CAJ | 학술논문

目的分析医院内暴发性军团菌肺炎的临床特点、诊治过程及暴发原因.方法回顾性分析6例医院内暴发性军团菌肺炎的临床资料、诊疗过程及暴发原因.结果 6例患者均为武警后勤学院附属医院呼吸与重症医学科医护人员,年龄23 ～ 27岁,男1例,女5例,通过尿军团菌1型抗原检测阳性而确诊,感染源系医院空调系统水被军团菌污染所致.6例均发热,体温为37.5 ～39℃,咳嗽及咳痰,1例有纳差、胸闷、胸痛,3例伴头痛,3例肺部可闻及湿性啰音.胸部CT表现为单发或多发小斑片状阴影.无相对缓脉、低钠血症、低磷血症及腹泻等典型消化道症状,也未出现肾脏以及神经系统等的典型肺外表现.结论本组资料提示,军团菌肺炎临床表现为轻度肺炎,实验室检查电解质在正常范围,影像学表现为双肺或单肺多发小斑片状阴影,与病毒性肺炎易混淆,应注意鉴别.军团菌可来自中央空调系统、热水管道系统,通过呼吸道传播而暴发,应加强医院空调系统的病原菌监测及清洁,防控军团菌医院内感染的暴发.
목적 분석의원내폭발성군단균폐염적림상특점、진치과정급폭발원인.방법 회고성분석6례의원내폭발성군단균폐염적림상자료、진료과정급폭발원인.결과 6례환자균위무경후근학원부속의원호흡여중증의학과의호인원,년령23 ～ 27세,남1례,녀5례,통과뇨군단균1형항원검측양성이학진,감염원계의원공조계통수피군단균오염소치.6례균발열,체온위37.5 ～39℃,해수급해담,1례유납차、흉민、흉통,3례반두통,3례폐부가문급습성라음.흉부CT표현위단발혹다발소반편상음영.무상대완맥、저납혈증、저린혈증급복사등전형소화도증상,야미출현신장이급신경계통등적전형폐외표현.결론 본조자료제시,군단균폐염림상표현위경도폐염,실험실검사전해질재정상범위,영상학표현위쌍폐혹단폐다발소반편상음영,여병독성폐염역혼효,응주의감별.군단균가래자중앙공조계통、열수관도계통,통과호흡도전파이폭발,응가강의원공조계통적병원균감측급청길,방공군단균의원내감염적폭발.
Objectives To describe the clinical characteristics,diagnosis,treatment and the causes of outbreak of nosocomial pneumonia due to Legionella pneumophila.Methods The medical records of 6 cases of nosocomial Legionella pneumophila pneumonia were retrospectively reviewed,and the clinical data of clinical presentation,treatment,and etiologic diagnosis were analyzed.Results The 6 patients were health care providers of the Department of Respiratory and Critical Care Medicine of the Affiliated Hospital of Logistics University of PAPF.There were 5 female and 1 male patients,aged 23 to 27 years.The diagnosis of Legionella pneumonia was made based on a positive Legionella urinary Ⅰ antigen test.In all the 6 cases,the disease was attributable to inhaling contaminated aerosols produced by the air conditioning system in our hospital.All the 6 patients presented with fever of 37.5-39 ℃,and productive cough.One patient had anorexia,dyspnoea,and pleuritic chest pain,while headache was reported in 3 patients.Physical examinations revealed lung rales in 3 patients.Single or multiple patchy infiltrates were found on Chest CT in all patients.However,the typical extrapulmonary manifestations of Legionnaires' disease,including relative bradycardia,hyponatremia,hypophosphatemia and diarrhea,were not present in the 6 patients.Neither neurological abnormalities nor renal involvement were observed.Conclusions Our data demonstrated that Legionella pneumonia may be mild with atypical laboratory findings and clinical manifestations,with fever,cough,chest tightness,headache,etc.The radiologic manifestations of Legionella pneumonia were single or multiple patchy infiltrates,similar to those of viral pneumonia,and therefore their differential diagnosis was needed.Legionella pneumophila can outbreak through the respiratory tract,in public places with central airconditioning system,hot water piping systems and hospitals,and therefore microbiological monitoring,cleaning and disinfection of the water system was required for prevention of the outbreaks of Legionnaires' disease.