5岁以下下呼吸道感染小儿嗜肺军团菌的检测及临床分布特征
摘要
背景
军团病首发于1976年的美国一次军人聚会，次年从死者肺组织中分离出一种新的病原体，1978年国际上正式将该病原体命名为嗜肺军团菌(Legionnairespneumophile，Lp)。1982年，我国南京首次证实了军团病。
至今已发现引起军团病的军团菌属有48个种，70个血清型。军团菌48个种中近一半与人类疾病有关，关系最密切的为Lp。普通肺炎中15％由Lp引起，而军团菌肺炎中90％由Lp引起。虽然Lp有15个血清型，但80％的嗜肺军团菌肺炎由1型(Lp1)引起，其次较多见的为2—6型。
随着城市化发展、现代化设施的广泛应用，军团菌污染已相当普遍，从近年来国内外军团病流行的报道可以看出军团菌对人类健康的威胁已不容忽视。
急性下呼吸道感染仍是目前我国儿科的常见病多发病，占儿科住院患儿的24.5％～65.2％，其中肺炎是5岁以下小儿死亡的第一位原因。军团病是非典型性肺炎的重要组成部分。军团菌可引起任何年龄的感染，自1982年康晓明国内首次报告军团菌肺炎以来，我国的军团病研究不断深入，时有局部暴发流行及散发病例的报道，但对小儿尤低龄儿的报道较少，因此我们对5岁以下下呼吸道感染患儿进行了Lp的检测研究。
目的
1．了解低年龄下呼吸道感染患儿Lp感染现况。
2．了解低年龄儿Lp感染临床分布特征。
方法
对我院2004年12月～2005年12月，呼吸科收治的300例下呼吸道感染患儿进行研究，其中男191例，女109例，年龄27d～5y，平均2.9y，病程1天～6月。
(1)嗜肺军团菌1—7型血清抗体IgM(Lp—IgM)的检测：用ELISA法对300例患儿进行血清Lp—IgM检测。
(2)嗜肺军团菌1型尿抗原(Lp-Ag)的检测：对300例患儿用ELISA法进行尿Lp1-Ag检测。
结果
300例患儿中共46例检测阳性，其中血清Lp—IgM阳性10例，尿Lp-Ag阳性36例。
(1)血清Lp—IgM：10例阳性，阳性率3.33％。其中27d～1y2例，～3y3例，～5y5例，三组年龄Lp感染阳性率差异有显著性(1.27％，3.16％，10.64％，P＜0.05)，且随年龄增长而阳性感染率增加，阳性率趋势有显著意义(x~2=8.47，P＜0.05)。男性7例，女性3例，，两者的差异无显著性(3.67％，2.75％，P＞0.05)。冬春季1例，夏秋季9例，两者的差异有显著性(0.74％，5.45％，P＜0.05)。来自城区7例，农郊3例，两者的差异有显著性(7.53％，1.45％，P＜0.05)。
(2)尿Lp-Ag：36例阳性，阳性率12％。其中27d～1y15例，～3y10例，～5y11例，三组年龄Lp感染阳性率差异有显著性(9.49％，10.53％，23.40％，P＜0.05)，且随年龄增长而阳性感染率增加，阳性率趋势有显著意义(x~2=5，P＜0.05)。男21例，女15例，两者的差异无显著性(10.99％，13.76％，P＞0.05)。冬春季8例，夏秋季28例，两者的差异有显著性(5.90％，16.96％，P＜0.05)。来自城区27例，农郊9例，两者的差异有显著性(29.03％，4.35％，P＜0.001)。
(3)同时Lp-IgM和Lp-Ag阳性的为0例，同时Lp-Ig和Lp-Ag阴性的为254例。两种样本的检测结果有差异，Lp—IgM的阳性率明显低于Lp-Ag的阳性率，一致性低。
结论
(1) 5岁以下下呼吸道感染患儿有一定的嗜肺军团菌感染率，该组患儿血清嗜肺军团菌抗体检测阳性率为3.33％，尿嗜肺军团菌抗原检测阳性率为12％。
(2) 5岁以下下呼吸道感染患儿不同年龄Lp感染阳性率有显著差异，且随年龄增长而阳性感染率增加，感染者夏秋季阳性率明显高于冬春季、城区的阳性率明显高于农郊。
Background:
Legionnaires' disease was discovered following an outbreak traced to a 1976 American Legion convention in Philadelphia, USA. In that outbreak, approximately 221 people contracted this previously unknown type of bacterial pneumonia, and 34 people died. A new pathogen was isolated from lungs of the dead next year, which was termed legionella pneumophila(Lp) in the worldwide in 1978. In China, Legionnaires' disease was firstly proved in Nanjing in 1982.
