鼻咽部肺炎球菌密度高，加上病毒合并感染，与侵袭性肺炎球菌肺炎有关。
High nasopharyngeal pneumococcal density, increased by viral coinfection, is associated with invasive pneumococcal pneumonia.
机构信息
Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service Faculty of Health Sciences Medical Research Council: Respiratory and Meningeal Pathogens Research Unit.
Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service Influenza Division, Centers for Disease Control and Prevention.
出版信息
J Infect Dis. 2014 Nov 15;210(10):1649-57. doi: 10.1093/infdis/jiu326. Epub 2014 Jun 6.
BACKGROUND
We identified factors associated with pneumococcal colonization, high colonization density, and invasive pneumococcal pneumonia among patients hospitalized with acute lower respiratory tract infections (ALRTIs).
METHODS
In 2010, 4025 cases were enrolled in surveillance in South Africa. A total of 969 of 4025 systematically selected nasopharyngeal-oropharyngeal specimens (24%) were tested for respiratory viruses and Streptococcus pneumoniae by real-time polymerase chain reaction. Of these, 749 (77%) had blood tested for S. pneumoniae.
RESULTS
Pneumococcal colonization was detected in 55% of cases (534 of 969). On multivariable analysis that controlled for age and tuberculosis treatment, infection with influenza virus (adjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1-4.5), adenovirus (adjusted OR, 1.7; 95% CI, 1.1-2.7), rhinovirus (adjusted OR, 1.6; 95% CI, 1.1-2.3), and human immunodeficiency virus (HIV; adjusted OR, 1.6; 95% CI, 1.1-2.4) were associated with pneumococcal colonization. High colonization density was associated with respiratory virus coinfection (adjusted OR, 1.7; 95% CI, 1.1-2.6) and invasive pneumococcal pneumonia (adjusted OR, 2.3; 95% CI, 1.3-4.0), after adjustment for age and sex. Seven percent (52 of 749) had pneumococci detected in blood. On multivariable analysis among colonized cases, invasive pneumococcal pneumonia was associated with HIV (adjusted OR, 3.2; 95% CI, 1.4-7.5), influenza virus (adjusted OR, 8.2; 95% CI, 2.7-25.0), high colonization density (adjusted OR, 18.7; 95% CI, 2.3-155.1), and ≥5 days of hospitalization (adjusted OR, 3.7; 95% CI, 1.7-8.2).
CONCLUSIONS
Respiratory virus infection was associated with elevated colonization density and, in turn, invasive pneumococcal pneumonia.
背景
我们确定了与肺炎球菌定植、高定植密度以及因急性下呼吸道感染（ALRTIs）住院的患者发生侵袭性肺炎球菌性肺炎相关的因素。
方法
2010 年，在南非进行了 4025 例病例监测。对 4025 例系统选择的鼻咽-口咽标本（24%）中的 969 例进行了实时聚合酶链反应检测，以检测呼吸道病毒和肺炎链球菌。其中，749 例（77%）进行了血培养以检测肺炎球菌。
结果
55%的病例（969 例中的 534 例）检测到肺炎球菌定植。在多变量分析中，控制年龄和结核病治疗因素后，感染流感病毒（调整后的优势比 [OR]，2.2；95%置信区间 [CI]，1.1-4.5）、腺病毒（调整后的 OR，1.7；95% CI，1.1-2.7）、鼻病毒（调整后的 OR，1.6；95% CI，1.1-2.3）和人类免疫缺陷病毒（HIV；调整后的 OR，1.6；95% CI，1.1-2.4）与肺炎球菌定植相关。高定植密度与呼吸道病毒合并感染（调整后的 OR，1.7；95% CI，1.1-2.6）和侵袭性肺炎球菌肺炎（调整后的 OR，2.3；95% CI，1.3-4.0）相关，调整年龄和性别后。7%（749 例中有 52 例）的血培养中检出肺炎球菌。在定植病例的多变量分析中，侵袭性肺炎球菌肺炎与 HIV（调整后的 OR，3.2；95% CI，1.4-7.5）、流感病毒（调整后的 OR，8.2；95% CI，2.7-25.0）、高定植密度（调整后的 OR，18.7；95% CI，2.3-155.1）和住院时间≥5 天（调整后的 OR，3.7；95% CI，1.7-8.2）相关。
结论
呼吸道病毒感染与高定植密度相关，进而与侵袭性肺炎球菌肺炎相关。
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