一起肺炎支原体感染暴发的报告

Emergent managements of mycoplasma infection outbreak in fresh students

目的总结一起某学校年轻学员肺炎支原体感染的防治经验。方法前瞻性地分析、总结某训练学校新学员肺炎支原体感染暴发的防治方法和经验。在给予皮质激素、喹诺酮和阿奇霉素治疗第1代患者有效和病因逐渐明确后,给予阿奇霉素治疗第2代肺炎支原体感染的部分患者。结果在182名新学员中,发生肺炎支原体感染108例(59.3%),其中发生支原体肺炎31例(28.7%),麻疹3例(其中2人合并肺炎),水痘1例(合并肺炎)和急性阑尾炎1例,未住院被隔离37例和暴露的(密切接触)人群72例。其特点是年轻学员呈集体暴发,山东学员为第1代,江苏等地学员为第2代;除高热外,临床症状较轻,预后佳;除1例两肺病变较广泛的患者在发病早期诉胸闷外,无呼吸窘迫,少部分患者低热,而肺部有阴影;第1代患者初入院时出现典型的"SARS恐惧症"和逃跑倾向;大部分患者血象正常,但22.5%白细胞减少,2～3d后恢复正常,PLC均正常;29.6%血清肌酸激酶升高,69.0%C-反应蛋白升高,8.5%(6/71)谷丙转氨酶升高;X片上28.7%有浸润性肺炎,左、右侧侵犯相当;心电图无异常改变。恢复期血清53%抗支原体-IgM阳性。结论来自北方的学员在突然进入南方学校学习时,由于体质、先前免疫接种和气候等原因会诱导肺炎暴发,必须有针对性地做好防病治病工作。

Objective To investigate the experience of quick-response to the outbreaks of mycoplasma infection in fresh students. Methods The emergent managements of mycoplasma infection in fresh students were prospectively studied. The dexamethasone, levofloxacin lactate and azithromycin were given to the first generation of patients with mycoplasma infection, and azithromycin alone to the second generation with mycoplasma pneumonia. Results One hundred and eighty-two fresh students gathered together in a school in December, 2007. Two weeks later, mycoplasma infection occurred in 108 （59.3 % ）, of which 31 （28.7 % ） were mycoplasma pneumonia, 3 （2 with pneumonia） were measles, 1 （with pneumonia） was chickenpox and 1 was acute appendicitis. The isolated infected persons were 37. The exposed individuals were 72. All the patients recovered with 12 ± 2 hospitalization days. Conclusions The outbreak of pneumoniae mycoplasma pneumonia occurs often recently, and the appropriate prevention and treatment strategy should be taken to deal with it.