儿科呼吸道疾病中肺炎支原体感染的结果分析

目的探讨儿科肺炎支原体（MP）感染特点,辅助临床医师早期诊断,合理用药。方法测定我院一年来2013例儿科呼吸道疾病患儿的肺炎支原体抗体（IgM）。结果2013例呼吸道感染患儿,检出肺炎支原体抗体（IgM）阳性者769例,占38.2%,769例阳性分别表现为肺炎369例（48%）,支气管炎238例（31%）,咽炎92例（12%）,哮喘70例（9%）。其中,肺炎组与各组相比较,具有统计学意义。MP IgM感染的检出率明显高于其他各组（P〈0.01）。结论MP感染是患儿不可忽视的病原体,检测患儿血清MP抗体能够及早诊断,指导治疗。     

Microbial associations in chronic respiratory tract diseases

In the peripheral blood of patients with chronic bronchitis the presence of Mycobacterium pneumoniae antigens has been registered in 20.0% of cases and the presence of group A Streptococcus haemolyticus antigens, in 24.0% of cases, the transformation of streptococci into the L-form being observed in 12.0% of cases. The presence of M. pneumoniae, streptococci and their L-forms, as well as associations of these microorganisms, is characteristic of patients with chronic obstructive bronchitis, which is, probably, one of the reasons for the maintenance of bronchial obstruction. In patients with chronic pneumonia and fibrosing alveolitis the antigens of the bacterial form of streptococcus and its L-forms have been detected only in a few cases.     

The detection of<Emphasis Type="Italic">Chlamydia pneumoniae</Emphasis> in aneurysm of abdominal aorta and in normal aortic wall of organ donors

Sixty patients underwent surgery due to abdominal aortic aneurysms; the group included 30 patients with asymptomatic aneurysm and 30 with ruptured aneurysm. A control group comprised 30 organ donors. Surgical specimens derived from aneurysm or aorta fragments were investigated for Chlamydia pneumoniae DNA using PCR. In asymptomatic aneurysms, DNA was found in 9 cases (29%), and in ruptured aneurysms in 14 cases (49%). In the control group, C. pneumoniae DNA was not detected in an aortic wall. These results suggest that healthy aortic wall is not susceptible to chlamydial infection. A large number of aneurysm infections implies C. pneumoniae role in proteolysis and degradation of the aneurysm wall. The biological effect of this process may cause an enlargement of the aneurysm.     

Evaluation of usefulness of OWD and OIEP in diagnosis of epidemically occurring infections caused by Mycoplasma pneumoniae]

Blood serum samples of 3593 persons clinically suspected of infection with Mycoplasma pneumoniae were tested. Of these, patients with pneumoniae constituted 66.5%, upper respiratory tract infection--24.0% and with symptoms localized outside the respiratory system--9.5%. These studies were performed by application of complement fixation test (OWD) and immunoelectroprecipitation (OIEP) methods, accepting as a diagnostically significant--titer 1:60 or higher and/or occurrence in OIEP reaction with serum diluted 1:2 or more. Among patients studied prevailed children in the age of 3 to 16 years (61.6%). Mycoplasmosis was detected in these patients in 1071 out of 2236 cases (47.9%). Compatible results in both tests were obtained in 90.6% patients, whereas OWD only in 3.0% and OIEP only in 6.4% cases. Simultaneous application of both tests increased detectability of infections caused by M. pneumoniae by 3% in relation to OIEP and by 6.4% in relation to OWD.     

肺炎支原体IgG类抗体亲和力检测的实验研究与临床应用

目的探讨肺炎支原体IgG类抗体亲和力检测在肺炎支原体感染诊断中的意义。方法用被动颗粒凝集试验(PPA)和间接免疫荧光法(IFA)检测儿童上呼吸道感染者血清IgM类抗体水平,同时用IFA法检测其IgG类抗体的亲和力,并对检测结果进行相关性分析和一致性检验。结果在IgM类抗体检测上PPA法检出阳性率(60/120)高于IFA法(49/120),两法检测结果缺乏一致性。而IFA法检测IgG类抗体阳性的97例中,有22例检出低亲和力IgG类抗体,其中20例同时检出IgM类抗体,两法检测结果具有显著的相关性(P<0.001)和较好的一致性(0.7>Kappa>0.4)。结论肺炎支原体低亲和力IgG类抗体检测有与IgM类抗体检测类似的早期诊断价值,可与IgM类抗体联合检测用于区分近期感染、感染后复发或再次感染。     