There are 48 species comprising 70 distinct serogroups in Legionella currently. Approximately one half of them are associated with human diseases, and Lp is the most important one. It has been reported that about 15% of pneumonia are caused by Legionella and 90% of Legionella pneumonia are caused by Lp. Although there are now 15 serogroups of Lp ,most of all Lp pneumonia are caused by Lp serogroup 1(Lp1)- serogroup 6,especially Lp1, which caused 80% of Lp pneumonia.
With the development of urbanization and wide use of modern equipment, legionella pollution had been considerably widespread. From the epidemic data of
Legionnaires' disease home and abroad, it is not difficult to draw a conclusion that the threat of legionella should not be ignored.
Acute low respiratory tract infection remains the most frequent and common disease in children in our country. It accounts for 24.5%～65.2% of hospitalized children. Pneumonia is the first cause of death in children younger than 5 years old. Legionella pneumonia is an important kind of atypical pneumonia. Legionella can infect everyone of any age. Since Xiaoming Kang first report LD in China in 1982, the research of LD has been continually developing. Some local fulminant epidemic and sporadic cases of LD were occasionally reported. However, few paper have illustrated the LD in young children in China. Here, we detected and analyzed Lp infection in children younger than 5 years old with low respiratory tract infections.
Objectives:
1. To study the present situation of Lp infections in children younger than 5 years old with low respiratory tract infections.
2. To study clinical distribution characteristics of Lp infection in children younger than 5 years old.
Methods:
Three hundreds hospitalized patients with the diagnosis of low respiratory tract infections from December 1,2004 to December 1,2005 in respiratory ward in our hospital were enrolled in the study. Of them, 191 were male and 109 were female ,with the mean age of 2.9 years (27days～5years). Disease duration was from one day to six months.
1. Serum antibody(IgM) of Lp serogroup 1-7(Lp-IgM) was detected by ELISA.
2. Urinary antigen of Lp serogroup 1(Lp-Ag) was measured by ELISA.
Results:
1. serum Lp-IgM: In the three hundred patients, ten cases were positive. The positive rate was 33.3%. Of the ten children, two were between 27 days and one year old, three were 1～3years old and five were 3～5 years old. The positive rates were significantly different among the three groups (1.27%vs 3.16% vs 10.64%) and tendentially increased following the increase of age ( x~2=8.47, P < 0.05). The genders did not significantly influence the positive rate with 3.67% in males and 2.75%in females. The spring and winter seasons (n=1), or summer and autum seasons (n=9) had obviously different positive rates(0.74%vs5.45%). Univariate analysis also demonstrated that the positive rate were also different between children come from town(n=7) or county(n=3) (7.53%vs1.45%).
2. Lp-Ag in urine: In the three hundred patients, thirty-six cases were positive. The positive rate was 12%. Of the thirty-six children, fifteen were between 27 days and one year old, ten were 1～3years old, eleven were 3～5 years old. The positive rates were significantly different among the three groups (9.49%vs 10.53% vs 23.40%) and tendentially increased following the increase of age (x~2 = 5, P < 0.05). The genders did not significantly influence the positive rate(10.99% in males vsl3.76% in females). The spring and winter seasons (n=1), or summer and autum seasons (n=9) had obviously different positive rates (5.90%vsl6.96%). Univariate analysis also demonstrated that the positive rate were also different between children come from town(n=7) or county(n=3) (29.03%vs4.35%).
