病人的菌種血清型態也與本論文做比較。統計學方法以費氏確率檢定(有意義值：p<0.05)及Goodness of fit test(有意義值：Sandardized Residuals >+1 , 或<-1作分析)。研究結果:以費氏確率檢定，臺灣沙門桿菌感染之血清型態與西方國家有顯著差異 ( p=0.004)。又依Goodness of fit test檢定，臺灣沙門桿菌脊椎炎的病例以血清型態C1最常見(standardized residuals:+2.21)，西方國家的病例序列則以D型為多(standardized residuals:+1.09)。討論:沙門桿菌脊椎炎在臺灣的病例顯著以血清型態C1最常見，而西方國家則顯著以D型為多。傳染源的不同或可解釋統計學上的差異。在臺灣被感染豬隻的排泄物是人類沙門桿菌主要傳染源；而在西方國家主要傳染源是雞蛋及其製品。防止豬隻的排泄物污染到食物或飲用水及適當的肉品冷凍保存應當是臺灣控制沙門桿菌脊椎炎的最重要戰略。未來希望可進一步配合多種PCR引子的技術進一步將沙門桿菌血清分型辨識，並開發為高檢驗精確度的快速檢測生物晶片。結論:臺灣沙門桿菌脊椎炎的病例以血清型態C1最常見，以費氏確率檢定，臺灣沙門桿菌感染之血清型態與西方國家有顯著差異 ( p= 0.004)。因此，我們推翻臺灣與西方國家沙門桿菌血清型態為同種類之感染，並證實臺灣與西方國家的沙門桿菌感染是不同種類血清型態之沙門桿菌。

Study background: According to Western literature, Most patients of salmonella spondylitis usually are either immunologically compromised or has sickle-cell anemia, and group B (S. typhimurium) and D (S. enteritidis) are the most common serogroups. While in Taiwan, group C1 salmonella (S. choleraesuis) is quite common infecting organism to previously normal host. We develop the researcher hypothesis that the salmonella serotypes distribution is not identical between Taiwan case series and western literature reports. Materials and Methods: Ten cases of salmonella spondylitis without sickle cell disease were reviewed. Salmonella grouping antisera and polymerase chain reaction-based enzyme linked immunosorbent assay (PCR-ELISA) were used to identify salmonella serogroups. 22 cases searched from 1988 to Dec 2005 by means of PubMed were collected for serotypes comparison between Taiwan and western journal reports. Statistical analysis was performed by using the Fisher’s exact test and Goodness of fit test. Results: The salmonella serotype distribution was significantly different between Taiwan and Western journal reports (P=0.004). According to Goodness of fit test, Group C1 salmonella (S. choleraesuis) were significantly more common in Taiwan case series (standardized residuals: +2.21); While Group D salmonella (S. enteritidis) were significantly more common in western journal reports (standardized residuals: +1.09). Discussion: Group C1 salmonella infections were almost due to contamination of infected pig feces. However group D was usually due to egg defilement. Different infection source and host immunity may explain the significant serotypes distribution difference. Pig feces contamination prevention and meat frozen preservation methods should be the most important control strategies of salmonella infection in Taiwan. Conclusion: Group C1 salmonella (S. choleraesuis) were the most common serotypes in this Taiwan case series. The P value of Statistical analysis of salmonella serotypes comparison was significant (P=0.004). Hence, we reject the null hypothesis of no difference and conclude the true hypothesis that the salmonella serotype distribution was significantly different between Taiwan and Western journal reports.