热带斯里兰卡两家三级护理医院患者肺炎支原体 DNA 检测和特异性抗体类别反应。
Mycoplasma pneumoniae DNA detection and specific antibody class response in patients from two tertiary care hospitals in tropical Sri Lanka.
机构信息
1Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya, Sri Lanka.
2Department of Microbiology and Infectious Diseases, School of Biological Sciences, University of Adelaide, Institute of Medical and Veterinary Science (IMVS), Adelaide, SA 5005, Australia.
出版信息
J Med Microbiol. 2018 Sep;67(9):1232-1242. doi: 10.1099/jmm.0.000813. Epub 2018 Aug 3.
PURPOSE
Respiratory tract infections are a major cause of global morbidity and mortality. Pneumonia is the ninth leading cause of mortality in Sri Lanka. Atypical pathogens cause about one-fifth of community-acquired pneumonia, while Mycoplasma pneumoniae accounts for about 50 %. This study aimed to determine the seroprevalence of M. pneumoniae respiratory tract infections in Sri Lanka while attempting to understand the relationships between the serology and PCR.
METHODOLOGY
Paired sera from 418 adult patients (pneumonia, n=97; bronchitis, n=183; pharyngitis, n=138) and 87 healthy controls were studied. IgM, IgG and IgA antibodies were tested by M. pneumoniae enzyme-linked immunosorbent assay (ELISA). Positive IgM and or IgG seroconversion was considered to be seropositive. M. pneumoniae DNA were tested by PCR in age and gender-matched seropositives and seronegatives.
RESULTS
M. pneumoniae IgG was in 14.4 % (14/97), 6.0 % (11/183) and 1.5 % (2/138) of pneumonia, bronchitis and pharyngitis patients, respectively, whilst IgM was in 6.2 % (6/97), 1.1 % (2/183) and 0 % (0/138), respectively. Amongst the pneumonia seropositives, 64.7 % (11/17) showed IgG alone, 17.5 % (3/17) showed IgM alone and 17.5 % (3/17) showed IgM and IgG. Amongst the bronchitis seropositives, 84.6 % (11/13) had IgG alone and 15.4 % (2/13) had IgM alone. In the pharyngitis seropositives, only IgG was detected 100 % (2/2). M. pneumoniae DNA was in 52.2 % (12/23) of seropositives and 15.4 % (4/26) of seronegatives. In pneumonia or bronchitis patients, specific DNA was in 77.8 % (7/10) and 50 % (6/12) of patients, respectively. M. pneumoniae DNA was not found in pharyngitis patients. Of the seropositive PCR-negative pneumonia patients, 66.7 % (2/3) showed IgG alone and 33.3 % (1/3)showed IgM alone. In bronchitis patients, 83.3 % (5/6) showed IgG alone and 16.7 % (1/6) showed IgM alone. Of the seronegative PCR-positive patients, 16.7 % (2/12) had pneumonia and 18.2 % (2/11) had bronchitis.
CONCLUSION
The serological evidence for M. pneumoniae infection in Sri Lanka comprised the following prevalences: 17.5 % (17/97), 7.1 % (13/183) and 1.4 % (2/138) in adults with pneumonia, bronchitis or pharyngitis, respectively. M. pneumoniae DNA was in 52.2 % (12/23) of seropositives and 15.4 % (4/26) of seronegatives. IgG was predominant in PCR positives and negatives.
目的
呼吸道感染是全球发病率和死亡率的主要原因。肺炎是斯里兰卡第九大死亡原因。非典型病原体导致约五分之一的社区获得性肺炎，而肺炎支原体约占 50%。本研究旨在确定斯里兰卡肺炎支原体呼吸道感染的血清流行率，同时试图了解血清学和 PCR 之间的关系。
方法
对 418 名成年患者（肺炎患者 97 例，支气管炎患者 183 例，咽炎患者 138 例）和 87 名健康对照者的配对血清进行了研究。采用肺炎支原体酶联免疫吸附试验（ELISA）检测 IgM、IgG 和 IgA 抗体。阳性 IgM 和/或 IgG 血清转化被认为是血清阳性。在年龄和性别匹配的血清阳性和阴性患者中，通过 PCR 检测肺炎支原体 DNA。
结果
肺炎、支气管炎和咽炎患者的肺炎支原体 IgG 分别为 14.4%（97/678）、6.0%（11/183）和 1.5%（2/138），IgM 分别为 6.2%（97/678）、1.1%（2/183）和 0%（0/138）。在肺炎血清阳性者中，64.7%（11/17）仅表现为 IgG 阳性，17.5%（3/17）仅表现为 IgM 阳性，17.5%（3/17）同时表现为 IgM 和 IgG 阳性。在支气管炎血清阳性者中，84.6%（11/13）仅表现为 IgG 阳性，15.4%（2/13）仅表现为 IgM 阳性。在咽炎血清阳性者中，仅检测到 IgG 100%（2/2）。52.2%（12/23）的血清阳性者和 15.4%（4/26）的血清阴性者中检测到肺炎支原体 DNA。在肺炎或支气管炎患者中，特异性 DNA 分别在 77.8%（10/13）和 50%（6/12）的患者中发现。在咽炎患者中未发现肺炎支原体 DNA。在血清阳性 PCR 阴性肺炎患者中，66.7%（2/3）仅表现为 IgG 阳性，33.3%（1/3）仅表现为 IgM 阳性。在支气管炎患者中，83.3%（5/6）仅表现为 IgG 阳性，16.7%（1/6）仅表现为 IgM 阳性。在血清阴性 PCR 阳性患者中，16.7%（2/12）有肺炎，18.2%（2/11）有支气管炎。
结论
斯里兰卡肺炎支原体感染的血清学证据包括以下流行率：成人肺炎、支气管炎和咽炎患者分别为 17.5%（17/97）、7.1%（13/183）和 1.4%（2/138）。52.2%（12/23）的血清阳性者和 15.4%（4/26）的血清阴性者中检测到肺炎支原体 DNA。IgG 在 PCR 阳性和阴性者中均占优势。
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