3. Of the 300 children, no one was double positive for serum Lp-IgM and urine Lp-Ag. However, 254 cases were both negative for the serum Lp-IgM and urine Lp-Ag. The positive rate of serum Lp-IgM was much lower than that of urine Lp-Ag, the consistency of two specimen was very low.
Conclusion
1. There are certain cases of Lp infections in children younger than 5 years old with low respiratory tract infections. The positive rate of serum Lp-IgM and urine Lp-Ag was 3.33% and 12% respectively in this cohort.
2. The infection rates are different among children of different ages and tendentially increased following the increase of age. There seems to be higher positive rates in summer and autumn season than in winter and spring season. Children coming from town also have a higher positive rate than those coming from country.
军团病首发于1976年的美国一次军人聚会，次年从死者肺组织中分离出一种新的病原体，1978年国际上正式将该病原体命名为嗜肺军团菌(Legionnairespneumophile，Lp)。1982年，我国南京首次证实了军团病。
至今已发现引起军团病的军团菌属有48个种，70个血清型。军团菌48个种中近一半与人类疾病有关，关系最密切的为Lp。普通肺炎中15％由Lp引起，而军团菌肺炎中90％由Lp引起。虽然Lp有15个血清型，但80％的嗜肺军团菌肺炎由1型(Lp1)引起，其次较多见的为2—6型。
随着城市化发展、现代化设施的广泛应用，军团菌污染已相当普遍，从近年来国内外军团病流行的报道可以看出军团菌对人类健康的威胁已不容忽视。
急性下呼吸道感染仍是目前我国儿科的常见病多发病，占儿科住院患儿的24.5％～65.2％，其中肺炎是5岁以下小儿死亡的第一位原因。军团病是非典型性肺炎的重要组成部分。军团菌可引起任何年龄的感染，自1982年康晓明国内首次报告军团菌肺炎以来，我国的军团病研究不断深入，时有局部暴发流行及散发病例的报道，但对小儿尤低龄儿的报道较少，因此我们对5岁以下下呼吸道感染患儿进行了Lp的检测研究。
目的
1．了解低年龄下呼吸道感染患儿Lp感染现况。
2．了解低年龄儿Lp感染临床分布特征。
方法
对我院2004年12月～2005年12月，呼吸科收治的300例下呼吸道感染患儿进行研究，其中男191例，女109例，年龄27d～5y，平均2.9y，病程1天～6月。
(1)嗜肺军团菌1—7型血清抗体IgM(Lp—IgM)的检测：用ELISA法对300例患儿进行血清Lp—IgM检测。
(2)嗜肺军团菌1型尿抗原(Lp-Ag)的检测：对300例患儿用ELISA法进行尿Lp1-Ag检测。
结果
300例患儿中共46例检测阳性，其中血清Lp—IgM阳性10例，尿Lp-Ag阳性36例。
(1)血清Lp—IgM：10例阳性，阳性率3.33％。其中27d～1y2例，～3y3例，～5y5例，三组年龄Lp感染阳性率差异有显著性(1.27％，3.16％，10.64％，P＜0.05)，且随年龄增长而阳性感染率增加，阳性率趋势有显著意义(x~2=8.47，P＜0.05)。男性7例，女性3例，，两者的差异无显著性(3.67％，2.75％，P＞0.05)。冬春季1例，夏秋季9例，两者的差异有显著性(0.74％，5.45％，P＜0.05)。来自城区7例，农郊3例，两者的差异有显著性(7.53％，1.45％，P＜0.05)。
(2)尿Lp-Ag：36例阳性，阳性率12％。其中27d～1y15例，～3y10例，～5y11例，三组年龄Lp感染阳性率差异有显著性(9.49％，10.53％，23.40％，P＜0.05)，且随年龄增长而阳性感染率增加，阳性率趋势有显著意义(x~2=5，P＜0.05)。男21例，女15例，两者的差异无显著性(10.99％，13.76％，P＞0.05)。冬春季8例，夏秋季28例，两者的差异有显著性(5.90％，16.96％，P＜0.05)。来自城区27例，农郊9例，两者的差异有显著性(29.03％，4.35％，P＜0.001)。
(3)同时Lp-IgM和Lp-Ag阳性的为0例，同时Lp-Ig和Lp-Ag阴性的为254例。两种样本的检测结果有差异，Lp—IgM的阳性率明显低于Lp-Ag的阳性率，一致性低。
结论
(1) 5岁以下下呼吸道感染患儿有一定的嗜肺军团菌感染率，该组患儿血清嗜肺军团菌抗体检测阳性率为3.33％，尿嗜肺军团菌抗原检测阳性率为12％。
(2) 5岁以下下呼吸道感染患儿不同年龄Lp感染阳性率有显著差异，且随年龄增长而阳性感染率增加，感染者夏秋季阳性率明显高于冬春季、城区的阳性率明显高于农郊。
Background:
Legionnaires' disease was discovered following an outbreak traced to a 1976 American Legion convention in Philadelphia, USA. In that outbreak, approximately 221 people contracted this previously unknown type of bacterial pneumonia, and 34 people died. A new pathogen was isolated from lungs of the dead next year, which was termed legionella pneumophila(Lp) in the worldwide in 1978. In China, Legionnaires' disease was firstly proved in Nanjing in 1982.