Etiology of pulmonary diseases in children in Khabarovsk Region

Microflora of upper respiratory tract in 658 children aged 1 month - 17 years hospitalized with acute pneumonia (AP), acute bronchitis (AB), recurrent obstructive bronchitis (ROB), malformation of lungs (ML) and broncho-alveolar dysplasia (BALD) were studied. Carriage rates of Streptococcus pneumoniae (up to 95%) and Haemophilus influenzae (up to 89%) in 240 children attending daycare centers and schools were determined. Etiology of infectious process was ascertained in 40% of cases. S. pneumoniae was isolated in 45% of acute cases (AP and AB) and in 25% of chronic cases (BALD). H. influenzae was isolated in 8 - 12% of acute cases and in 32% of chronic cases. In 23 - 29% of all cases of pulmonary pathology in children persistence of Enterococcus faecium was determined. There were 13 different serotypes among isolated pneumococci. In patients with pneumonia the rate of detection of S. pneumoniae and H. influenzae DNA fragments by PCR was significantly higher compared with rate of their isolation from sputum.     

The prospects for the diagnosis of bacterial meningitis]

The samples of spinal fluid arriving to the Clinical Infectious Hospital in 1994-1996 with the clinical diagnosis "generalized form of meningococcal infection" or "purulent meningitis of unclear etiology" were studied. The etiological agent was bacteriologically identified in 35% of 487 patients (in 25% of cases Neisseria meningitidis, in 7% of cases Streptococcus pneumoniae and in 2% of cases Haemophilus influenzae, type b, were detected). The method of latex agglutination, used in this study, was highly specific (100%) and moderately sensitive (67%); this method made it possible to diagnose 25% of cases additionally (N. meningitidis in 15% of cases, S. pneumoniae in 5% of cases and H. influenzae in 3% of cases). Diagnostics with the use of PCR was characterized by high specificity (> 97%) and sensitivity (> 85%) relatively to the "golden standard" of microbiological diagnostics. There were few false positive results (3 samples), caused probably by contamination at the moment of taking the samples. For this reason the results obtained by PCR could be used for diagnostic purposes even in cases of negative results given by other methods. Tests with the use of PCR made it possible to diagnose 29% more cases additionally (in 26% of cases N. meningitidis DNA and in 3% of cases S. pneumoniae DNA were detected. Thus the complex of methods used in this study permitted the detection of the etiological agent altogether in 87% of cases.     

The characteristics of nasopharyngeal Streptococcus pneumoniae in children attending a daycare unit

S. pneumoniae is a component of normal nasopharyngeal flora in children. Nasopharyngeal colonization in children attending daycare units has an important effect on the spread of S. pneumoniae. In this study, we aimed to investigate colonization status, antimicrobial susceptibility, and clonal relatedness of the S. pneumoniae strains in children attending a daycare unit. One hundred and six nasopharyngeal swabs were collected from 25 children attending a daycare unit in an 8-month period. S. pneumoniae was identified by a conventional method. Antibacterial sensitivities of the strains were tested by disc diffusion method. Pulsed field gel electrophoresis (PFGE) was used to analyze the clonal relationship of the strains. A total of 25 (23.5%) S. pneumoniae strains were identified from 106 nasopharyngeal swaps. S. pneumoniae growth was detected in at least one culture of the 19 children (colonization rate; 76%). Seven of the 25 strains (28%) showed resistance to penicillin, 5 (20%) were resistant to trimethoprim-sulfomethoxsazole. The other tested antibiotics were almost effective. The clonal relationship among strains was found as 54.5%. The highest rate of strain entry was in the winter months with strains of opaque colonies, which are known to be more pathogenic. However, the spreading rate among the children was the highest in the summer months and the strains detected in these months had transparent colonies with more transmitting characteristics. Therefore, to prevent S. pneumoniae infection in closed crowded areas, the summer months should not be overlooked.     

Characteristics of the immunologic response to Mycoplasma pneumoniae as a polyclonal lymphocyte activator

M. pneumoniae, used as mitogen, was shown to initiate the synthesis of antibodies to salmonellae in the culture of lymphocytes obtained from healthy donors as actively as lectins and Staphylococcus aureus protein A. In these experiments IgG antibodies were mainly synthesized. The serological study of a group of persons (333 subjects) for 2.5 years revealed that seroconversion to M. pneumoniae and simultaneously to viruses occurred in 78% of cases. In more than a half of the cases a rise in the titers of antibodies to M. pneumoniae and simultaneously to salmonellae was found to occur with no cases of salmonellosis being registered. The results of this study make it possible to come to the conclusion that M. pneumoniae is a polyclonal activator of antibody-producing cells in vitro and, probably, in vivo.     

Prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in pneumonia patients in four major hospitals in Trinidad

The prevalence of current Mycoplasma pneumoniae and Chlamydia pneumoniae infections in patients with pneumonia in Trinidad, and the relationship between pneumonia and risk factors were investigated. Blood samples were collected from 132 patients diagnosed by attending physicians, as suffering from pneumonia at four hospitals in Trinidad. Serum samples were tested for M. pneumoniae IgM and IgG and C. pneumoniae IgM by the enzyme immunoassay (EIA). In addition, C. pneumoniae IgM and IgG were detected using microimmunofluorescence (MIF). A comprehensive questionnaire which addressed demographic information as well as risk factors for pneumonia was administered to patients. All analyses were done using the Statistical Package for Social Sciences (SPSS), version 9. Seroprevalences of 46.0% (58 of 126) were found for C. pneumoniae Ig M/G, and 66.7% (88 of 132) for M. pneumoniae Ig M/G. The difference was statistically significant (p < 0.01; chi2). Thirty-four percent (43 of 125) for C. pneumoniae Ig M/acute Ig G and 28.8% (36 of 125) of M. pneumoniae IgM were not statistically significant (p > 0.05; chi2). Hospital, gender and ethnicity of patients did not significantly (p > 0.05; chi2) affect the seroprevalence of the bacteria assayed for. However, the prevalence of C. pneumoniae (23.3%) in patients under 21 years old compared to other age groups was statistically significant (p = 0.043; chi2). Overall, the seroprevalence to both pathogens was not significantly (p > 0.05; chi2) affected by comorbidities and signs/symptoms. It was concluded that new infections by C. pneumoniae in pneumonia patients may be an important aetiological agent for the condition in Trinidad.     

Hydrolytic and haemolytic activity of Klebsiella pneumoniae and Klebsiella oxytoca

Hydrolytic enzymes and haemolysins are important extracellular substances produced by many bacteria. We investigated 57 K. pneumoniae strains and 40 K. oxytoca strains isolated from clinical materials. We estimated the ability to produce: proteases hydrolyzing milk powder, caseinase, gelatinase, elastase, lecithinase, lipases, DNase and haemolysins on human, sheep and horse erythrocytes on TSA medium with or without 5% Egg Yolk. We detected that K. oxytoca strains produced proteases hydrolyzing milk powder (37.5%), caseinase (15.0%) and gelatinase (17.5%) more frequently than K. pneumoniae strains (respectively 21.0%, 5.3%, 8.9%). None of the analysed Klebsiella spp. strains produced elastase. Only K. pneumoniae strains produced lecithinase (5.3%). Lipases hydrolyzing Tween were produced from 3.5% (for Tween 60 and 80) to 7.0% (for Tween 20). Among K. oxytoca strains only one (2.5%) hydrolyzing Tween 20. DNase was produced by 38.6% of K. pneumoniae strains and by 27.5% K. oxytoca strains. Haemolytic properties on human erythrocytes were detected in 5.3% K. pneumoniae strains on TSA medium and 29,8% on medium with Egg Yolk. In K. oxytoca strains haemolytic properties on human erythrocytes were detected only on medium with Egg Yolk (12.5%). Haemolytic properties on sheep erythrocytes were detected respectively in 21.0% and 22.8% K. pneumoniae strains and in 7.5% K. oxytoca strains on each medium. Haemolytic properties on horse erythrocytes were detected respectively in 33.4% and 52.6% K. pneumoniae strains and in 15.0% and 20.0% K. oxytoca strains.     

Etiology of pneumonia in children in the absence of pneumococcal and antihaemophilus vaccines

Childhood pneumonia represents an important pathology, a cause of morbidity and mortality worldwide. Our study aims to determine etiology of pneumonia in hospitalized children using several laboratory methods. We performed a prospective study that enrolled 560 children age 1 up to 18 years old all diagnosed with pneumonia by clinical and radiological features. We applied various laboratory methods (serologic, bacteriologic: bronchial aspirate, sputum, pleural effusion and blood culture) in order to identify a pathogen agent that caused pneumonia. Statistics used Statistical Package for Social Science. An etiology was established in 68.92% of all cases included in the study, as follows: in 33.93% viral etiology, in 25.13% we identified Streptococcus pneumoniae, in 20.2% Mycoplasma pneumoniae, Klebsiella pneumoniae in 8.29%, Staphylococcus aureus in 7.51%, Haemophilus influenzae in 4.92%. Mixed bacterial and viral infection was identified in 4.40% of all cases. A potential causative agent of childhood pneumonia was determined in most cases, S. pneumoniae being the main agent involved in community acquired childhood pneumonia in our country.     

