医护人员肺炎衣原体呼吸道感染的暴发流行

目的研究肺炎衣原体（CP）呼吸道感染暴发流行的临床特征及胸部影像学表现。方法15例暴发流行的CP呼吸道感染住院患者（1例为原发病例，14例为医护人员）痰和咽拭子标本，应用聚合酶链反应（PCR）检测CP的DNA，使用微量免疫荧光技术（MIF）检测CP的IgG和IgM抗体，同时对胸部X线和CT表现进行分析。结果本组暴发流行的CP感染患者均有发热，头痛，全身肌肉酸痛，干咳，声音嘶哑，咽痛等症状。咳嗽剧烈时伴有胸痛，其中痰中带血3例（3／15，20％），肺部呼吸音减低或细湿哕音5例（5／15，33％）。PCR检测CP阳性13例（13／15，87％），出现明显肺部影像学表现10例（10／15，67％）。主要影像学表现是：一侧和（或）两侧肺部单发或多发腺泡结节状阴影9例，斑片状阴影2例，片状阴影合并局限性肺气肿1例，无肺门及纵隔淋巴结增大、胸腔积液。结论医护人员CP呼吸道感染的暴发流行具有群体发病，发热、头痛、干咳、咽痛和单发或多发腺泡结节状阴影相同的特征。早期CT检查更能真实地反应病变大小，多少和分布范围。诊断时应与严重急性呼吸综合征（SARS）进行鉴别。

An epidemic outbreak of respiratory infection caused by Chlamydia pneumoniae in medical workers

Objective To investigate the clinical manifestations and the chest imaging characteristics of an epidemic outbreak of respiratory infection caused by Chlamydia pneumoniae(CP).Methods A prospective study for CP infection in 15 patients from September 2003 was carried out.Sputum and throat swab specimen were obtained and CP DNA was detected by polymerase chain reaction(PCR).Serum samples were obtained and immunoglobulin G and M(IgG and IgM) of antibodies to CP.pneumoniae were studied by microimmunofluorescence test.Chest X-ray and computed tomography were retrospectively analyzed.Results All patients presented fever,headache,sore throat,hoarseness,muscular ache,and dry cough.Acute cough was often associated with chest pain.The sputum blood was present in 3 patients(20%).Moist rales were heard in 4 patients.Chest imaging abnormalities were present in 67%(10 patients).The organism was demonstrated in 87%(13 patients) by PCR.The most common imaging abnormalities were unilateral and(or) bilateral multi-focal or solitary alveoliar nodular opacities(9 patients).The patchy shadows were found in 2 patients,and pulmonary consolidation associated with the local pulmonary edema in 1 patient.Hilar or mediastinal lymphadenopathy and pleural effusion was not found.Conclusions The colony occurrences and similar clinical and chest imaging manifestations are characteristics of an outbreak of respiratory infection caused by CP in medical workers.An outbreak of respiratory infection caused by CP should be differentiated from severe acute respiratory syndrome(SARS).