There are 48 species comprising 70 distinct serogroups in Legionella currently. Approximately one half of them are associated with human diseases, and Lp is the most important one. It has been reported that about 15% of pneumonia are caused by Legionella and 90% of Legionella pneumonia are caused by Lp. Although there are now 15 serogroups of Lp ,most of all Lp pneumonia are caused by Lp serogroup 1(Lp1)- serogroup 6,especially Lp1, which caused 80% of Lp pneumonia.
With the development of urbanization and wide use of modern equipment, legionella pollution had been considerably widespread. From the epidemic data of
Legionnaires' disease home and abroad, it is not difficult to draw a conclusion that the threat of legionella should not be ignored.
Acute low respiratory tract infection remains the most frequent and common disease in children in our country. It accounts for 24.5%～65.2% of hospitalized children. Pneumonia is the first cause of death in children younger than 5 years old. Legionella pneumonia is an important kind of atypical pneumonia. Legionella can infect everyone of any age. Since Xiaoming Kang first report LD in China in 1982, the research of LD has been continually developing. Some local fulminant epidemic and sporadic cases of LD were occasionally reported. However, few paper have illustrated the LD in young children in China. Here, we detected and analyzed Lp infection in children younger than 5 years old with low respiratory tract infections.
Objectives:
1. To study the present situation of Lp infections in children younger than 5 years old with low respiratory tract infections.
2. To study clinical distribution characteristics of Lp infection in children younger than 5 years old.
Methods:
Three hundreds hospitalized patients with the diagnosis of low respiratory tract infections from December 1,2004 to December 1,2005 in respiratory ward in our hospital were enrolled in the study. Of them, 191 were male and 109 were female ,with the mean age of 2.9 years (27days～5years). Disease duration was from one day to six months.
1. Serum antibody(IgM) of Lp serogroup 1-7(Lp-IgM) was detected by ELISA.
2. Urinary antigen of Lp serogroup 1(Lp-Ag) was measured by ELISA.
Results:
1. serum Lp-IgM: In the three hundred patients, ten cases were positive. The positive rate was 33.3%. Of the ten children, two were between 27 days and one year old, three were 1～3years old and five were 3～5 years old. The positive rates were significantly different among the three groups (1.27%vs 3.16% vs 10.64%) and tendentially increased following the increase of age ( x~2=8.47, P < 0.05). The genders did not significantly influence the positive rate with 3.67% in males and 2.75%in females. The spring and winter seasons (n=1), or summer and autum seasons (n=9) had obviously different positive rates(0.74%vs5.45%). Univariate analysis also demonstrated that the positive rate were also different between children come from town(n=7) or county(n=3) (7.53%vs1.45%).
