发热门诊呼吸道感染患者中的肺炎衣原体感染调查（英文）

目的了解发热门诊呼吸道感染患者中的肺炎衣原体感染状况,为临床诊断和治疗提供依据。方法采集2010年11月15日至12月15日在北京友谊医院发热门诊就诊,诊断为呼吸道感染患者的咽拭子标本92例,采用国际肺炎衣原体参考菌株TW-183作为阳性对照和优化PCR条件。用肺炎衣原体种特异性引物对其16SrRNA基因进行PCR检测,阳性产物进行基因测序,结果采用SPSS 10.0软件进行数据统计分析,计数资料比较用(2检验,P≤0.05为差异有统计学意义。结果 CpnA-CpnB PCR可检测到5×10-1 IFU的肺炎衣原体。92例呼吸道感染患者的咽拭子标本中PCR阳性者为30例,阳性率为32.6%。男性和女性、不同年龄组、以及上呼吸道和下呼吸道感染病例的阳性率间差异均无统计学意义(P0.05)。结论在发热门诊有呼吸道症状的病例中,肺炎衣原体感染率较高。临床医生应对肺炎衣原体感染加以重视。CpnA-CpnB PCR法是一灵敏快速的肺炎衣原体筛查方法。     

老年人呼吸道衣原体感染的研究

目的探讨老年人呼吸道衣原体感染的状况。方法采用放线菌酮处理的Ｈｅｌａ２２９细胞、单克隆抗体免疫荧光对健康老年组、老年呼吸道感染组及肺部肿瘤组的咽拭子及纤维支气管镜标本进行了衣原体的分离培养鉴定。结果健康老年组６６例的咽拭子标本中均未分离到衣原体。呼吸道感染组１３５保做了沙眼在原体分离，７例阳性，阳性率为５．１８％；其中１１３例亦做了肺炎衣原体分离，也有７例阳性，阳性率为６．１９％；而１１３例标本中均未检出鹦鹉热衣原体。４２例肺部肿瘤患者的上述３种衣原体检出的结果分别为沙眼衣原体阳性率１１．９０％（４２例中５例阳性），肺炎衣原体阳性率为１４．２８％（２１例中３例阳性），２１例标本中均未检出鹦鹉热衣原体。结论肺炎衣原体和沙眼衣原体均可能是老年人呼吸道感染的重要病原因之一，对老年人肺部肿瘤患者呼吸道衣原体感染亦应引起重视     

肺炎衣原体急性呼吸道感染的临床研究

目的了解成人呼吸道感染患者急性肺炎衣原体感染的患病情况及临床特征。方法呼吸道感染住院患者１１０例，同时采集痰和咽拭子标本，应用聚合酶链反应（ＰＣＲ）检测肺炎衣原体ＤＮＡ，及采取静脉血检测肺炎衣原体ＩｇＧ和ＩｇＭ抗体。结果本组患者肺炎衣原体ＩｇＧ抗体的阳性率为７０％（７７／１１０），其中１７例（１６％）有肺炎衣原体近期感染的急性抗体，１２例（１１％）痰和（或）咽拭子肺炎衣原体ＰＣＲ检测结果阳性，联合应用两种方法的阳性率为２３％（２５／１１０）。肺炎衣原体急性感染以支气管哮喘急性发作、肺炎、慢性阻塞性肺疾病急性加重和急性支气管炎患者多见（分别为５７％、３５％、２６％和２５％），其临床表现无特征性。结论结果提示成人呼吸道感染患者肺炎衣原体急性感染的阳性率较高，提示肺炎衣原体是呼吸道感染的重要致病原，应引起临床的高度重视     

老年呼吸道感染患者肺炎衣原体、肺炎支原体感染情况分析

目的了解我院老年呼吸道感染患者肺炎衣原体(CP)和肺炎支原体(MP)感染状况,为临床诊断和治疗提供依据。方法采用胶体金法定性对263例老年呼吸道感染患者进行CP和MP及其血清抗体Ig G、Ig M检测。结果 263例老年呼吸道感染患者中,CP阳性52例,阳性率为19.8%;MP抗体阳性69例,阳性率为26.2%;MP阳性率略高于CP阳性率,但差异无统计学意义(P0.05)。CP和MP阳性患者共121例,阳性率为46.0%。在52例CP阳性患者中,CP-Ig G阳性33例,阳性率为63.5%;CP-Ig M阳性19例,阳性率为36.5%;CP-Ig G阳性率显著高于CP-Ig M阳性率,差异有统计学意义(P0.01)。在69例MP阳性患者中,MP-Ig G阳性43例,阳性率为62.9%;MP-Ig M阳性26例,阳性率为37.7%;MP-Ig G阳性率显著高于MP-Ig M阳性率,差异有统计学意义(P0.01)。结论老年呼吸道感染患者中CP抗体和MP抗体阳性率较高,CP、MP阳性患者的Ig G阳性率高于Ig M阳性率,对于老年呼吸道感染患者,在进行痰细菌培养检测的同时应进行肺炎衣原体、支原体Ig G、Ig M的检测,才能做到早发现、早诊断,对患者进行正确的治疗。     

