CAJ | 학술논문

目的：探讨以发热为主要症状的嗜肺军团菌(LP)感染的临床特点,为临床医师提供正确诊断疾病的思路及恰当用药方法。方法收集2012年5月10日至2015年5月10日在我院发热门诊就诊的138例 LP 感染患者流行病学资料及一般情况和伴随症状,回顾分析临床 LP 常见的感染途径、诱发因素、临床特征、高发人群及发病季节。结果138例 LP 感染者中,感染途径多与蒸汽吸入有关；诱发因素中,因空调使用不当感染占43.8%(59/138),因加湿器使用不当感染占42.0%(58/138),因雾化器使用不当感染占15.2%(21/138)。138例患者临床表现均有发热,体温37.8~38.9℃；其中伴有咳嗽,胸部 X 光片显示斑片影37例；伴有咽痛、咳嗽、胸部 X 光片显示肺纹理粗101例；仅以发热为临床表现22例。血常规普遍增高138例,白细胞(10~20)×109/L,中性粒细胞0.75~0.89；高发人群多见于城市；家庭聚集发病者多见；发病季节全年可见,多见于每年4月、7月及11月和12月份,冬季发病人数高于春夏季。结论我院 LP 感染诱发因素主要为加湿器及家用雾化器,发病季节多为夏初及冬春季节,冬季发病人数最高,发病人群可见于各个年龄段,家庭聚集者或群居感染者多见。治疗中尤其关注因白细胞或中性粒细胞比例增高,应用β-内酰胺类药物治疗后不佳的患者,除考虑常见感染性发热外应警惕 LP 感染的可能。
목적：탐토이발열위주요증상적기폐군단균(LP)감염적림상특점,위림상의사제공정학진단질병적사로급흡당용약방법。방법수집2012년5월10일지2015년5월10일재아원발열문진취진적138례 LP 감염환자류행병학자료급일반정황화반수증상,회고분석림상 LP 상견적감염도경、유발인소、림상특정、고발인군급발병계절。결과138례 LP 감염자중,감염도경다여증기흡입유관；유발인소중,인공조사용불당감염점43.8%(59/138),인가습기사용불당감염점42.0%(58/138),인무화기사용불당감염점15.2%(21/138)。138례환자림상표현균유발열,체온37.8~38.9℃；기중반유해수,흉부 X 광편현시반편영37례；반유인통、해수、흉부 X 광편현시폐문리조101례；부이발열위림상표현22례。혈상규보편증고138례,백세포(10~20)×109/L,중성립세포0.75~0.89；고발인군다견우성시；가정취집발병자다견；발병계절전년가견,다견우매년4월、7월급11월화12월빈,동계발병인수고우춘하계。결론아원 LP 감염유발인소주요위가습기급가용무화기,발병계절다위하초급동춘계절,동계발병인수최고,발병인군가견우각개년령단,가정취집자혹군거감염자다견。치료중우기관주인백세포혹중성립세포비례증고,응용β-내선알류약물치료후불가적환자,제고필상견감염성발열외응경척 LP 감염적가능。
Objective To investigate the clinical features of legionella pneumophila (LP)with major symptom of fever and provide clinical evidence for correct diagnosis and reasonable treatment.Methods The epidemiological data and general situations of 138 LP cases were collected from April 2012 to April 201 5.The infection route, predisposing factors, clinical manifestations, the high-risk of population the onset seasons were anlyzed retrospectively.Results Among 138 LP cases,the routes of infection were mainly related to steam inhalation and the inducing factors were consisted of improper use of air conditioning (43.75%,59/138),humidifier (42.03%,58/138) and atomizer (1 5.22%,21/138).Clinical manifestations of 138 patients were all involved with fever,about 37.8-38.9℃;37 cases had a cough and patchy shadows in chest X-ray;101 cases were with sore throat,cough and pulmonary bronchovascular boundles thicken inchest X-ray;22 cases with fever as the only clinical manifestation.Among 138 LP cases,WBC arranged from 10 × 10 9/L to 20 × 10 9/L and neutrophils percentage (N)arranged from 75% to 89%. Patients who lived in the city faced with high risk of LP.The high onset seasons were 4,7,1 1 and 12 months. Conclusion The main inducing factors of LP were the use of air conditioning and humidifier.The main onset seasons were summer and winter.The main onset crowds were visible at all ages with high clustering in families and social groups.In conclusion,we suggested to clean up the air conditioning or humidifier first before use.Moreover,we should pay attention to LP patients when high WBC or N existed if treated by β-lactam drugs with poor therapeutic outcome.In addition to the common infectious fever,LP should be considered.