2. Lp-Ag in urine: In the three hundred patients, thirty-six cases were positive. The positive rate was 12%. Of the thirty-six children, fifteen were between 27 days and one year old, ten were 1～3years old, eleven were 3～5 years old. The positive rates were significantly different among the three groups (9.49%vs 10.53% vs 23.40%) and tendentially increased following the increase of age (x~2 = 5, P < 0.05). The genders did not significantly influence the positive rate(10.99% in males vsl3.76% in females). The spring and winter seasons (n=1), or summer and autum seasons (n=9) had obviously different positive rates (5.90%vsl6.96%). Univariate analysis also demonstrated that the positive rate were also different between children come from town(n=7) or county(n=3) (29.03%vs4.35%).
3. Of the 300 children, no one was double positive for serum Lp-IgM and urine Lp-Ag. However, 254 cases were both negative for the serum Lp-IgM and urine Lp-Ag. The positive rate of serum Lp-IgM was much lower than that of urine Lp-Ag, the consistency of two specimen was very low.
Conclusion
1. There are certain cases of Lp infections in children younger than 5 years old with low respiratory tract infections. The positive rate of serum Lp-IgM and urine Lp-Ag was 3.33% and 12% respectively in this cohort.
2. The infection rates are different among children of different ages and tendentially increased following the increase of age. There seems to be higher positive rates in summer and autumn season than in winter and spring season. Children coming from town also have a higher positive rate than those coming from country.
引文
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[1] Barry S. Fields, Robert F. Bcnson, and Richard E. Bcsscr. Legionella and legionnaires' disease: 25 Years of Investigation [J].Clin Microbiol Rev. 2002; 15(3): 506-526.
[2] 林爱红，梁焯南，叶宝英，等．深圳市中央空调系统军团菌污染的初步调查[J]．职业与健康，2006，22(16)：1283—1284．
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[4] 李亚．儿童军团菌肺炎的研究进展[J]．中国妇幼保健，2005，20(5)：634—636．
[5] 宫道华，吴升华主编小儿感染病学[M]．第1版，北京：人民卫生出版社，2002：925—930．
[6] Safdar N,Crnich CJ,Maki DG.The pathogenesis of ventilator-associated pneumonia:its relevance to developing effective strategies for prevention[J].Respiratory Care.2005;50 (6): 725-739.
[7] Benson RF, Fields BS. Classification of the genus Legionella[J]. Semin Respir Infect, 1998; 13(2):90-99.
[8] 王新凤．军团菌的污染与军团病的研究[J]．生物学通报，2004，39(3)：6-8．
[9] Szymanska J.Risk of exposure to legionella in dental practice[J].Ann Agric Environ Med,2004; 11 (1):9-12.
[10] Storey MV, Ashbolt J, Stenstrem TA. Biofilms, thermophilic amoebae an d Legionella pneumophila: a quantitative risk assessment for distributed water[J]. Water Sci Technol, 2004;50 (1): 77—82.
[11] Thomas V,Bonchez T,Nicolas V,etal. Amoebaeindomesticwater systems: resistance to disinfection treatments and implication in Legionella persistence[J]. J ApplMicrobiol, 2004;97 (5): 950-963.
[12] FiddsB. Themolecular ecologyoflegioneUae[J]. TrendsMicrobiol, 1996;4 (7): 286-290.
[13] Lay CJ,Yu KW,Chi CY,etal.Impact of the 1997 revised centers for disease control criteria on case rates legionellosis in Taiwan:review of 38 cases at a teaching hospital,1998-2002[J].J Microbiol Immunol Infect,2005;38(1): 211-217.
[14] 王素萍，王俊升，赵淑芳．儿童军团菌病危险因素的研究[J]．中国公共卫生学报，1994；13(6)：348—351．
[15] Lvey L,Rubin LG, Legionella pneumonia in neonates: a literature review[J].J Perinatol, 1998; 18(4):287-290. Review.
[16] 肖钧．军团菌的污染和控制研究进展[J]．国外医学卫生学分册，2003；(4)：196—197
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