重症肺炎新生儿支气管肺泡灌洗液 病原菌分布及耐药性

目的研究重症肺炎新生儿支气管肺泡灌洗液的病原菌分布和耐药性。方法选择2016年4月至2018年4月在本院呼吸科治疗的新生儿268例,其中符合重症肺炎诊断标准的患儿142例,归为重症肺炎组;不符合重症肺炎诊断标准的患儿126例,归为对照组。检测患儿肺泡灌洗液病原菌分布情况和耐药情况。结果重症肺炎组患儿肺炎克雷伯菌、流感嗜血菌、铜绿假单胞菌、阴沟肠杆菌、大肠埃希菌、金黄葡萄球菌、溶血葡萄球菌、表皮葡萄球菌、肺炎链球菌、草绿链球菌检出率明显高于对照组。肺炎克雷伯菌对亚胺培南,美罗培南的耐药性为0.0%,大肠埃希菌对亚胺培南,美罗培南,阿米卡星的耐药性为0.0%,阴沟肠杆菌对亚胺培南,美罗培南,左氧氟沙星的耐药性为0.0%,肺炎链球菌对万古霉素的耐药性为0.0%,金黄葡萄球菌对万古霉素的耐药性为0.0%。结论新生儿重症肺炎患者病原菌以革兰阴性菌为主,亚胺培南、美罗培南、万古霉素可以用于治疗新生儿重症肺炎,但由于其毒副作用较大,应严格把握适应症。     

Dysbacteriosis in patients with colon polyposis

The study revealed the most profound changes in the composition of intestinal microflora in patients with polyposis of the large intestine. In these patients anaerobic microflora (bifidobacteria, lactic acid bacteria) was more often suppressed than in other examined groups, in particular, patients with cholelithic disease. The associations of hemolytic Escherichia with Klebsiella pneumoniae, Pseudomonas aeruginosa, Citrobacter freundii were often observed as well as the increased content of enterococci and fungi of the genus Candida. The determination of frequency and degree of manifestations showed that dysbacteriosis was registered in the absolute majority of patients (97.4%) with polyposis of the large intestine. Among patients with cholelithic disease disturbances in microbiocenosis were detected in 60.0% of cases, the profundity and character of the microflora composition changes being less pronounced.     

产ESBLs肺炎克雷伯菌的基因型和耐药性研究

超广谱β-内酰胺酶(extended spectrumβ-lactamase,ESBLs)与细菌耐药性密切相关,为了揭示产ESBLs肺炎克雷伯菌的基因型和耐药性,本研究在2017年1月至2018年9月期间,共检测了466例肺炎克雷伯菌感染的患者标本,并分析了产ESBLs肺炎克雷伯菌的基因型和耐药性。研究结果显示,466例患者中共检出562个肺炎克雷伯菌菌株。其中,呼吸内科的检出数最多(212株,37.72%),其次为重症监护科(106株,18.86%)。对于不同标本来源,痰液中检出菌数最多(331株),占总数的58.90%。562株肺炎克雷伯菌中共检测出237株产ESBLs(42.17%)。产ESBLs肺炎克雷伯菌对阿莫西林(89.03%)、替卡西林(87.34%)、氨苄西林(81.43%)的耐药率最高;而对替加环素(9.28%)、阿米卡星(6.75%)、亚胺培南(1.27%)和美罗培南(0.84%)的耐药率最低。237株产ESBLs的肺炎克雷伯菌菌株中,53.59%扩增出CTX-M型,48.95%扩增出TEM型,40.93%增出SHV型。另外,237株产ESBLs的肺炎克雷伯菌菌株中,产两个及以上的ESBLs的菌株共111株(46.84%)。     

