流行性嗜血桿菌(Hemophilus influenzae；Hi)主要感染人的上呼吸道，其中絕大多數是無莢膜的。所導致的人類疾病可分為原發性外源性感染和繼發性內源性感染兩類。原發性感染多為強毒株引起的急性化膿性感染，常見的有腦膜炎、鼻咽炎、急性氣管炎、化膿性關節炎和心包炎等。繼發性感染常發生在流感、麻疹、百日咳及肺結核等疾病之後，如支氣管肺炎和中耳炎等。病人主要病理反應為以體液免疫為主，病後有特異性抗體的產生，能增強吞噬作用及補體的溶菌作用。Hi 可產生內毒素，在致病過程中有重要作用。無外毒素者，其多糖莢膜有抗吞噬作用，可產生 lgA1 蛋白酶，水解感染區域的分泌型 lgA1 而使細菌在感染部位形成菌落。本研究的主要目的是探討並確定感染之流行性嗜血桿菌所引起侵襲性疾病在抗藥性與 IgA1 蛋白酶活性間的基因型 (genotype) 之關係。本研究的主要方法及流程包括收集臨床感染病患的血液、膿液、痰液、氣管沖洗液和喉頭培養之檢體，以巧克力培養基進行分離培養並鑑定出各種菌種；應用 PCR 對分離出的 Hi 進行血清及基因分型，並研究其 lgA1 蛋白酶的活性與產生 β 內醯胺酶(beta-lactamase) 所引起的病原菌抗性的酶學及基因學之間的關係等。研究結果顯示，此 45 位侵襲性流行性嗜血桿菌感染病患的臨床症狀包括肺炎、鼻竇炎、菌血症、支氣管炎、慢性阻塞性肺病、結膜炎或中耳炎等疾病，病患年齡介於 1-71 歲之間。在所有分離的 45 位患者的檢體中，無分型嗜血桿菌(non-typable H. influenzae； NTHi) 在引起侵襲性疾病過程中已成為優勢菌種，皆包含 iga 基因，但只有 80% 具有 IgA1 蛋白酶之活性，這是由於 iga 基因中常見的無意義突變之所致。在 Hi 感染的菌種中有 84% 優勢種群是 NTHi 。約 76% 的 NTHi 和 85% 的可分型嗜血桿菌(typable H. influenzae；THi)具有活性的 IgA1 蛋白酶。 PFGE 基因分析顯示這 45 株 Hi 分離菌株皆不是同源性的基因型。具有活性的 IgA1 蛋白酶的表現型(Phenotypes) 與這 45 株的 Hi 的抗藥性顯示彼此無密切關係。本報告向醫界警告：NTHi 在引起侵襲性疾病中已成為優勢的菌株。這些菌株的抗藥性與具活性的 IgA1 蛋白酶基因是獨立的，但與 beta-lactamase 的存在呈極顯的關係。

Hemophilus influenzae (Hi) has been an important strain in clinical examination, but it is not clear about its subtype, non-typable Hi, in causing invasive diseases after years of application of vaccines against typable Hi. Thus, the study is to determine the major infected bacterium causing invasive diseases and investigate the genotype relationship between antibiotic resistance and active IgA1 protease. Practical approaches of the study include clone each microorganism from infected blood, pus, sputum, bronchial washing and thorax samples of patients with invasive diseases. Each of the organisms was assayed for IgA1 protease activity, the type of the enzyme and antibiotic resistance. Forty-five patients aged 1 to over 71 with invasive diseases of diagnosed pneumonia, sinusitis, bacteremia, bronchitis, chronic obstructive of pulmonary diseases (COPD), conjunctivitis or otitis media, were analyzed, and all the 45 Hi isolates contain iga gene but only 80% contain active IgA1 protease. Mutations to silence iga gene are common in Hi isolates. The dominant population of infected bacterium is Hi, 84% of which are non-typable (NTHi). About 76% of NTHi and 85% of typable Hi (THi) contained active IgA1 protease. PFGE analysis showed that none of the 45 Hi isolates had identical genome. Phenotypes of active IgA1 protease and antibiotic resistance of the 45 Hi isolates showed no close relations each other. This study clearly demonstrated that NTHi has become a dominant strain in causing invasive diseases. Antibiotic resistance and active IgA1 protease are two essential but independent phenotypes for NTHi to infect and colonize. Antibiotic resistance of NTHi is dependent on the presence of beta-lactamase.

Chapter 1 Introduction.................................. 1
Chapter 2 Materials and methods ........................ 15
Chapter 3 Results....................................... 20
Chapter 4 Discussion ................................... 22
Chapter 5 Conclusion ................................... 26
List of References ..................................... 28
List of Figures ........................................ 39
List of Tables.......................................... 47

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