Maartens G, Lewis S J, de Goveia C, Bartie C, Roditi D, Klugman K P
Department of Medicine, Groote Schuur Hospital.
S Afr Med J. 1994 Oct;84(10):678-82.
To assess the proportion of cases of community-acquired pneumonia caused by 'atypical' bacteria, including the recently discovered Chlamydia pneumoniae, and to compare the clinical, radiographic and laboratory features of patients with and without 'atypical' bacteria.
A prospective serological study was carried out on consecutive adult pneumonia patients from July 1987 to July 1988. Acute and convalescent sera were tested in batches for antibodies against Legionella pneumophila serogroup 1, C. pneumoniae, Chlamydia psittaci, Coxiella burnetii (phase-2 antigen) and Mycoplasma pneumoniae (IgG and IgM). Records and chest radiographs were examined retrospectively.
Acute and convalescent sera were available from 113 patients. The records of 4 patients could not be traced and 17 patients did not fulfil the inclusion criteria. Thirty-two of these 92 patients (35.9%) were found to be infected with 'atypical' bacteria. The two most common organisms were C. pneumoniae (20.7%) and L. pneumophila (8.7%). There were no differences in the clinical and radiographic features of patients with and without 'atypical' bacteria. Clinicians prescribed erythromycin or tetracyclines with equal frequency in the two groups.
'Atypical' bacteria, especially C. pneumoniae, are a common cause of community-acquired pneumonia in adults in South Africa. This is the first demonstration of an aetiological role of C. pneumoniae in this country. We confirmed the finding of other studies that there are no clinical, radiographic or laboratory features characteristic of 'atypical' bacterial infection in hospitalised patients. This has major implications for therapy, as these organisms respond to erythromycin and tetracyclines, but not to beta-lactam antibiotics.
评估由“非典型”细菌引起的社区获得性肺炎病例的比例，包括最近发现的肺炎衣原体，并比较有和没有“非典型”细菌感染的患者的临床、影像学和实验室特征。
对1987年7月至1988年7月期间连续的成年肺炎患者进行了一项前瞻性血清学研究。对急性期和恢复期血清分批检测抗嗜肺军团菌血清1型、肺炎衣原体、鹦鹉热衣原体、贝纳柯克斯体（二期抗原）和肺炎支原体（IgG和IgM）的抗体。对记录和胸部X光片进行回顾性检查。
113例患者有急性期和恢复期血清。4例患者的记录无法追踪，17例患者不符合纳入标准。在这92例患者中，有32例（35.9%）被发现感染了“非典型”细菌。两种最常见的病原体是肺炎衣原体（20.7%）和嗜肺军团菌（8.7%）。有和没有“非典型”细菌感染的患者在临床和影像学特征上没有差异。两组中临床医生开具红霉素或四环素的频率相同。
“非典型”细菌，尤其是肺炎衣原体，是南非成年人社区获得性肺炎的常见病因。这是该国首次证明肺炎衣原体的病因学作用。我们证实了其他研究的发现，即住院患者中没有“非典型”细菌感染的特征性临床、影像学或实验室特征。这对治疗有重大影响，因为这些病原体对红霉素和四环素敏感，但对β-内酰胺类抗生素不敏感。
