A case-control study of acute respiratory tract infection in general practice patients in the Netherlands
A case-control study of acute respiratory tract infection in general practice patients in the Netherlands
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DOI：
10.1086/431982
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发表时间：
2005-08-15
影响因子：
11.8
通讯作者：
Wilbrink, B
中科院分区：
文献类型：
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作者：
van Gageldonk-Lafeber, AB;Heijnen, MLA;Wilbrink, B
背景。急性呼吸道感染（ARTI）是社区中相当大的发病率的原因，但人们对无症状个体中是否存在呼吸道病原体知之甚少。我们假设无症状者可能存在亚临床感染，从而成为传播源。方法。 2000-2003 年期间，所有去看哨点全科医生的 ARTI 患者都报告了他们的数据，以估计荷兰全科诊所中 ARTI 的发病率。病例对照研究中包括随机选择的这些患者（病例患者）和同等数量的因其他投诉而就诊的无症状患者（对照受试者）。对参与者的鼻子和喉咙拭子进行了多种病原体检测。结果。 ARTI 的总体发病率为每 10,000 人年 545 例，这表明在荷兰人口中，估计每年有 900,000 人因呼吸系统疾病咨询全科医生。鼻病毒在病例患者中最常见（24%），其次是甲型流感病毒（11%）和冠状病毒（7%）。 58%的病例患者检出病毒，11%检出A组β溶血性链球菌，3%检出混合感染。与 30% 的对照受试者相似，尤其是在最年轻的年龄组中，检测到了病原体。结论。这项研究证实，大多数 ARTI 都是病毒性的，并支持开抗生素处方的保留政策。在病例和对照受试者中，鼻病毒是最常见的病原体。在细菌感染中，只有 A 组 β 溶血性链球菌在病例患者中比对照组更常见。此外，我们证明无症状者可能是被忽视的传播源。
Background. Acute respiratory tract infections (ARTIs) are responsible for considerable morbidity in the community, but little is known about the presence of respiratory pathogens in asymptomatic individuals. We hypothesized that asymptomatic persons could have a subclinical infection and thus act as a source of transmission.Methods. During the period of 2000-2003, all patients with ARTI who visited their sentinel general practitioner had their data reported to estimate the incidence of ARTI in Dutch general practices. A random selection of these patients (case patients) and an equal number of asymptomatic persons visiting for other complaints (control subjects) were included in a case-control study. Nose and throat swabs of participants were tested for a broad range of pathogens.Results. The overall incidence of ARTI was 545 cases per 10,000 person-years, suggesting that, in the Dutch population, an estimated 900,000 persons annually consult their general practitioner for respiratory complaints. Rhinovirus was most common in case patients (24%), followed by influenza virus type A (11%) and coronavirus (7%). Viruses were detected in 58% of the case patients, beta-hemolytic streptococci group A were detected in 11%, and mixed infections were detected in 3%. Pathogens were detected in similar to 30% of control subjects, particularly in the youngest age groups.Conclusion. This study confirms that most ARTIs are viral and supports the reserved policy of prescribing antibiotics. In both case and control subjects, rhinovirus was the most common pathogen. Of bacterial infections, only group A beta-hemolytic streptococci were more common in case patients than in control subjects. Furthermore, we demonstrated that asymptomatic persons might be a neglected source of transmission.