青海省急性呼吸道感染病原学分析

目的了解青海省急性呼吸道感染常见病原,探讨高原地区发热呼吸道症候群的病原谱构成。方法采集急性呼吸道感染患者的呼吸道分泌物、血液和尿液标本,用多重RT-PCR方法对标本进行9种细菌(支原体、衣原体)和7种病毒核酸检测。结果受检患者329例,细菌(支原体、衣原体)阳性率为5.86%(19/324),病毒阳性率为14.94%(46/308),差异有统计学意义(χ2=14.08,P<0.01)。检出的细菌主要为肺炎链球菌(占47.37%),其次为肺炎克雷伯菌(占31.58%);检出的病毒主要为人腺病毒(占31.25%),其次为人副流感病毒(占27.08%)。男性患者病原体核酸阳性率为21.26%(44/207),女性患者为13.93%(17/122),差异无统计学意义(χ2=2.72,P>0.05)。结论青海高原地区急性呼吸道感染病原主要为人腺病毒、副流感病毒、流感病毒、肺炎链球菌和肺炎克雷伯菌,且病毒性呼吸道疾病所占比例较大,提示高原地区发热呼吸道感染病原以病毒为主。     

郑州地区11299例急性呼吸道感染儿童病原体检查结果分析

目的了解郑州地区急性呼吸道感染儿童病原体流行情况。方法取11299名急性呼吸道感染住院患儿的咽分泌物、痰液或肺泡灌洗液,采用基于毛细管电泳的多重PCR法检测12种呼吸道病原体。结果11299例样本中,检测结果为阳性的8742例,阳性率为77.37%,其中,单纯感染6943例(79.42%),混合感染1799例(20.58%)。阳性标本中鼻病毒(HRV)阳性标本最多,2859例,阳性率25.3%;其次为肺炎支原体(MP),2047例,阳性率18.12%。不同性别患儿中,HRV和MP的阳性检出率有统计学意义。结论HRV是郑州地区急性呼吸道感染儿童的最常见病原体。12种呼吸道病原体的阳性率随月份变化呈现不同的特点;甲型流感病毒H1N1型和肺炎衣原体(Ch)的阳性率与患儿年龄无关,其他病原体阳性率与患儿年龄相关。     

实时荧光定量PCR技术检测肺炎衣原体的诊断价值

目的探讨实时荧光定量PCR技术检测肺炎衣原体的诊断价值。方法对呼吸道感染的186例患者的痰液分别采用实时荧光定量PCR技术和基因测序检测,以评价实时荧光定量PCR技术检测肺炎衣原体感染的准确性。结果实时荧光定量PCR检测肺炎衣原体的灵敏度为100.0%,特异度为93.1%,阳性预期值为80.8%,阴性预期值为100.0%,准确率为94.6%。结论实时荧光定量PCR技术检测肺炎衣原体具有较高的可靠性,适用于临床快速诊断肺炎衣原体感染的相关疾病。     

聚合酶链反应检测新生儿衣原体感染

目的用聚合酶链反应检测新生儿衣原体感染状况。方法参照文献报道的沙眼衣原体及肺炎衣原体基因序列,分别设计一对引物,采用ＰＣＲ法检测住院新生儿衣原体感染。结果因呼吸道感染住院的１２３名新生儿的咽拭子标本,沙眼衣原体及肺炎衣原体感染率分别为１３．８％和４．９％。结论ＰＣＲ检测沙眼衣原体及肺炎衣原体感染具有特异、敏感、快速的特点,可为临床诊断提供科学依据。     

