长滩军团菌、肺炎支原体、肺炎衣原体导致的重型肺炎的流行病学分析（泰国）

David

Clinical Infectious Diseases 2007;45:e147–e155

MAJOR ARTICLE
Epidemiology of Severe Pneumonia Caused by Legionella longbeachae, Mycoplasma pneumoniae, and Chlamydia pneumoniae: 1-Year, Population-Based Surveillance for Severe Pneumonia in Thailand
长滩军团菌、肺炎支原体、肺炎衣原体导致的重型肺炎的流行病学分析：来自泰国一年的重型肺炎的监测报告
Christina R. Phares,1,2
Piyada Wangroongsarb,3
Somrak Chantra,5
Wantana Paveenkitiporn,3
Maria-Lucia Tondella,2
Robert F. Benson,2
W. Lanier Thacker,2
Barry S. Fields,2
Matthew R. Moore,2
Julie Fischer,4
Scott F. Dowell,4 and
Sonja J. Olsen4

1Epidemic Intelligence Service Program, Office of Workforce and Career Development, and 2Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; 3Thailand National Institute of Health and 4International Emerging Infections Program, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, and 5Crown Prince General Hospital, Sa Kaeo, Thailand

Received 17 April 2007; accepted 7 August 2007; electronically published 9 November 2007.

Reprints or correspondence: Dr. Christina R. Phares, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop E-03, Atlanta, GA 30333 (CPhares@cdc.gov).
Background.  Legionella species, Mycoplasma pneumoniae, and Chlamydia pneumoniae are recognized as important causes of pneumonia in high-income countries, but their significance in middle-income countries, such as Thailand, is unknown.

Methods.  Population-based surveillance identified inpatient 3489 cases of clinically-defined pneumonia in a rural Thai province for 1 year. Patients who had a chest radiograph performed (for 2059 cases of pneumonia) were enrolled in an etiology study (which included 755 cases of pneumonia among 738 patients). Paired serum, nasopharyngeal swab, and urine specimens were obtained for diagnostic immunologic and molecular tests. Patients aged <18 years were not systematically tested for Legionella species. We report a lower limit of incidence (observed incidence) and an upper limit extrapolated to persons not tested or not enrolled in the study.

Results.  The incidence of pneumonia due to Legionella longbeachae requiring hospitalization was 5–29 cases per 100,000 population. No case of Legionella pneumophila pneumonia was observed. The definite C. pneumoniae pneumonia incidence was 3–23 cases per 100,000 population; rates were highest among patients aged <1 year (18–166 cases per 100,000 population) and those aged 70 years (23–201 cases per 100,000 population). M. pneumoniae pneumonia had a similar age distribution, with an overall incidence of 6–44 cases per 100,000 population. These pathogens were associated with 15% of all cases of pneumonia. A nonsignificantly higher proportion of patients with pneumonia associated with L. longbeachae, compared with patients with pneumonia associated with M. pneumoniae or C. pneumoniae, required supplemental oxygen or mechanical ventilation (45% vs. 18%; ). Among patients with atypical pneumonia, only 15% received antibiotics with activity against the associated pathogen.

Conclusion.  M. pneumoniae, C. pneumoniae, and L. longbeachae, but not L. pneumophila, are frequently associated with severe pneumonia in rural Thailand. Few patients receive antibiotics that cover atypical pathogens.

