一起成人肺炎支原体肺炎暴发案例的流行病学调查分析

Epidemiological investigation and analysis of an outbreak of mycoplasma pneumoniae pneumonia in adult

目的 对一起成人肺炎支原体肺炎暴发案例进行流行病学调查分析.方法 2015年7月16日,来自第三军医大学、在解放军福州总医院实习的1名23岁男性学员,因"低热、乏力、头晕、胸闷"行胸部CT检查发现肺部结节影,与其密切接触的11名同校学员行胸部CT检查后均发现类似肺部结节影.立即电话报告南京军区卫生部卫生防疫处和南京军区疾病预防控制中心,防控小组到达后对"疫情"开展了一系列流行病学调查和现场防控处置,并对居住在同一生活区的其他289名自愿接受检查的学员及职工进行胸部CT筛查.筛选出类似肺结节影患者后,对依从性好者进行肺炎支原体抗体滴度检测及胸部CT随访.结果 对集体生活在学生生活区2栋宿舍楼(A楼和B楼)的301名学员进行胸部CT筛查,共发现肺结节影者27例,其中48.1%(13/27)为单发结节,51.9%(14/27)为多发结节,92.6%(25/27)伴有晕征.多数案例无症状,2例有咳嗽,少数有发热、头晕、乏力等全身症状.A楼(卫生环境较差)肺结节阳性率为32.8%(22/67),B楼阳性率为2.14%(5/234),总罹患率8.97%.首批发现的12例急性期和恢复期肺炎支原体血清抗体滴度呈4倍及以上改变.采取消毒隔离及维护环境卫生等措施控制了疫情传播;发病者均痊愈,无重症及死亡病例.结论 肺炎支原体肺炎易暴发于人群密集场所,临床影像学特征均不典型.对不明原因暴发性呼吸道疾病应及早进行规范的流行病学干预.

Objective To conduct an epidemiological investigation and analysis of an outbreak of mycoplasma pneumonia in adults .Methods The first case was a 23-year-old male came from the Third Military Medical University , who served as an intern in the Fuzhou General Hospital of PLA and presented on July 16, 2015 with a history of low-grade fever, dizziness, fatigue and chest tightness.Chest CT revealed pulmonary nodules shadow .It was found that other 11 individuals who had been in close contact with the first patient also had similar pulmonary nodules shadow after chest CT examination .Immediately , the health and epidemic prevention department of the ministry of health of Nanjing Military Command and the disease prevention and control center of the Nanjing Military Command received a phone call from Fuzhou General Hospital of PLA.Upon arrival, the prevention and control team conducted a series of epidemiological investigations and on-site prevention , control and disposal of the event , and conducted chest CT screening for other 289 students and staff who volunteered to be examined living in the same area .After the patients with similar pulmonary nodules shadow were screened out , mycoplasma antibody titer detection and chest CT re-scanning were performed for compliance patients . Results There were 301 students living in the dormitories ( Building A and B ) of the student living area , and they were screened by chest CT , and it was found that 27 of them had pulmonary nodules shadow , including single pulmonary nodules shadow (48.1%, 13 out of 27) and multiple pulmonary nodules shadow (51.9%, 14 out of 27).And halo sign was observed in 25 of 27 patients ( 92.6%) . The majority of the 27 patients were asymptomatic , only 2 patients got cough , a few of them had systemic symptoms such as fever , dizziness , fatigue. The positive rate of pulmonary nodules shadow was 32.8% ( 22/67 ) in building A ( poor environmental hygiene ) , 2.14%(5/234) in building B, and the total incidence rate was 8.97%.Four-fold increase in the mycoplasma pneumoniae ( MP) antibody titer in the paired sera was observed in first 12 patients.Measures such as disinfection, isolation and sanitation were taken to control the spread of the epidemic .There was no serious and death cases on the basis of active treatment on the affected patients .Conclusions The outbreak of mycoplasma pneumoniae pneumonia often occur in crowded places .And the clinical and imaging features of mycoplasma pneumoniae pneumonia are atypical .Standard epidemiological intervention should be adopted for the sudden onset of respiratory diseases with unknown causes .