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Hand special chronic infection in coastal areas is a common multiple of the disease, poor prognosis due to its long course, difficult to treat, and may be left serious dysfunction caused harm to society. Its pathogenic factors over the years has been controversial, including the common bacteria, tuberculosis, non-tuberculous mycobacteria, fungi, Nocardia bacteria. Although many scholars have suggested that it may Mycobacterium tuberculosis and non-tuberculous mycobacteria, but related study of the country, especially the lack of bacteriological evidence to support. Awareness of the disease is still in its infancy, the clinical diagnosis and treatment of established only on the basis of empirical diagnosis and treatment. According to the symptoms of the disease, signs and pathological changes, combined with the information at home and abroad, we believe that the disease is likely mycobacteria, especially non-tuberculous mycobacterial infection caused. The purpose of this paper is to first start by looking for bacteriological basis to confirm our assumptions or find its true pathogens in the etiology and drug sensitivity experiments based on a more reasonable early diagnosis and treatment measures. First part: special infected lesions of chronic hand bacteriological culture and strain identification of pathogenic factors to explore the coastal areas of the hand special chronic infection with tuberculosis, provide the basis for clinical early diagnosis and treatment, June 2002 admitted in March 2005, 48 cases of coastal hand special chronic infections for pathological examination, direct acid-fast staining, ordinary bacterial culture, fungal culture, mycobacterial culture, and isolates the biochemical and gene identification . The study found that: direct acid-fast staining examination in 5 cases positive the microbiological examination star Nocardia cases, mixed infection of Staphylococcus epidermidis and xylose oxidation products Alcaligenes in 1 case, 17 cases of Mycobacterium, the total positive rate 35.4%. Which Mycobacterium marinum 13 cases, birds, incidental mycobacteria in 1 case, did not produce color mycobacterial cases, Mycobacterium tuberculosis cases. Conclusion: chronic hand special infected patients should also do routine bacterial culture, fungal and mycobacterial culture. Non-tuberculous mycobacterial infections, especially Mycobacterium marinum than TB is common, may be the major risk factors of the coastal areas of special hand infection. The second part: preliminary study on the use of PCR technology combined with sequences direct detection of lesions in Mycobacterium Mycobacterium PCR and sequencing technologies early and rapid detection of chronic hand special foci of infection, provide direct evidence for the early diagnosis, treatment. Nest-PCR technology direct detection of mycobacteria in 37 cases of chronic hand special foci of infection, and nucleic acid sequencing typing of Mycobacterium. Results: PCR positive results in 24 cases, the positive rate was 64.9%. Sea branch by sequencing typing in 17 cases, the Kansas / stomach two cases, the bird branch two cases, 2 cases of tuberculosis, turtle / abscess. Conclusion: Nest-PCR technology to make up for the defects of extrapulmonary mycobacterial culture positive rate, greatly reducing the time required for diagnosis (from traditional diagnostic 2 months to days) is especially suitable for culture-negative and can not be ruled out mycobacterial infection of the hand special chronic infected patients, combined with the culture results, Mycobacterium positive rate of 66%, proving once again that non-tuberculous mycobacterial infections are major pathogens of coastal hand special chronic infection, especially Shanghai Branch Mycobacterium. Part III: PCR-reverse dot blot hybridization assay pathological manifestations of the pathology of chronic granulomatous inflammation wax block
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