An outbreak of primary pneumonic tularemia on martha's vineyard
An outbreak of primary pneumonic tularemia on martha's vineyard
复制标题
DOI：
10.1056/nejmoa011374
复制
发表时间：
2001-11-29
影响因子：
158.5
通讯作者：
Hayes, EB
中科院分区：
文献类型：
--
作者：
Feldman, KA;Enscore, RE;Hayes, EB
背景：2000年夏天，马萨诸塞州玛莎葡萄园岛爆发了原发性肺炎土拉菌病。1978年，美国也发生了肺型土拉菌病的暴发。方法：我们对肺型土拉菌病成人进行了病例对照研究，并调查了环境，以确定原发性肺型土拉菌病的危险因素。确诊病例的患者是玛莎葡萄园岛的居民或游客，他们有原发性肺炎土拉菌病的症状，在2000年5月15日至10月31日期间患病，实验室土拉菌病检测呈阳性。对照组为2000年5月15日至9月28日期间在玛莎葡萄园岛度过至少15天的成年人。结果：我们确定了15例土拉菌病患者，其中11例为原发性肺炎土拉菌病。从一名死亡男子的血液和肺组织中分离出了A型土拉热弗朗西斯菌。患者比对照组更有可能在患病前两周（比值比，9.2; 95%置信区间，1.6至68.0）和夏季（比值比，未定义; 95%置信区间，1.8至（无穷大））使用割草机或割灌机。在调整其他潜在的混杂变量后，修剪草坪和修剪灌木仍然是重要的风险因素。只有一名患者报告在切割刷子时暴露于兔子。在40只诱捕动物中，1只条纹臭鼬和1只挪威鼠血清抗F. tularensis.Conclusions:对这次原发性肺炎土拉菌病爆发的研究表明，割草和修剪灌木是这种感染的危险因素。（N Engl J Med 2001;345：1601-6.）版权所有（C）2001马萨诸塞州医学会。
Background: In the summer of 2000, an outbreak of primary pneumonic tularemia occurred on Martha's Vineyard, Massachusetts. The only previously reported outbreak of pneumonic tularemia in the United States also occurred on the island in 1978.Methods: We conducted a case-control study of adults with pneumonic tularemia and investigated the environment to identify risk factors for primary pneumonic tularemia. Patients with confirmed cases were residents of or visitors to Martha's Vineyard who had symptoms suggestive of primary pneumonic tularemia, were ill between May 15 and October 31, 2000, and had a positive laboratory test for tularemia. Controls were adults who had spent at least 15 days on Martha's Vineyard between May 15 and September 28, 2000.Results: We identified 15 patients with tularemia; 11 of these cases were primary pneumonic tularemia. Francisella tularensis type A was isolated from blood and lung tissue of the one man who died. Patients were more likely than controls to have used a lawn mower or brush cutter in the two weeks before the illness (odds ratio, 9.2; 95 percent confidence interval, 1.6 to 68.0) and during the summer (odds ratio, undefined; 95 percent confidence interval, 1.8 to (infinity)). Lawn mowing and brush cutting remained significant risk factors after adjustment for other potentially confounding variables. Only one patient reported being exposed to a rabbit while cutting brush. Of 40 trapped animals, 1 striped skunk and 1 Norway rat were seropositive for antibodies against F. tularensis.Conclusions: Study of this outbreak of primary pneumonic tularemia implicates lawn mowing and brush cutting as risk factors for this infection. (N Engl J Med 2001;345:1601-6.) Copyright (C) 2001 Massachusetts Medical Society.