不明原因非典型肺炎局部暴发流行26例

不明原因非典型肺炎局部暴发流行26例 作者：刘文成,王宗烨,郑成中,苗宁,敬华,李洁,杨戈,姜玉峰,顾颖 【关键词】 非典型肺炎；传染；流行病学 　　Local epidemic of atypical pneumonia with unknown cause: A clinical analysis of 26 cases 　　【Abstract】 AIM: To investigate the epidemiological characteristics and clinical manifestations of atypical pneumonia with unknown cause. METHODS: Clinical data were retrospectively analyzed in 26 cases of atypical pneumonia with unknown cause. RESULTS: A group of 26 patients (18 males and 8 females, average age: 22.5 years) were admitted in the hospital. The patients worked at the same institution and resided in the same building. The main symptom was fever, with less or no infectiontoxic manifestations and respiratory symptoms. All the Xray examinations showed multiple or solitary dotmassive shadows with high or inconsistent density, and the edge of the shadows was not clear. Laboratory assays demonstrated that the number of leukocytes was decreased or normal, and monocytes were increased. All the antibodies to known pathogenies were negative. The patients were isolated during the treatment, in which 16 patients were treated with antibiotics and antivirus, 8 patients with antivirus only. The body temperature became normal in all the patients after 5day treatment, without respiratory failure and death. CONCLUSION: The basic features of the patients are in accord with those of atypical pneumonia with high infectiosity. Respiratory spread is the main route of transmission. The disease occurs in an aggregated population with an incubation period of 0.5-6 d and with slight symptoms and a tendency of spontaneous cure. Pulmonary shadows appear quickly after onset of the disease. 　　【Keywords】 atypical pneumonia; infectiosity; epidermiology 　　【摘要】 目的：探讨不明原因非典型肺炎患者的流行病学特征和临床现. 方法：对26例集中发病的不明原因非典型肺炎患者的临床资料进行回顾性研究. 结果： 观察对象中男性18例，女性8例，平均年龄22.5岁，均为同一单位，同一大楼集体居住. 主要症状为发热、感染中毒症状，呼吸道症状轻或缺如. 肺部X线片均表现为多发或单发的点片状密度增高影，密度不均，边缘不清. 外周血白细胞总数正常或降低；单核细胞百分比升高；引起非典型肺炎的常见已知的病原体抗体检测均阴性，全部住院隔离治疗；应用甲磺酸培氟沙星/环丙沙星 利巴韦林治疗16例，单纯抗病毒治疗8例. 26例入院5 d体温恢复正常. 无呼吸衰竭及死亡病例. 结论：本病基本特征符合非典型肺炎特点且具有较强传染性，呼吸道为主要传播途径；发病呈人群聚集性，发病后迅速出现肺部片影；潜伏期0.5~6 d. 症状轻微，有自愈倾向. 　　【关键词】 非典型肺炎；传染；流行病学 　　【中图号】 R563.1 　　0引言 　　由于非典型肺炎、禽流感这些呼吸道传染病的出现，给人类健康带来极大威胁，人们对不明原因非典型肺炎更加重视. 某单位聚集性发生一批临床表现相同的非典型肺炎小范围暴发流行. 8 d内共发病26例，现就此的临床流行病学特征、临床诊断、治疗及转归等进行初步分析. 　　1对象和方法 　　1.1对象20040418/20040424某单位集中发病的非典型肺炎患者26(男18，女8)例，年龄19~27（22±2.2）岁. 仅2例有既往疾病史（1例患鱼鳞病，另1例有肺结核病史）. 　　1.2方法所有病例均进行血液细胞及血沉检测. 健康对照组采用同期体检人员30(男20，女10)例，年龄18~29(平均24)岁. 取其静脉血同时进行实验