Takayanagi Noboru, Tokunaga Daidou, Matsushima Hidekazu, Ubukata Mikio, Sato Nagato, Kurashima Kazuyoshi, Yanagisawa Tsutomu, Sugita Yutaka, Kanazawa Minoru
Department of Respiratory Medicine, Saitama Cardiovascular Center, 1696 Itai, Kohnan, Ohsato, Saitama, Japan.
Nihon Kokyuki Gakkai Zasshi. 2004 Jan;42(1):62-7.
We assessed the frequency and clinical significance of polymicrobial infections in 31 patients with sporadic community-acquired Legionella pneumonia. Twenty-six patients were men, 5 were women and mean age was 61 years. Eighteen patients were smokers, 6 patients were chronic alcoholics and 23 had underlying diseases. Regarding severity, the illnesses were mild (two patients), moderate (seven patients) and severe (twenty-two patients). In 9 (29%) of the patients, one other etiologic agent for community-acquired pneumonia was identified in addition to the Legionella species. The distribution of one other causal agent was as follows: Mycoplasma pneumoniae, 2 patients; Chlamydia pneumoniae, 2; Chlamydia psittaci, 1; Influenza virus, 1; Streptococcus pneumoniae, 1; Klebsiella pneumoniae, 1; Pseudomonas aeruginosa, 1 patient. Because an antimicrobial agent with activity against Legionella species can also provide coverage for Mycoplasma pneumoniae. Chlamydia pneumoniae, and Chlamydia psittaci, the patients with these coinfections improved without any complications. The patient with influenzavirus coinfection became seriously ill, and the condition was complicated by disseminated intravascular coagulation, renal failure and aspergillus bronchitis. The case of Pseudomonas aeruginosa coinfection was accompanied with a lung abscess and empyema. Our experience illustrates the importance of considering polymicrobial infections in patients with sporadic community-acquired Legionella pneumonia.
我们评估了31例散发性社区获得性军团菌肺炎患者中多重微生物感染的频率及临床意义。26例为男性，5例为女性，平均年龄61岁。18例患者为吸烟者，6例为慢性酒精中毒者，23例有基础疾病。就严重程度而言，病情为轻度（2例患者）、中度（7例患者）和重度（22例患者）。9例（29%）患者除军团菌属外还鉴定出另一种社区获得性肺炎的病原体。另一种病原体的分布如下：肺炎支原体，2例患者；肺炎衣原体，2例；鹦鹉热衣原体，1例；流感病毒，1例；肺炎链球菌，1例；肺炎克雷伯菌，1例；铜绿假单胞菌，1例患者。由于对军团菌属有活性的抗菌药物也可覆盖肺炎支原体、肺炎衣原体和鹦鹉热衣原体，这些合并感染的患者病情改善且无任何并发症。流感病毒合并感染的患者病情严重，并发弥散性血管内凝血、肾衰竭和曲霉性支气管炎。铜绿假单胞菌合并感染的病例伴有肺脓肿和脓胸。我们的经验表明，在散发性社区获得性军团菌肺炎患者中考虑多重微生物感染很重要。
