Dey A B, Chaudhry R, Kumar P, Nisar N, Nagarkar K M
All India Institute of Medical Sciences, New Delhi, India.
Natl Med J India. 2000 Mar-Apr;13(2):66-70.
Community-acquired pneumonia is an important cause of mortality and hospitalization in all age groups. In temperate climates, Mycoplasma pneumoniae is a common respiratory pathogen causing pneumonia. Information on human Mycoplasma infection in India is scarce.
We aimed to determine the frequency of Mycoplasma pneumoniae infection among patients with community-acquired pneumonia in a prospective cross-sectional study. The assessment included clinical and radiological evaluation followed by microbiological evaluation for the specific pathogen. Microbiological investigations included aerobic and anaerobic blood culture, anti-Mycoplasma IgM antibody detection by gelatin particle agglutination test and ELISA, culture of respiratory tract secretions for Mycoplasma pneumoniae and other organisms, and detection of specific Mycoplasma pneumoniae antigen by indirect immunofluorescence.
Sixty-two patients (42 men and 20 women; mean age 41.7 years) with community-acquired pneumonia were investigated prospectively. They included 42 immunocompetent and 20 immunocompromised patients. Six patients had definitive evidence of Mycoplasma pneumoniae infection and an additional 16 patients had a probable diagnosis. In all, 22 (35.5%) patients with pneumonia had Mycoplasma pneumoniae infection. Of these, 12 patients belonged to the immunocompromised group and 10 to the immunocompetent group. Patients with Mycoplasma pneumoniae infection also had secondary bacterial infection as evidenced by organisms isolated from blood in 50% and from respiratory tract secretions in 68%.
Community-acquired pneumonia has a polymicrobial aetiology, of which the prevalence of Mycoplasma pneumoniae is 35%. The study has two implications: (i) Mycoplasma pneumoniae infection is frequently associated with secondary bacterial infection; and (ii) initial empirical antibiotic therapy for community-acquired pneumonia in India must include antibiotics with activity against Mycoplasma pneumoniae.
社区获得性肺炎是各年龄组死亡和住院的重要原因。在温带气候地区，肺炎支原体是引起肺炎的常见呼吸道病原体。关于印度人类支原体感染的信息匮乏。
我们旨在通过一项前瞻性横断面研究确定社区获得性肺炎患者中肺炎支原体感染的频率。评估包括临床和影像学评估，随后对特定病原体进行微生物学评估。微生物学检查包括需氧和厌氧血培养、通过明胶颗粒凝集试验和酶联免疫吸附测定检测抗支原体 IgM 抗体、培养呼吸道分泌物以检测肺炎支原体和其他病原体，以及通过间接免疫荧光检测特定的肺炎支原体抗原。
对 62 例社区获得性肺炎患者（42 例男性和 20 例女性；平均年龄 41.7 岁）进行了前瞻性研究。其中包括 42 例免疫功能正常患者和 20 例免疫功能低下患者。6 例患者有肺炎支原体感染的确切证据，另有 16 例患者可能诊断为此病。总共有 22 例（35.5%）肺炎患者患有肺炎支原体感染。其中，12 例患者属于免疫功能低下组，10 例属于免疫功能正常组。肺炎支原体感染患者还存在继发细菌感染，50%的患者血液中分离出病原体，68%的患者呼吸道分泌物中分离出病原体。
社区获得性肺炎病因具有多微生物性，其中肺炎支原体的患病率为 35%。该研究有两个意义：（i）肺炎支原体感染常与继发细菌感染相关；（ii）印度社区获得性肺炎的初始经验性抗生素治疗必须包括对肺炎支原体有活性的抗生素。
