68例社区获得性肺炎病原及临床特征分析

目的　 68例外周血白细胞正常或降低的社区获得性肺炎 (CAP)病原及临床特点分析。方法　检测CAP患者呼吸道及血液标本的常见病原体 ,并分析其临床特点。结果　军团菌属占 2 2 .1 % (1 5/ 68) ,肺炎支原体占 1 1 .8% (8/ 68) ,病毒占 1 6 .2 % (1 1 / 68) ,其中甲型流感病毒 2例、乙型流感病毒 5例 ,副流感病毒 1例 ,腺病毒 1例 ,艾滋病病毒 2例。细菌占 2 .9% (2 / 68) ,有 47.1 % (32 / 68)不能明确病原体 ,混合感染率为 8.8% (6/ 68)。病毒性肺炎、军团菌肺炎及肺炎支原体肺炎的临床症状、体征、外周血白细胞、胸部影像均无特异性 ,其鉴别需靠病原学检查。结论　外周血白细胞正常或降低的CAP病因主要为非典型病原体和病毒 ,对此类CAP的经验治疗应首选大环内酯类抗生素或抗病毒药物。

Analysis of Causes and Clinical Characters in Community Acquired Pneumonia:A Report of 68 Cases

Objective To analysis the causes and clinical characters in 68 cases of community acquired pneumonia (CAP), peripheral leukocyte count was normal or decreased in these cases. Methods Pathogens of respiratory tract sputum and blood specimen were detected by bacterial culture, RT-PCR and immunofluorescence method. Results Among the patients, Legionella pneumonia was 22.1%(15/68), other bacterial pneumonia was 2.95(2/68), mycoplsma pneumonia was 11.85(8/68), viral pneumonia 16.2%(11/68). Among the cases of virus infection, Influenza A Virus was 3 cases, influenza B virus was 4 cases, parainfluenza virus was 1 case and adenovirus was 1 case, HIV was 2 cases, 8.8%(6/68) patients were mixed infection. Pathogens in 32 cases were not identified (47.1%). The clinical manifestations, signs, peripheral leukocyte count, and chest image had't any special characters in viral, Legionella and mycoplasma pneumonia. Their differentiation mainly depends on identification of pathogen. Conclusions The cases with normal or low peripheral leukocyte count are mainly caused by atypical pathogen or virus. These results showed that macrolides antibiotics and antiviral drugs should be used as preferred drug in CAP.