Fernández-Sabé Núria, Rosón Beatriz, Carratalà Jordi, Dorca Jordi, Manresa Frederic, Gudiol Francesc
Infectious Disease Service, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain.
Clin Infect Dis. 2003 Aug 15;37(4):483-9. doi: 10.1086/376627. Epub 2003 Jul 28.
This prospective case-control study sought to identify differences in presentation between Legionella pneumonia (LP) diagnosed by urinary antigen and bacteremic pneumococcal pneumonia (PP), with the aim of assessing the ability of physicians to recognize such differences at admission and validating the Community-Based Pneumonia Incidence Study (CBPIS) Group scoring system for LP diagnosis. Significant differences in presentation were found: male sex, previous receipt of beta-lactam therapy, and temperature >39 degrees C were positively associated with LP; purulent sputum, pleuritic chest pain, and previous upper respiratory tract infection were negatively associated with LP. Physicians considered Legionella to be the most likely diagnosis in 52 (64%) of 81 LP cases and in 8 (6%) of 136 PP cases. Initial administration of a macrolide and rifampin and requests for urinary antigen testing for Legionella at admission were significantly more frequent among patients with LP. Overall, the CBPIS score did not differentiate reliably between LP and PP. Although certain presenting clinical features may allow recognition of LP, it is difficult to express them in a reliable scoring system.
这项前瞻性病例对照研究旨在确定通过尿抗原诊断的军团菌肺炎（LP）和菌血症性肺炎球菌肺炎（PP）在临床表现上的差异，目的是评估医生在入院时识别这些差异的能力，并验证基于社区的肺炎发病率研究（CBPIS）小组用于LP诊断的评分系统。研究发现临床表现存在显著差异：男性、既往接受β-内酰胺治疗以及体温>39摄氏度与LP呈正相关；脓性痰、胸膜炎性胸痛和既往上呼吸道感染与LP呈负相关。在81例LP病例中，52例（64%）医生认为军团菌是最可能的诊断，而在136例PP病例中，8例（6%）医生也这样认为。LP患者入院时初始使用大环内酯类药物和利福平以及要求进行军团菌尿抗原检测的频率明显更高。总体而言，CBPIS评分不能可靠地区分LP和PP。虽然某些临床表现特征可能有助于识别LP，但很难用一个可靠的评分系统来体现这些特征。
