Aetiology and clinical presentation of mild community-acquired bacterial pneumonia
Aetiology and clinical presentation of mild community-acquired bacterial pneumonia
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DOI：
10.1007/s10096-003-0997-0
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发表时间：
2003-10-01
影响因子：
4.5
通讯作者：
Letonja, S
中科院分区：
文献类型：
--
作者：
Beovic, B;Bonac, B;Letonja, S
采用先前描述的肺炎严重程度指数，启动了一项前瞻性研究，以分析斯洛文尼亚轻度社区获得性肺炎的细菌病原学和临床表现。纳入了7个研究中心接受口服抗生素治疗的患者中经放射学证实的肺炎病例。通过血液和痰培养、肺炎链球菌和嗜肺军团菌尿抗原检测以及配对血清样本中肺炎支原体、肺炎衣原体和嗜肺军团菌抗体检测，尝试进行病原学诊断。113例患者可评价临床表现，109例可评价病因学诊断。62.4%的患者至少检出一种病原体。最常见的病原体为肺炎支原体（24.8%）、肺炎衣原体（21.1%）和肺炎链球菌（13.8%）。8.3%的患者检测到双重感染。大多数患者患有咳嗽，疲劳和发烧。非典型病原性肺炎患者与典型细菌性肺炎或不明病原性肺炎患者在年龄、呼吸困难和肺部听诊支气管呼吸方面存在差异。肺炎球菌、衣原体和支原体感染的患者在年龄、危险等级、呼吸困难、支气管呼吸和蛋白尿方面存在差异。在按病因分类的患者组中，其他临床症状、基础疾病、实验室检查和影像学检查结果存在重叠。由于轻度社区获得性肺炎患者表现出相似的临床特征，而且，由于相当大比例的病例可归因于非典型细菌，因此建议使用广谱抗生素治疗。
A prospective study was initiated to analyse the bacterial aetiology and clinical picture of mild community-acquired pneumonia in Slovenia using the previously described Pneumonia Severity Index. Radiographically confirmed cases of pneumonia in patients treated with oral antibiotics in seven study centres were included. An aetiological diagnosis was attempted using culture of blood and sputum, urinary antigen testing for Streptococcus pneumoniae and Legionella pneumophila, and antibody testing for Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila in paired serum samples. One hundred thirteen patients were evaluable for clinical presentation and 109 for aetiological diagnosis. At least one pathogen was detected in 62.4% patients. The most common causative agents were Mycoplasma pneumoniae in 24.8%, Chlamydia pneumoniae in 21.1%, and Streptococcus pneumoniae in 13.8% of patients. Dual infection was detected in 8.3% of patients. Most patients suffered from cough, fatigue, and fever. Patients with atypical aetiology of pneumonia differed from those with typical bacterial pneumonia or pneumonia of unknown aetiology in age, presence of dyspnea, and bronchial breathing on lung auscultation. Patients with pneumococcal, chlamydial, and mycoplasmal infections differed in age, risk class, presence of dyspnea, bronchial breathing, and proteinuria. There was an overlap of other clinical symptoms, underlying conditions, and laboratory and radiographic findings among the groups of patients classified by aetiology. Since patients with mild community-acquired pneumonia exhibit similar clinical characteristics and, moreover, since a substantial proportion of cases are attributable to atypical bacteria, broad-spectrum antibiotic treatment seems to be recommended.