Email this article Community-acquired pneumonia with atypical (mycoplasmic and chlamydial) infection
- Authors: Trubnikov GV, Polyakova IG, Butakova LY., Trubnikov GV, Polyakova IG, Butakova LY.
- Issue: Vol 81, No 1 (2009)
- Pages: 16-20
- Section: Editorial
- URL: https://journals.rcsi.science/0040-3660/article/view/33355
- ID: 33355
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Abstract
Aim. To perfect prehospital diagnosis of community-acquired pneumonia (CAP) of atypical etiology (mycoplastic - Mp and chlamydial - Ch).
Material and methods. Routine clinical examinations, sputum seeding, enzyme immunoassay were made in 214 patients admitted to therapeutic departments of two large Barnaul hospitals.
Results. Mp CAP was diagnosed in 21.5%, Ch CAP - in 12.1%, combination - in 7.0% patients. Sputum seeding was made in 67 patients. Of them 41.8% patients were found to have bacterial infection. Atypical infection combined with bacterial in 44.1% patients. The above combination was more frequent in patients with Ch CAP than with Mp CAP (58.8 and 29.7%, respectively). Bacterial flora was detected in 39.1% CAP patients without atypical infection. A retrospective analysis of case histories in respect of prehospital stage discovered that CAP patients with atypical infection are characterized by more frequent contact with patients with acute respiratory viral infection and workers of services sector. CAP arises primarily in autumn and winter with morbidity correlating with acute respiratory diseases morbidity.
Conclusion. CAP with atypical infection is characterized with prodromal period, late visit to the doctor, late hospitalization, late x-ray verification of the disease especially in Ch CAP. Mp CAP is more prevalent in young patients, Ch CAP occurs most frequently in young, presenile and senile patients. The presence of the prodromal period in CAP patients with atypical infection is the cause of mistakes in outpatient diagnosis. Instead of CAP such patients are often diagnosed to have acute respiratory viral infection (54.5%) or exacerbation of chronic bronchopulmonary disease (15.9%).
Material and methods. Routine clinical examinations, sputum seeding, enzyme immunoassay were made in 214 patients admitted to therapeutic departments of two large Barnaul hospitals.
Results. Mp CAP was diagnosed in 21.5%, Ch CAP - in 12.1%, combination - in 7.0% patients. Sputum seeding was made in 67 patients. Of them 41.8% patients were found to have bacterial infection. Atypical infection combined with bacterial in 44.1% patients. The above combination was more frequent in patients with Ch CAP than with Mp CAP (58.8 and 29.7%, respectively). Bacterial flora was detected in 39.1% CAP patients without atypical infection. A retrospective analysis of case histories in respect of prehospital stage discovered that CAP patients with atypical infection are characterized by more frequent contact with patients with acute respiratory viral infection and workers of services sector. CAP arises primarily in autumn and winter with morbidity correlating with acute respiratory diseases morbidity.
Conclusion. CAP with atypical infection is characterized with prodromal period, late visit to the doctor, late hospitalization, late x-ray verification of the disease especially in Ch CAP. Mp CAP is more prevalent in young patients, Ch CAP occurs most frequently in young, presenile and senile patients. The presence of the prodromal period in CAP patients with atypical infection is the cause of mistakes in outpatient diagnosis. Instead of CAP such patients are often diagnosed to have acute respiratory viral infection (54.5%) or exacerbation of chronic bronchopulmonary disease (15.9%).
About the authors
G V Trubnikov
I G Polyakova
L Yu Butakova
G V Trubnikov
I G Polyakova
L Yu Butakova
References
- Внебольничная пневмония у взрослых: Практ. рекомендации по диагностике, лечению и профилактике: Пособие для врачей / Чучалин А. Г., Синопальников А. И., Яковлев С. В. и др. М.; 2003.
- Диагностика и лечение внебольничной пневмонии. Рекомендации Американского общества инфекционистов, 2003. Стандарты мировой медицины 2004; 3:1-30.