石家庄地区肺炎支原体感染的流行病学调查

目的：了解石家庄地区肺炎支原体感染的血清流行病学情况。方法：选择2011年3月-2012年2月我院住院和门诊收治的急性呼吸道感染患者1902例为研究对象,采用间接免疫荧光法（IFA）检测其血清肺炎支原体IgM抗体,并分析其流行病学资料。结果：1902例血清标本中,284例（14．93％）肺炎支原体IgM抗体阳性,男性和女性的阳性率无显著差异。肺炎支原体抗体阳性的患者主要分布于0～15岁年龄段,阳性检出率最高的年龄组为0～6岁,占21．26％（132／621）。各个季节均有肺炎支原体感染阳性患者,感染率无显著差异性,秋（80例）、冬（96例）两季的阳性感染率高于春（56例）、夏（52例）两季。患者100％出现发热症状,95．77％出现咳嗽。结论：石家庄地区肺炎支原体感染的主要人群为未成年人,无季节性和性别差异,以发热和咳嗽为最主要的临床症状。     

Combined method of community-acquired pneumonia prevention in military staff

Efficacy of pneumococcal polysaccharide vaccine "Pneumo 23" or its combination with food products prepared from vegetative material for prevention of community-acquired pneumonias has been compared. Advantages of combined method of prophylaxis in setting where pneumonia caused by different pathogens have been noted. Variability in etiology of community-acquired pneumonia was demonstrated by serological tests of patients' blood. During spring-summer season antibodies to Mycoplasma pneumoniae, Chlamydia pneumoniae, and Streptococcus pneumoniae were detected in 25.9, 2.5, and 7.0% of the patients respectively. During autumn-winter season antibodies to M. pneumoniae and S. pneumoniae were detected in 30.0 and 50.0% of the patients respectively.     

儿童肺炎肺实变住院患儿支气管肺泡灌洗液病原分析

本研究分析肺炎肺实变患儿支气管肺泡灌洗液病原谱构成,旨在为临床经验性抗感染治疗提供指导。收集2019年1月-2020年1月复旦大学附属儿科医院纤维支气管镜室诊治的住院肺炎病例临床资料,其中肺实变的诊断基于影像学证据,依托国家儿童医学中心病原学检测平台,并参考感染传染科医生解读,本研究对肺炎伴肺实变患儿支气管肺泡灌洗液标本的病原学检测结果进行回顾性分析。结果显示,286例肺炎患儿的286份支气管肺泡灌洗液标本被纳入研究,平均年龄5.5(5.8±3.1)岁,其中195例(68.2%)存在肺炎伴肺实变。总病原体检出率为76.6%(219/286),肺实变和无肺实变肺炎患儿病原体检出率分别为77.9%(152/195)和73.6%(67/91),差异无统计学意义;检出的前5种病原体均为肺炎支原体、腺病毒、鼻病毒、呼吸道合胞病毒和副流感病毒3型。5周岁及以上患儿肺炎支原体检出率达最高77.0%(127/165),肺实变病例和无肺实变病例肺炎支原体检出率分别为67.2%(131/195)和61.5%(56/91),差异无统计学意义。本研究结果提示,肺炎支原体、腺病毒、鼻病毒、呼吸道合胞病毒和副流感病毒3型是导致本研究目标人群患病的主要病原体;病原体检出率高低与是否肺实变无关。     

Serological study on Chlamydophila pneumoniae in patients with community-acquired pneumonia

This study aimed to evaluate the incidence of Chlamydophila pneumoniae antibodies in patients with community acquired pneumonia (CAP) by a new ELISA test (EIA CP-IgG, IgA, IgM--Eurospital, Trieste, Italy). From January 1999 to July 2001 141 patients with clinical signs of CAP were enrolled in sixteen Italian Hospitals. Specific IgM and IgG antibodies anti-C. pneumoniae in serum and IgA in both serum and sputum were detected. At a primary inspection (time T-0) serum and sputum samples were taken from 115/141 patients, whereas serum was collected from only 100/141 patients after 30 days (time T-30). At T-0 24/115 (20.8%) patients showed serological markers thus suggesting an acute C. pneumoniae infection. In 23/24 patients the overall serological pattern found at T-0 was confirmed at T-30. In 32/115 patients (27.8%) serological markers of C. pneumoniae past infection were found positive and were confirmed 30 days later. These data support the role of C. pneumoniae as an important aetiological agent of CAP throughout different geographic areas of Italy. The test was suitable for the laboratory diagnosis of C. pneumoniae infection. In particular, the presence of specific IgA anti- C. pneumoniae in both serum and sputum proved useful to define different stages and evolution of infection.