广州发热呼吸道症候群成年患者临床特征及病原学检测

Clinical characteristics and pathogen detection of febrile respiratory syndrome in adults from Guangzhou

目的探讨广州地区发热呼吸道症候群成年患者临床特征及非典型病原体与病毒分布。方法收集2014年9月—2015年8月400份发热呼吸道症候群成年患者血清标本,应用呼吸道病原体九联检试剂盒检测9项病原体Ig M抗体,并对患者临床特征进行分析。结果病原学分布:400例患者中共检测病原体阳性131份,总阳性率为32.8%,以肺炎支原体为主,共54例(13.5%),其余分别为乙型流感病毒33例(8.3%);嗜肺军团菌血清1型14例(3.5%);Q热立克次体和甲型流感病毒各7例(1.8%);呼吸道合胞病毒和肺炎衣原体各6例(1.5%);副流感病毒4例(1.0%);未发现腺病毒。多重感染14例,以肺炎支原体合并乙型流感病毒为多见;三重感染1例。临床特征:广州发热呼吸道症候群成年患者平均年龄68.58岁,以发热、咳嗽、咳痰、畏寒、气促、头痛及口干为主要临床症状,均见肺部实变体征;实验室血常规检查见白细胞计数升高,其中中性粒细胞百分比明显升高,淋巴细胞百分比明显降低。结论广州地区发热呼吸道症候群成年患者的非典型病原体及病毒检测以肺炎支原体及乙型流感病毒为主,其他病原体散发;不同非典型病原体和病毒感染的患者多见发热,伴有明显的全身和呼吸道症状,肺部感染多见。

Objective To investigate the clinical characteristics of febrile respiratory syndrome in the adult patients of Guangzhou,and explore the distribution of atypical pathogens and viruses causing the syndrome. Methods Serum samples of400 adult patients with febrile respiratory syndrome admitted in Guangdong Provincial Hospital of Traditional Chinese Medicine from September 2014 to August 2015 were collected. Pneumoslide Ig M kits were used to detect the corresponding Ig M antibodies of 9 pathogens, and the results were analyzed with the clinical characteristics of the patients.Results Pathogen distribution： There were 131 positive sera detected from the 400 samples,with a positive rate of 32.8%.The main pathogen was Mycoplasma pneumoniae,accounting for 13.5%（54 cases）,followed by Influenza B virus for 33 cases（8.3%）,Legionella pneumophilasero group 1 for 14 cases（3.5%）,Coxiella burnetii and Influenza A virus both for 7 cases（1.8%）,Respiratory syncytial virus and Chlamydophila pneumoniae both for 6 patients（1.5%）,and Parainfluenza viruses for 4 patients（1.0%）,and none of adenovirus.There were 14 cases of multiple infection,mainly caused by Mycoplasma pneumonia and Influenza B virus,and 1 cases of triple infection. Clinical characteristics： the average age of 68.58. The main clinical symptoms were fever,cough,sputum,chills,headache,dry mouth,and shortness of breath,and the consolidation of lung was found in all of patients. Blood routine examination showed elevated white blood cell count,with obviously increased neutrophil percentage while decreased lymphocyte percentage. Conclusion For the adults with febrile respiratory syndrome in Guangzhou,the most common atypical pathogens and viruses are Mycoplasma pneumoniae and Influenza B virus,while other pathogens cause sporadic infection.The main manifestation is fever,accompanied with obvious systemic and respiratory symptoms,mostly lung infectionin the patients with atypical pathogens and virus infection.