太原地区成人及儿童社区获得性肺炎非典型病原体流行病学调查

目的对引起社区获得性肺炎(CAP)的病原体进行流行病学调查,以了解非典型病原体感染的状况并分析其感染的流行病学特征。方法收集2005年12月至2006年12月CAP成人患者86例,儿童患者375例。取患者急性期痰标本进行细菌培养,应用常规方法分离鉴定细菌。应用被动凝集法检测血清肺炎支原体抗体,应用间接免疫荧光(IIF)法检测血清肺炎衣原体抗体,应用聚合酶链反应(PCR)扩增痰中军团菌属特异性16SrRNA基因,应用酶联免疫吸附试验(ELISA)检测患儿血清中呼吸道合胞病毒,腺病毒,流感病毒A型、B型,副流感病毒1、3型等6种病毒抗体。结果86例成人CAP患者,病原体检出率为64.0%,其中17例(19.8%)检出肺炎支原体,16例(18.6%)检出军团菌,2例(2.3%)检出肺炎衣原体,14例(16.3%)分离出肺炎链球菌,4例(4.6%)为肺炎克雷伯菌,2例(2.3%)流感嗜血杆菌,19例(22.1%)患者存在混合感染,混合感染者中10例为肺炎支原体混合其他病原体。375例患儿中,痰培养360例,其中细菌培养阳性者148例(41.1%);在同时进行痰培养和血清学检测的350例患儿中,254例(72.6%)检测到病原体,其中细菌感染138例(39.4%),病毒感染133例(38.0%),肺炎支原体感染77例(22.0%),肺炎衣原体感染8例(2.3%),军团菌感染7例(2.03%),混合感染112例(32.0%)。成人患者,≤25岁组肺炎支原体感染率高于>25岁组,无基础疾病组肺炎支原体感染率高于有基础疾病组,冬季肺炎支原体感染率高于其他季节;儿童肺炎支原体感染以1～7岁为主。结论非典型病原体尤其是肺炎支原体感染在CAP中占据重要地位。

Prevalence of atypical pathogens in adults and children with community-acquired pneumonia in Taiyuan

Objective To investigate the prevalence and epidemiological features of atypical pathogens through a study on pathogens to community-acquired pneumonia （CAP）. Methods Between December 2005 and December 2006, 86 adult and 375 children with community-acquired pneumonia in Taiyuan were enrolled in the study. From these subjects, sputum samples were collected and cultured for bacteria that were then isolated and identified using conventional methods. Antibodies of Mycoplama pneumoniae were detected by microparticle agglutination, antibodies of Chlamydia pneumoniae by indirect immunofluorescence test （IIFT）, genus-specific sequence of 16Sribesome gene of legionella amplified by polymerase chain reaction （PCR）, antibodies of respiratory syncytial virus, adenovirus, influenza virus types A and B, and parainfluenza virus types 1 and 3, by enzyme-linked immunosorbent assay （ELISA）, Results Of 86 CAP adults, 55 （64.0%） were confirmed to have pertinent pathogens, which included Myeoplasma pneumoniae in 17 （19.8%） cases , Legionella in 16 （18.6%） , Chlamydia pneumoniae in 2 （2.3%） , streptococcus pneumoniae in 14 （16.3%） , Klebsiella pneumoniae in 4 （4.6%） , and Haemophilus influenzae in 2 （2.3%）. More than one causal pathogen was found in 19 patients （22.1%）, including 10 cases of mixed infection with Mycoplasma pneumoniae and other microbes. Of the CAP children, the rate of positive sputum culture was in 41.1% （148/360） . CAP-related pathogens were identified in 254 of 350 patients （72.6%） with valid sputum culture, serum samples and PCR, suggesting bacterial infection in 138 （39.4%）, viral infection in 133 （38.0%）, mycoplasma pneumoniae infection in 77（22.0%）, Chlamydia pneumoniae infection in 8 （2.3%）, legionella infection in 7（2.0%）, and mixed infection in 112 （32.0%）. For CAP adults, the rate of myeoplasma pneumoniae infection was higher in those below 25 years old than in those aged above 25 years old, in those without underlying diseases than in those with these conditions, and in winter than in the other seasons of the year. The children aged between 1 and 7 years old were most susceptible to mcoplasma pneumoniae. Conclusion Atypical pathogens, particularly the Myeoplasma pneumoniae, may have an important role in CAP.