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。     

一对检测肺炎衣原体的新引物

为建立一种更敏感的肺炎抗原体PCR检测方法,根据肺炎衣原体种特异性 53kDa蛋白基因序列设计一对引物53A、53B,用PCR进行肺炎衣原体的检测研究。结果该引物仅能扩增肺炎衣原体DNA,而与沙眼衣原体,鹦鹉热衣原体不反应,且对呼吸道常见病原菌之DNA的扩增亦为阴性,它能扩增出少至10fg的肺炎衣原体DNA,比我们以前合成的一对肺火衣原体16s rDNA基因检测引物Cpnl、Cpn2更敏感,分别用这两对引物检测30例有呼吸道疾患病人的鼻咽拭子标本,PCR的阳性符合率为86.7%。表明53A、53B是一对有效、敏感的肺炎衣原体检测引物。     

呼吸道感染患者外周血中肺炎嗜衣原体的检测与分析

目的检测并分析呼吸道疾病患者的肺炎嗜衣原体（Cpn）感染率。方法收集173例呼吸道感染患者和52例健康体检者外周血标本,分离外周血单核细胞（PBMC）血清。提取纯化PBMC的DNA,以该DNA为模板,用特异性引物体外扩增CpnMOMP基因。扩增产物经电泳及测序鉴定,确认为Cpn特异性的目的基因。用ELISA法检测待测血清中的Cpn-IgG抗体。通过PCR与ELISA的检测结果,结合临床资料进行流行病学综合分析Cpn感染率。结果以PBMC基因组DNA为模板,呼吸道感染组患者标本中CpnMOMP阳性率为32．40％（56／173）,健康对照组中阳性率为9．62％（5／52）;经测序比对,所有MOMP阳性扩增产物与Cpn AR-39的MOMP基因同源性在99％以上。ELISA检测血清Cpn-IgG,感染组阳性率50．87％（88／173）,对照组阳性率为30．77％（16／52）,两组差异有统计学意义。比较不同年龄组ELISA及MOMPPCR两种方法检测Cpn感染指标的阳性率,发现老年人的Cpn感染率最高。结论在呼吸道感染患者不同年龄阶段均检出较高的Cpn感染指标,其中老年人群中检出率最高,说明Cpn是本地区呼吸道感染常见的病原体之一。     

PCR and serology were effective for identifying Chlamydophila pneumoniae in a lower respiratory infection outbreak among military recruits

During endemic infections, the sensitivity of diagnostic tests and rapid diagnosis of the respiratory tract pathogens is particularly important. Utilization of just one diagnostic technique, such as serological tests or polymerase chain reaction (PCR)-based detection methods, during outbreaks of lower respiratory tract infections (LRI) can result in some of the patients being missed. In this study we aimed to investigate the etiology of LRI in military recruits in Izmir, Turkey, among whom several pneumonia cases have been reported and 47 patients have been hospitalized. Nasopharyngeal swabs were used for PCR analysis of Chlamydophila pneumoniae, Mycoplasma pneumoniae and Legionella spp. Serum samples were collected in the acute and convalescent phase of infection for C. pneumoniae and M. pneumoniae. Thirty-nine patients were diagnosed with C. pneumoniae infection by PCR and/or serology. Diagnoses were established by PCR in the acute phase of infection in 40.4% of the group. Based on the results of these studies, PCR is a useful method for early detection and identification of C. pneumoniae-related LRI outbreaks. However, this technique is not sufficient to detect all positive cases per se. After effective therapy and introduction of appropriate infection control measures, the outbreak ceased without mortality. This is the first closed-community C. pneumoniae outbreak report from Turkey.     

Chlamydia pneumoniae infection and Mycoplasma pneumoniae infection in pediatric patients

We evaluated a total of 1104 pediatric patients with acute lower respiratory tract infection for C. pneumoniae infection and M. pneumoniae infection by serology during July 1995 to December 1998. A microimmunofluorescence test was used for diagnosis of C. pneumoniae infection and a high density particle agglutination test for that of M. pneumoniae infection. Acute C. pneumoniae infection was found in 149 patients (13.5%), acute M. pneumoniae infection in 118 patients (10.7%), and dual infection in 27 patients (2.4%). Among 305 patients with pneumonia, M. pneumoniae infection (83 patients, 27.2%) was more common than C. pneumoniae infection (47 patients, 15.4%). However among 799 patients with bronchitis. C. pneumoniae infection (102 patients, 12.8%) was more common than M. pneumoniae infection (35 patients, 4.4%). Patients with C. pneumoniae infection were more younger and more frequently wheezing than patients with M. pneumoniae infection. These findings demonstrate that C. pneumoniae infection in very common pathogen of pediatric lower respiratory tract infection as M. pneumoniae infection in Japan.     

