臺灣救傷海龜血液培養及關節囊液分析研究 (2019-2022)

Abstract

菌血性關節炎為救傷海龜醫療中最為棘手的疾病之一，目前在臨床上遭遇的問題包括：不明確的病生理機制、經常於復健中後期出現、需要長期療程，及大多引致不佳的預後。過去文獻中針對患病的個體使用的檢驗工具包括Ｘ光、血液培養及關節囊液穿刺採樣，然而，依據目前可取得的資料中，於血液培養及關節囊液採樣此二低侵入性診斷卻尚未有正常海龜的檢驗值可做為比對。曾有研究發現菌血症可普遍存在於臨床表現健康的爬蟲個體，因此針對海龜是否亦普遍有菌血症情形以及血液培養陽性是否具有診斷意義等疑問目前仍尚未明瞭。此外，海龜正常的關節囊液特性亦未被完整報告。 本研究旨為建立海龜血液培養及關節囊液特性之基本資訊，研究過程採集於2019至2022年由國立臺灣海洋大學、國立屏東海洋生物博物館及行政院農業委員會水產試驗所澎湖海洋生物研究中心收容之17隻救傷海龜的血液及關節囊液樣本，個體須符合以下條件方納入本研究：臨床表現及四肢活動正常、Ｘ光下無關節病灶、血液檢查無全身性感染證據及採樣當時未在使用抗生素等。所有個體均進行血液培養、肩關節囊液培養以及關節囊液分析檢查，研究結果發現大多海龜的血液及關節囊液於37°C培養條件下均呈現陰性；正常關節囊液的特性如顏色、黏稠度及細胞性均與哺乳類相似，細胞相以單核細胞及淋巴球為主，僅含有少數異嗜球及紅血球。本研究所呈現之數據包括海龜血液培養結果、關節囊液培養及其特性之參考值，可有助於未來更精確診斷海龜之菌血性關節炎。

Septic arthritis is one of several frustrating illness in sea turtle rehabilitation due to its unclear pathogenesis, delay-onset during rehabilitation, long-term treatment requirement and often poor prognosis. Radiographs, blood culture and arthrocentesis had been used as diagnostic tools for suspected cases. According to our knowledge, there is currently lack of published data regarding the reference of blood culture and characteristics of synovial fluid in sea turtles. Previous studies showed that bacteremia could exist in clinically healthy reptiles. It was unclear whether bacteria also commonly exist in the blood of sea turtles and whether positive culture result indicates pathogenicity. In addition, the characteristics of normal synovial fluid in sea turtles had not been described exhaustively. To establish the reference data of blood culture and characteristics of synovial fluid in sea turtles, blood and synovial fluid of rescued sea turtles were sampled and analyzed in this study. During 2019-2022, we enrolled 17 rescued sea turtles from National Taiwan Ocean University, National Museum of Marine Biology and Aquarium and Penghu Fisheries Research Institute under inclusion criteria: normal attitude and limb motor functions, no radiographic evidence of joint lesion and no hematologic or plasma biochemistry evidence of systemic infection and no ongoing usage of antibiotics. Bacterial culture of the blood and synovial fluid from shoulder joints as well as qualitative analysis of the synovial fluid were obtained from these sea turtles. The results revealed bacterial culture-negative of both blood and synovial fluid under 37°C in arthritis-free sea turtles. Most of the characteristics of normal synovial fluid in sea turtles, such as color, viscosity and cellularity, were similar to that of mammals. Cytology of the normal synovial fluid were dominated by mononuclear cells, lymphocytes and occasionally a few heterophils or red blood cells. This study provided information of bacterial culture of blood and normal synovial fluid characteristics in rescued sea turtles in Taiwan. The results of the study could improve the diagnosis of sea turtles’ septic arthritis in the future.