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某军事训练基地发生的与A群链球菌相关的肺炎疫情。

Pneumonia outbreak associated with group a Streptococcus species at a military training facility.

作者信息

Crum Nancy F, Russell Kevin L, Kaplan Edward L, Wallace Mark R, Wu Jianguo, Ashtari Parvin, Morris Dana J, Hale Braden R

机构信息

Infectious Diseases Division, Clinical Investigation Dept., Naval Medical Center San Diego, CA 92134-1005, USA.

出版信息

Clin Infect Dis. 2005 Feb 15;40(4):511-8. doi: 10.1086/427502. Epub 2005 Jan 20.

DOI:10.1086/427502
PMID:15712072
Abstract

BACKGROUND

Although group A streptococci (GAS) infections are a major cause of morbidity and mortality, outbreaks of associated pneumonia are rare. We report an outbreak of GAS pneumonia that occurred at a US military training camp.

METHODS

Standard epidemiologic and laboratory procedures were used to characterize the outbreak and causative organism(s). A case-control study and determination of the prevalence of GAS infection among camp personnel were also performed.

RESULTS

A total of 162 of 4500 Marine Corps personnel were hospitalized for respiratory symptoms during the period of 1 November and 20 December 2002, and 127 (78%) had radiographically confirmed pneumonia. The attack rate was 1.6 cases per 100 person-months. Thirty-four (27%) of 127 patients with pneumonitis had definite or probable GAS pneumonia; an additional 22 (17.3%) were coinfected with GAS and another pathogen. Pathogens, in addition to GAS, included Chlamydia pneumoniae (27 patients), Mycoplasma pneumoniae (19), adenovirus (5), and Streptococcus pneumoniae (2). A survey revealed that the pharyngeal carriage rate of GAS among camp personnel was 16%. Molecular characterization of the GAS isolates found emm type 3, multilocus sequence type 15. The epidemic ended after administration of additional prophylaxis with a single dose of intramuscular benzathine penicillin (1.2 million U) or azithromycin (1 g orally). Because the number of days from the last penicillin injection was correlated with a positive throat culture result and the occurrence of pneumonia, the dosing interval of benzathine penicillin was shortened from every 28-35 days to every 21 days.

CONCLUSIONS

This is the largest outbreak of GAS pneumonia reported in >30 years. This outbreak emphasizes the potential for GAS to cause epidemics of severe infection and demonstrates the need for surveillance and consideration of appropriate antibiotic prophylaxis among particularly high-risk populations.

摘要

背景

虽然A组链球菌(GAS)感染是发病和死亡的主要原因,但相关肺炎的暴发却很罕见。我们报告了在美国一个军事训练营发生的一起GAS肺炎暴发事件。

方法

采用标准的流行病学和实验室程序来描述此次暴发及致病病原体。还进行了一项病例对照研究,并测定了营地人员中GAS感染的患病率。

结果

在2002年11月1日至12月20日期间,4500名海军陆战队人员中有162人因呼吸道症状住院,其中127人(78%)经影像学检查确诊为肺炎。发病率为每100人月1.6例。127例肺炎患者中有34例(27%)确诊或可能为GAS肺炎;另有22例(17.3%)同时感染了GAS和另一种病原体。除GAS外,病原体还包括肺炎衣原体(27例)、肺炎支原体(19例)、腺病毒(5例)和肺炎链球菌(2例)。一项调查显示,营地人员中GAS的咽部携带率为16%。对GAS分离株的分子特征分析发现为emm3型、多位点序列型15。在额外给予单剂量肌内注射苄星青霉素(120万单位)或阿奇霉素(口服1克)进行预防后,疫情结束。由于距上次注射青霉素的天数与咽拭子培养结果阳性及肺炎的发生相关,苄星青霉素的给药间隔从每28 - 35天缩短至每21天。

结论

这是30多年来报告的最大规模的GAS肺炎暴发。此次暴发强调了GAS引发严重感染流行的可能性,并表明在特别高危人群中需要进行监测并考虑采取适当的抗生素预防措施。

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