Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Université Paris-Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, APHP, Institut Hospitalo-Universitaire Imagine, Paris, France.
Respir Med. 2013 Oct;107(10):1625-32. doi: 10.1016/j.rmed.2013.07.018. Epub 2013 Aug 9.
Little is known about post-infectious pulmonary sequelae in countries like Cambodia where tuberculosis is hyper-endemic and childhood pulmonary infections are highly frequent. We describe the characteristics of hospitalized Cambodian patients presenting with community-acquired acute lower respiratory infections (ALRI) on post-infectious pulmonary sequelae (ALRIPS).
Between 2007 and 2010, inpatients ≥15 years with ALRI were prospectively recruited. Clinical, biological, radiological and microbiological data were collected. Chest radiographs were re-interpreted by experts to compare patients with ALRIPS, on previously healthy lungs (ALRIHL) and active pulmonary tuberculosis (TB). Patients without chest radiograph abnormality or with abnormality suggestive as other chronic respiratory diseases were excluded from this analysis.
Among the 2351 inpatients with community-acquired ALRI, 1800 were eligible: 426 (18%) ALRIPS, 878 (37%) ALRIHL and 496 (21%) TB. ALRIPS patients had less frequent fever than other ALRI (p < 0.001) and more productive cough than ALRIHL (p < 0.001). Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa accounted for 83% of ALRIPS group positive cultures. H. influenzae and P. aeruginosa were significantly associated with ALRIPS compared with ALRIHL. Treatment was appropriate in 58% of ALRIPS patients. Finally, 79% of ALRIPS were not recognized by local clinicians. In-hospital mortality was low (1%) but probably underestimated in the ALRIPS group.
ALRIPS remains often misdiagnosed as TB with inappropriate treatment in low-income countries. Better-targeted training programs would help reduce the morbidity burden and financial costs.
在结核病高度流行且儿童肺部感染率极高的柬埔寨等国家，人们对感染后肺部后遗症知之甚少。我们描述了在感染后肺部后遗症（ALRIPS）下因社区获得性急性下呼吸道感染（ALRI）住院的柬埔寨患者的特征。
在 2007 年至 2010 年期间，前瞻性招募了≥15 岁的患有 ALRI 的住院患者。收集了临床、生物学、放射学和微生物学数据。胸部 X 光片由专家重新解读，以比较 ALRIPS、既往健康肺部（ALRIHL）和活动性肺结核（TB）患者。排除了无胸部 X 光片异常或异常提示其他慢性呼吸道疾病的患者。
在 2351 名社区获得性 ALRI 住院患者中，有 1800 名符合条件：426 名（18%）为 ALRIPS、878 名（37%）为 ALRIHL 和 496 名（21%）为 TB。与其他 ALRI 相比，ALRIPS 患者的发热频率较低（p<0.001），咳嗽更为多痰（p<0.001）。肺炎链球菌、流感嗜血杆菌和铜绿假单胞菌占 ALRIPS 组阳性培养物的 83%。与 ALRIHL 相比，H. influenzae 和 P. aeruginosa 与 ALRIPS 显著相关。在 ALRIPS 患者中，58%的治疗是合适的。最后，79%的 ALRIPS 未被当地临床医生识别。住院死亡率较低（1%），但在 ALRIPS 组中可能被低估。
在低收入国家，ALRIPS 仍常被误诊为结核病，导致治疗不当。有针对性的培训计划将有助于减轻发病率负担和经济成本。
