Trends in legionnaires disease, 1980-1998: Declining mortality and new patterns of diagnosis
Trends in legionnaires disease, 1980-1998: Declining mortality and new patterns of diagnosis
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DOI：
10.1086/342903
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发表时间：
2002-11-01
影响因子：
11.8
通讯作者：
Besser, RE
中科院分区：
文献类型：
--
作者：
Benin, AL;Benson, RF;Besser, RE
新的肺炎诊断测试和经验性治疗可能对军团病 (LD) 的识别、治疗和控制产生重要影响。为了确定 LD 的流行病学趋势，我们分析了 1980-1998 年美国疾病控制和预防中心被动监测系统的数据。在此期间，共有 6757 例 LD 确诊病例（年中位数，360 例/年）。通过培养、直接荧光抗体和血清学检测进行的诊断显着减少；尿液抗原检测诊断率从 0% 增加到 69%。除嗜肺军团菌血清组 1 (LP1) 之外的分离株的频率从 38% 下降至 4% (P = .003)。所有病例的病死率均显着下降，从 34% 降至 12% (P < .001)，院内病例从 46% 降至 14% (P < .001)，社区获得病例从 26% 降至 10% (P = .05)。 LD 相关死亡率急剧下降。基于培养的诊断的减少限制了对非 LP1 疾病的识别，并损害了疫情调查，因为可供进一步检查的军团菌分离株较少。
New diagnostic tests and empirical therapy for pneumonia may have important ramifications for the identification, treatment, and control of legionnaires disease (LD). To determine trends in the epidemiology of LD, we analyzed data for 1980-1998 from the passive surveillance system of the Centers for Disease Control and Prevention. During this time period, there were 6757 confirmed cases of LD (median annual number, 360 cases/year). Diagnosis by culture and by direct fluorescent antibody and serologic testing decreased significantly; diagnosis by urine antigen testing increased from 0% to 69%. The frequency of isolates other than Legionella pneumophila serogroup 1 (LP1) decreased from 38% to 4% (P = .003). The case-fatality rate de creased significantly, from 34% to 12% (P < .001) for all cases, from 46% to 14% (P < .001) for nosocomial cases, and from 26% to 10% (P = .05) for community-acquired cases. LD-related mortality has decreased dramatically. The decrease in culture-based diagnosis limits the recognition of non-LP1 disease and impairs outbreak investigation, because fewer Legionella isolates are provided for further examination.