Pneumonia outbreak associated with group A Streptococcus species at a military training facility
Pneumonia outbreak associated with group A Streptococcus species at a military training facility
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DOI：
10.1086/427502
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发表时间：
2005-02-15
影响因子：
11.8
通讯作者：
Hale, BR
中科院分区：
文献类型：
--
作者：
Crum, NF;Russell, KL;Hale, BR
背景虽然A组链球菌（GAS）感染是发病率和死亡率的主要原因，但相关性肺炎的爆发是罕见的。我们报告的GAS肺炎的爆发，发生在美国军事训练营。标准流行病学和实验室程序用于描述暴发和病原体。还进行了一项病例对照研究，并确定了营地人员中GAS感染的患病率。在2002年11月1日至12月20日期间，4500名海军陆战队人员中共有162人因呼吸道症状住院，127人（78%）经放射学确诊为肺炎。发病率为1.6例/100人月。127例肺炎患者中有34例（27%）明确或可能为GAS肺炎;另外22例（17.3%）合并GAS和其他病原体感染。除GAS外，病原体还包括肺炎衣原体（27例患者）、肺炎支原体（19例）、腺病毒（5例）和肺炎链球菌（2例）。一项调查显示，营地人员中GAS的咽部携带率为16%。GAS分离株的分子特征发现emm 3型，多位点序列15型。在给予单剂量肌内注射苄星青霉素（120万U）或阿奇霉素（1 g口服）进行额外预防后，疫情结束。由于距离最后一次青霉素注射的天数与咽部培养阳性结果和肺炎的发生相关，因此苄星青霉素的给药间隔从每28 - 35天缩短为每21天。这是130年来报道的最大规模的GAS肺炎疫情。这次暴发强调了GAS引起严重感染流行的可能性，并表明需要在特别高风险人群中进行监测和考虑适当的抗生素预防。
Background. Although group A streptococci ( GAS) infections are a major cause of morbidity and mortality, outbreaks of associated pneumonia are rare. We report an outbreak of GAS pneumonia that occurred at a US military training camp.Methods. Standard epidemiologic and laboratory procedures were used to characterize the outbreak and causative organism(s). A case-control study and determination of the prevalence of GAS infection among camp personnel were also performed.Results. A total of 162 of 4500 Marine Corps personnel were hospitalized for respiratory symptoms during the period of 1 November and 20 December 2002, and 127 (78%) had radiographically confirmed pneumonia. The attack rate was 1.6 cases per 100 person-months. Thirty-four (27%) of 127 patients with pneumonitis had definite or probable GAS pneumonia; an additional 22 (17.3%) were coinfected with GAS and another pathogen. Pathogens, in addition to GAS, included Chlamydia pneumoniae ( 27 patients), Mycoplasma pneumoniae ( 19), adenovirus ( 5), and Streptococcus pneumoniae ( 2). A survey revealed that the pharyngeal carriage rate of GAS among camp personnel was 16%. Molecular characterization of the GAS isolates found emm type 3, multilocus sequence type 15. The epidemic ended after administration of additional prophylaxis with a single dose of intramuscular benzathine penicillin (1.2 million U) or azithromycin ( 1 g orally). Because the number of days from the last penicillin injection was correlated with a positive throat culture result and the occurrence of pneumonia, the dosing interval of benzathine penicillin was shortened from every 28 - 35 days to every 21 days.Conclusions. This is the largest outbreak of GAS pneumonia reported in 130 years. This outbreak emphasizes the potential for GAS to cause epidemics of severe infection and demonstrates the need for surveillance and consideration of appropriate antibiotic prophylaxis among particularly high-risk populations.