非嗜肺军团菌血清群 1 导致的军团菌肺炎：六点评分系统的实用性。
Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system.
机构信息
Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan.
Department of Respiratory Medicine, Saiseikai Fukuoka General Hospital, Tenjinn 1-3-46, Chuoku, Fukuoka, Fukuoka, 810-0001, Japan.
出版信息
BMC Pulm Med. 2017 Dec 16;17(1):211. doi: 10.1186/s12890-017-0559-3.
BACKGROUND
Because of a limited number of reports, we aimed to investigate the clinical characteristics of patients with Legionella pneumonia due to non-Legionella pneumophila serogroup 1 and the diagnostic usefulness of the six-point scoring system for such patients compared with patients with pneumonia caused by L. pneumophila serogroup 1.
METHODS
We retrospectively analysed patients diagnosed with Legionella pneumonia due to non-L. pneumophila serogroup 1 between March 2001 and June 2016. We examined the clinical characteristics, including symptoms, laboratory findings, radiologic findings, pneumonia severity, initial treatment and prognosis. We also calculated scores using the six-point scoring system in these patients. Furthermore, we compared the clinical characteristics and six-point scores between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients among hospitalized community-acquired pneumonia patients enrolled prospectively between October 2010 and July 2016.
RESULTS
Eleven patients had pneumonia due to non-L. pneumophila serogroup 1; their median age was 66 years and 8 patients (72.7%) were male. The most common pathogen was L. pneumophila serogroup 3 (6/11), followed by L. pneumophila serogroup 9 (3/11), L. pneumophila serogroup 6 (1/11) and L. longbeachae (1/11). Non-specific symptoms, such as fever and cough, were common. Six patients (54.5%) had liver enzyme elevation, but no patient developed hyponatraemia at <130 mEq/L. Nine patients (81.8%) showed lobar pneumonia and 7 patients (63.6%) manifested with consolidation and ground-glass opacity. Patients with mild to moderate severity comprised 10 (90.9%) by CURB-65 and 5 (45.5%) by the Pneumonia Severity Index. Of all patients, 4 were admitted to the intensive care unit and 3 died despite appropriate empiric therapy. The clinical characteristics were not significantly different between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients (n = 23). At a cut-off value of ≥ 2 points, the sensitivity of the six-point scoring system was 54.5% (6/11) for non-L. pneumophila serogroup 1 patients and 95.7% (22/23) for L. pneumophila serogroup 1 patients.
CONCLUSIONS
Cases of non-L. pneumophila serogroup 1 pneumonia varied in severity from mild to severe and the clinical characteristics were often non-specific. The six-point scoring system was not useful in predicting such Legionella pneumonia cases.
背景
由于报告数量有限，我们旨在研究非嗜肺军团菌血清群 1 引起的军团菌肺炎患者的临床特征，以及与嗜肺军团菌血清群 1 引起的肺炎患者相比，该评分系统对这类患者的诊断价值。
方法
我们回顾性分析了 2001 年 3 月至 2016 年 6 月期间诊断为非嗜肺军团菌血清群 1 所致军团菌肺炎的患者。我们检查了这些患者的临床特征，包括症状、实验室检查、影像学检查、肺炎严重程度、初始治疗和预后。我们还使用六点评分系统计算了这些患者的分数。此外，我们比较了 2010 年 10 月至 2016 年 7 月期间前瞻性纳入的住院社区获得性肺炎患者中，非嗜肺军团菌血清群 1 患者和嗜肺军团菌血清群 1 患者的临床特征和六点评分。
结果
11 例患者患有非嗜肺军团菌血清群 1 肺炎；中位年龄为 66 岁，8 例（72.7%）为男性。最常见的病原体是嗜肺军团菌血清群 3（6/11），其次是嗜肺军团菌血清群 9（3/11）、嗜肺军团菌血清群 6（1/11）和长滩军团菌（1/11）。非特异性症状，如发热和咳嗽，较为常见。6 例（54.5%）患者出现肝酶升高，但无患者发生<130mEq/L 的低钠血症。9 例（81.8%）患者表现为大叶性肺炎，7 例（63.6%）表现为实变和磨玻璃影。根据 CURB-65，10 例（90.9%）患者为轻度至中度严重程度，根据肺炎严重程度指数，5 例（45.5%）患者为中度严重程度。所有患者中，4 例入住重症监护病房，尽管接受了适当的经验性治疗，仍有 3 例死亡。非嗜肺军团菌血清群 1 患者与嗜肺军团菌血清群 1 患者的临床特征无显著差异（n=23）。在≥2 分的截断值时，六点评分系统对非嗜肺军团菌血清群 1 患者的敏感性为 54.5%（6/11），对嗜肺军团菌血清群 1 患者的敏感性为 95.7%（22/23）。
结论
非嗜肺军团菌血清群 1 肺炎的严重程度从轻度到重度不等，临床特征通常不具特异性。六点评分系统对预测此类军团菌肺炎病例无帮助。
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