- Зубков М. Н., Чучалин А. Г., Синопальников А. И., Чернеховская Н. Е. Этиология и микробиологическая диагностика внебольничных пневмоний. В кн.: Пневмония. М.: Экономика и информатика; 2002.
- Гучев И. А. Внебольничная пневмония как проблема организованного коллектива. Инфекции и антимикроб. тер. 2004; 6 (1): 16.
- Зайцев А. А. Респираторные бактериальные инфекции. Новые Санкт-Петербург. врач. ведомости 2004; 4: 101-104.
- Зубков М. Н. Этиология и патогенез внебольничных пневмоний у взрослых. Пульмонология 2005; 5: 53-60.
- Mandell L. A., Marrie T. J., Grossman R. E. Canadian guidelines for the initial management of adults with community-acquired pneumonia: an evidence based update by Canadian Infection Diseases Society and the Canadian Thoracic Society. Clin. Infect. Dis. 2000; 31: 383-421.
- Мусалимова Г. Г. Внебольничные пневмонии (этиология, патогенез, иммунопатология, диагностика и лечение): Пособие для врачей. СПб.; 2006.
- Назаренко Г. И., Антипин А. Н., Новиков Ю. К. Антибактериальная терапия внебольничных пневмоний (анализ литературы и собственных данных, клиническая эффективность рекомендаций). Пульмонология 2004; 4:60-66.
- Рачина С. А., Козлов С. Н., Иделевич Е. А. и др. Представления врачей поликлиник об этиологии и тактике лечения внебольничной пневмонии в амбулаторных условиях. Пульмонология 2004; 2: 6-10.
- Чучалин А. Г. (науч. ред.) Стандарты (протоколы) диагностики и лечения больных с неспецифическими заболеваниями легких (взрослое население). М.; 1998. 25-29.
- Чучалин А. Г., Синопальников А. И., Страчунский Л. С. Пневмония. М.: ООО "Мед. информ. агентство"; 2006.
- Kauppinen M. T., Herva E., Kujala P. et al. The etiology of community-acquired pneumonia among hospitalized patients during a Chlamydia pneumoniae epidemic in Finland. J. Infect. Dis. 1995; 172: 1330-1335.
- Huchon G., Woodhead M., Gialdroni-Grassi G. Management of adult community-acquired lower respiratory tract infections. Eur. Respir. J. 1998; 11: 986-991.
- Авдеев С. Н., Баймаканова Г. Е., Зубаирова П. А. и др. Пневмония как причина острой дыхательной недостаточности у больных ХОБЛ. Пульмонология 2006; 5: 115-121.
- Ноников В. Е. Дифференциальная диагностика и антибактериальная терапия пневмоний. Consilium-Medicum 2001; 12: 569-574.
- Новиков Ю. К. Атипичные пневмонии. Рус. мед. журн. 2002; 20: 915-918.
- Falk G., Gnarpe I., Gnarpe H. Prevalence of Chlamydia pneumonia in healthy chidren and in children with respiratory tract infections. Pediatr. Infect. Dis. J. 1997; 16 (6): 549-554.
- Вишнякова Л. А., Никитина М. А., Петрова С. И. и др. Роль Streptoccocus pneumoniae, Mycoplasma pneumoniae и Chlamydia pneumoniae при внебольничной пневмонии у детей. Пульмонология 2005; 3: 43-47.
- Kraft M., Cassel G. H., Pak I., Martin R. I. Mycoplasma pneumoniae and Chlamydia pneumoniae in asthma: effect of clarithromycin. Chest 2002; 121 (6): 1782-1788,
- Lieberman D., Printz S. et al. Atypical pathogen infection in adults with acute exacerbation of bronchial asthma. Am. J. Respir. Care Med. 2003; 167 (3): 406-410.
- Гомберг М. А., Орлова О. Е. Хламидийные инфекции. Особенности и диагностические возможности. М.: 1997.
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