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ackground.  Legionella species, Mycoplasma pneumoniae, and Chlamydia pneumoniae are recognized as important causes of pneumonia in high-income countries, but their significance in middle-income countries, such as Thailand, is unknown.背景 军团菌，肺炎支原体，衣原体被认为是高收入国家肺炎的重要原因，但它们在中等收入国家的意义仍不知道。
Methods.  Population-based surveillance identified inpatient 3489 cases of clinically-defined pneumonia in a rural Thai province for 1 year. Patients who had a chest radiograph performed (for 2059 cases of pneumonia) were enrolled in an etiology study (which included 755 cases of pneumonia among 738 patients). 方法  在泰国的一个乡村省份历时一年的以人口为基础的监测发现 3489例临床诊断肺炎病例。接受胸部放射学检查的患者（2059例肺炎）被安排进行病因学研究 （包括了755肺炎病人中的738名患者—原文可能有误）。
Paired serum, nasopharyngeal swab, and urine specimens were obtained for diagnostic immunologic and molecular tests. Patients aged <18 years were not systematically tested for Legionella species. We report a lower limit of incidence (observed incidence) and an upper limit extrapolated to persons not tested or not enrolled in the study.双份血清，鼻咽拭子、尿标本等被收集用于诊断性免疫和分子生物学测试。年龄小于18岁者不做军团菌的系统测试。
Results.  The incidence of pneumonia due to Legionella longbeachae requiring hospitalization was 5–29 cases per 100,000 population. No case of Legionella pneumophila pneumonia was observed. 结果 由长滩军团菌引起的院内肺炎发生率为5-29例/每10万人，未发现嗜肺军团菌肺炎。
The definite C. pneumoniae pneumonia incidence was 3–23 cases per 100,000 population; rates were highest among patients aged <1 year (18–166 cases per 100,000 population) and those aged 70 years (23–201 cases per 100,000 population). M. pneumoniae pneumonia had a similar age distribution, with an overall incidence of 6–44 cases per 100,000 population. 明确的衣原体肺炎发生率为3-23例/10万人，发生率最高的见于年龄小于1岁（18-166例/10万人）和年龄大于70岁（23-201例/10万人）的人群，支原体肺炎有类似的人群分布，发生率为6-4例/10万人。
These pathogens were associated with 15% of all cases of pneumonia. A nonsignificantly higher proportion of patients with pneumonia associated with L. longbeachae, compared with patients with pneumonia associated with M. pneumoniae or C. pneumoniae, required supplemental oxygen or mechanical ventilation (45% vs. 18%; ). Among patients with atypical pneumonia, only 15% received antibiotics with activity against the associated pathogen.这些病原体与所有肺炎病例的15%有关，与支原体肺炎或衣原体肺炎病人相比，军团菌费炎病人需要给氧或机械通气（45%和18%）的比例曾非显著性增高。非典型肺炎中，只有15%接受针对相关病原体的抗生素治疗。
Conclusion.  M. pneumoniae, C. pneumoniae, and L. longbeachae, but not L. pneumophila, are frequently associated with severe pneumonia in rural Thailand. Few patients receive antibiotics that cover atypical pathogens.结论 支原体肺炎、衣原体肺炎和长滩军团菌肺炎而非嗜肺军团菌肺炎常与严重的泰国乡村肺炎相关，只有少数病人接受了覆盖非典型病原体的抗生素。
背景 军团菌，肺炎支原体，衣原体被认为是高收入国家肺炎的重要原因，但它们在中等收入国家的意义仍不知道。方法  在泰国的一个乡村省份历时一年的以人口为基础的监测发现 3489例临床诊断肺炎病例。接受胸部放射学检查的患者（2059例肺炎）被安排进行病因学研究 （包括了755肺炎病人中的738名患者—原文可能有误）。双份血清，鼻咽拭子、尿标本等被收集用于诊断性免疫和分子生物学测试。年龄小于18岁者不做军团菌的系统测试。 结果 由长滩军团菌引起的院内肺炎发生率为5-29例/每10万人，未发现嗜肺军团菌肺炎。明确的衣原体肺炎发生率为3-23例/10万人，发生率最高的见于年龄小于1岁（18-166例/10万人）和年龄大于70岁（23-201例/10万人）的人群，支原体肺炎有类似的人群分布，发生率为6-4例/10万人。这些病原体与所有肺炎病例的15%有关，与支原体肺炎或衣原体肺炎病人相比，军团菌费炎病人需要给氧或机械通气（45%和18%）的比例曾非显著性增高。非典型肺炎中，只有15%接受针对相关病原体的抗生素治疗。结论 支原体肺炎、衣原体肺炎和长滩军团菌肺炎而非嗜肺军团菌肺炎常与严重的泰国乡村肺炎相关，只有少数病人接受了覆盖非典型病原体的抗生素。