不明原因呼吸道感染疫情病原学分析  

Etiological analysis of an outbreak of respiratory infection with unknown reason in a certain unit of PLA

作　　者：徐军[1] 郭静霞[1] 李浩 刘爱霞[1] 马洪滨[1] 杨丽华[1] 崔恩博[1] 陈素明[1] 赵鹏[3] 赵敏[3] 李伯安[1] 毛远丽[1] 

机构地区：[1]解放军302医院临检中心,北京100039 [2]解放军152中心医院检验科,河南平顶山467000 [3]解放军302医院感染1科,北京100039

出　　处：《解放军医学杂志》2010年第3期252-255,共4页Medical Journal of Chinese People's Liberation Army

基　　金：军队"十一五"科技攻关项目(06G143)

摘　　要：目的对某部营区内的群发上呼吸道感染进行病因学研究,以明确诊断,控制并预防疫情扩散。方法采集32例住院患者的血清和咽拭子标本,其中4例有急性期及恢复期双份血清。血清标本采用欧蒙间接免疫荧光法(IFA)和ELISA法进行20种呼吸道相关病原IgM抗体筛查,双份血清进行滴度比较;咽拭子标本进行病毒分离培养和细菌培养。依据血清学结果对咽拭子进行相关病原DNA的提取、扩增及测序分析。结果血清ELISA检测结果显示32例患者中腺病毒IgM阳性12例,肺炎衣原体IgM阳性15例。IFA检测结果显示肺炎衣原体IgM阳性17例,肺炎支原体、流感A病毒、副流感病毒IgM阳性各1例。4例双份血清中肺炎衣原体和腺病毒IgM各有2例滴度呈4倍变化。细菌培养及病毒分离培养均阴性。1例高热患者咽拭子标本3对腺病毒相关引物PCR呈阳性,测序显示为腺病毒11型。采用大环内酯类抗生素进行治疗,大部分病例有效。结论结合临床特征及病原学分析结果,判断此次疫情的原因主要为腺病毒及肺炎衣原体的合并或交替感染。Objective To investigate the etiology of an outbreak of upper respiratory infection in 2009 in a unit of PLA stationed in Pingdingshan City, Henan Province, in order to establish the diagnosis and to control the spread of the epidemic. Methods The throat swabs and serum samples of 32 inpatients were collected, and paired serum samples, i.e. that of acute stage and also convalescence, were collected from 4 of the 32 patients. The serum samples were then screened for 20 common respiratory pathogens by indirect immunofluorescence assay （IFA） and ELISA, and the titers of the paired serum samples were compared. Virus isolation and bacterial culture were carried out with the throat swab samples. The DNA extraction, amplification and sequence analysis of relevant pathogens detected from the throat swabs were then performed based on the serological results. Results ELISA results showed that 12 of 32 serum samples were positive for adenovirus, and 15 for Chlamydophila pneumoniae. IFA results showed that 17 serum samples were positive for Chlamydophila pneumoniae, 1 for Mycoplasma pneumoniae, 1 for influenza A virus and 1 for parainfluenza virus. Among the 4 paired serum samples, 4-fold variations of IgM antibody titer were found on Chlamydophila pneumoniae and adenovirus each in 2 cases. None of throat swabs were positive in virus isolation and bacterial culture. One throat swab sample taken from a patient with high fever, the specific DNA fragments of human adenovirus were detected by PCR, and confirmed as adenovirus type 11 by sequencing. Macrolide antibiotics were effective for the majority of the patients. Conclusion It has been confirmed according to the clinical features and laboratory diagnosis that human adenovirus type 11 and Chlamydophila pneumoniae were the pathogens responsible for outbreak of the upper respiratory infection in this occasion.

关 键 词：腺病毒科 呼吸道感染 疾病暴发流行 衣原体 肺炎 

分 类 号：R446.5[医药卫生—诊断学]