First report on clinical features of Mycoplasma pneumoniae infections in Vietnamese children

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP) in children, but there has been no clinical report on M. pneumoniae infections in Vietnamese children. We investigated the clinical features of M. pneumoniae infection when the pathogen was detected in the respiratory tract in hospitalized children aged 1-15 years due to lower respiratory tract infections or CAP in Vietnamese children. Throat swabs from 47 patients (18.6%) of 252 patients with a clinical diagnosis of CAP were PCR positive (male, 34; female, 13), and 21 throat swabs (8.3%) showed culture positive for M. pneumoniae. The M. pneumoniae pathogen could be detected by PCR and/or culture in 52 patients (male, 36; female, 16). The major clinical signs in the 52 patients were fever (>38 degrees C) in 100%, pharyngitis in 100%, tachypnea in 94%, dry cough in 86.5%, and rough breathing in 83% of patients. The average term of illness prior to hospitalization was 7.5+/-4.1 days, and the average number of hospitalized days was 7.9+/-3.5 days. Beta-lactam group antibiotics, which were ineffective against M. pneumoniae infection, were used in 37 cases (71%).     

Pneumonia--a clinical or radiographic diagnosis? Etiology and clinical features of lower respiratory tract infection in adults in general practice.

Etiology and clinical manifestations have been studied in 153 adult patients with lower respiratory tract infection, and the results are presented according to clinical and radiographic diagnosis. Laboratory investigations revealed that bacterial infection, mycoplasma and chlamydia included, occurred as often in 22 patients whose clinical diagnoses of pneumonia were not evident radiographically, as in 20 patients with radiographic pneumonia. In the latter group significantly higher values of erythrocyte sedimentation rate and C-reactive protein were demonstrated. The most common pathogen was influenzavirus A, followed by respiratory syncytial virus, Streptococcus pneumoniae, and Mycoplasma pneumoniae. Chlamydia pneumoniae infection was found in 3 patients with radiographic pneumonia. The study supports the traditional view that patients with a positive chest radiograph as a rule present more serious manifestations of lower respiratory tract pathology than patients with a normal radiograph. However, as only 1/9 patients with pneumococcal infection and 2/7 with mycoplasmal infection had radiographic evidence of pneumonia, radiography alone did not seem to offer sufficient information for selecting patients for antibacterial therapy.     

7例肺结核合并超鞭毛虫感染的诊断和治疗分析

目的探讨肺结核合并超鞭毛虫感染的临床诊断和治疗。方法对7例肺结核合并超鞭毛虫感染患者的临床和影像表现、实验室检查和治疗进行分析。结果患者以咳嗽和发热为主要症状,正规抗结核治疗后多仍有发热和明显盗汗,支气管肺泡灌洗液沉渣涂片镜检有助于提高超鞭毛虫检出率,甲硝唑治疗效果良好,可进一步恢复患者体温并消除盗汗。结论深圳地区肺结核患者合并超鞭毛虫感染临床并不少见,提高认识及时诊断治疗预后良好。     

2009年和2013年儿科病区下呼吸道感染致病菌分布与细菌耐药性的比较

目的：回顾性分析2009年和2013年儿科病区下呼吸道感染患者致病菌构成、分布及细菌耐药性的变迁,为临床抗感染药物的合理使用提供依据。方法收集2009年和2013年儿科病区下呼吸道感染患者痰培养的药敏试验结果,分析病原学构成和分布特点以及致病菌耐药性。结果致病菌以革兰阴性杆菌为主(分别占83.05%和76.52%),首要致病细菌为肺炎克雷伯菌,铜绿假单胞菌感染率5年内由22.03%降至12.88%,鲍曼不动杆菌感染率由6.78%上升至13.64%。金黄色葡萄球菌是最主要的革兰阳性球菌,且所占比例从5.93%上升至11.36%。2013年与2009年相比,下呼吸道感染患者致病细菌的耐药性及敏感性发生了较大的变迁,其趋势是对多种药物的耐药性增加,敏感性降低。2013年,肺炎克雷伯菌对头孢哌酮舒巴坦、美罗培南和阿米卡星有较好的敏感性,但对氨苄西林的耐药率高,均较2009年明显增加。2013年鲍曼不动杆菌对头孢哌酮舒巴坦有较好的敏感性,对头孢替坦、头孢曲松、氨曲南及氨苄西林的耐药率大于95%,与2009年相比较差异具有统计学意义(P<0.05)。且鲍曼不动杆菌多重耐药性菌株比例也呈现波动性上升。结论急性下呼吸道感染患儿致病细菌仍以革兰阴性杆菌为主,革兰阳性球菌中金黄色葡萄球菌比例升高。主要致病细菌对多种药物的耐药性增加,敏感性降低。急性下呼吸道感染患儿病原学构成、分布与耐药性已发生较大变迁,应调整经验性抗生素使用,以推迟耐药性的继续产生。     

Diagnosis of atypical pathogens in patients hospitalized with community-acquired respiratory infection

The object of our study was to determine the proportion of atypical respiratory pathogens among patients hospitalized with a community-acquired respiratory infection. From September 1997 to May 1999, 159 patients (57% male, median age 55, range 1-88 y) admitted to 3 regional hospitals for a community acquired respiratory infection, were enrolled in the study. Microbiological diagnosis for the atypical pathogens Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila was performed with PCR on a throat swab, sputum and/or broncho alveolar lavage (BAL). In addition, Legionella species other than L. pneumophila (L. non-pneumophila species) were detected by PCR. Two serum samples were collected and processed for M. pneumoniae and C. pneumoniae serology. In total, 27 patients (17%) were diagnosed with an atypical pathogen. Infection with M. pneumoniae was detected in 19 patients (12%) (PCR positive n = 7), with C. pneumoniae in 5 patients (3%) (PCR positive n = 0) and with L. pneumophila in 4 patients (2.5%) (PCR positive n = 4). In 54 (34%) patients routine microbiological investigations revealed aetiological agents other than the 3 atypical pathogens, the most frequently diagnosed pathogens being Streptococcus pneumoniae (n = 18), Haemophilus influenzae (n = 17), Gram-negative rods (n = 13), Moraxella catarrhalis (n = 6) and Staphylococcus aureus (n = 6). More than 1 pathogen was found in 13 patients. Atypical pathogens were found more often in the young age group (0-18 y), in contrast to bacterial pathogens that were found more often in the older age groups (> or = 65 y). Atypical pathogens were found less often in patients with a clinical presentation of atypical pneumonia. Legionella species other than L. pneumophila were found by PCR in 13 patients (8%), and in 6 patients in combination with another pathogen. An atypical pathogen (M. pneumoniae, C. pneumoniae or L. pneumophila) was found in 17% of the patients hospitalized with a community acquired respiratory infection, predominantly in the young age group. The role of Legionella non-pneumophila species as pathogen in community acquired respiratory infection needs to be determined. The clinical presentation does not predict the type of pathogen found.     

Chlamydia pneumoniae infection in adults with chronic cough compared with healthy blood donors.

In a small uncontrolled study, persistent cough has recently been found to be associated with serological evidence of acute Chlamydia pneumoniae infection. In order to assess whether C. pneumoniae plays a role in chronic cough, the prevalence of C. pneumoniae infection in 201 adult patients with chronic cough was compared with the prevalence in 106 healthy blood donors without respiratory tract symptoms in the preceding 3 months. A microimmunofluorescence antibody test was used to determine C. pneumoniae antibodies in the immunoglobulin (Ig)M, IgG and IgA fractions. Further, nasopharyngeal aspirates from the 201 patients were examined for C. pneumoniae deoxyribonucleic acid by polymerase chain reaction (PCR). As judged by serology, nine patients (4%) and one control (1%) had acute C. pneumoniae infection, and 92 patients (46%) and 42 controls (40%) had previous or chronic C. pneumoniae infection. Of the nine patients with acute infection, three were C. pneumoniae PCR positive, and they all had an IgM antibody titre response. The remaining six patients had either an IgG antibody titre of > or =512 (five patients) or an IgA antibody titre of > or =512 (one patient). None of these six patients had detectable IgM antibodies. The mean cough period for the five IgG positive patients (10.8 weeks) was significantly longer than the mean cough period for the remaining patient population (6.4 weeks; p=0.004). It is concluded that Chlamydia pneumoniae infection was not statistically significantly more prevalent in patients with chronic cough than in healthy blood donors, and that Chlamydia pneumoniae appears to have a minor role in patients with chronic cough. Direct detection of Chlamydia pneumoniae by polymerase chain reaction on nasopharyngeal aspirates is highly correlated with detectable immunoglobulin M antibodies, but in the late stages of prolonged cough serological testing of immunoglobulin G and immunoglobulin A may be more beneficial for obtaining a microbiological diagnosis.