Csángó P A, Haraldstad S, Pedersen J E, Jagars G, Føreland I
Department of Clinical Microbiology, Vest-Agder Central Hospital, Kristiandsand S. Norway.
Scand J Infect Dis Suppl. 1997;104:26-9.
The objective of this investigation was to determine whether Chlamydia pneumoniae was involved in an outbreak of respiratory disease among military recruits, 92 patients (average age 20.1 years) were included in the study if they had a sore throat or cough for more than 1 week. In addition to sore throat and cough, fatigue, headache, dyspnoea and vertigo were the most frequent symptoms. The patients received standard treatment with 100 mg of doxycycline b.i.d. for 14 days. In 38.8% of cases symptoms were alleviated after 1-2 weeks of treatment, and in 22.4% of cases after 2-3 weeks of treatment. Pretreatment throat washings and sera were sampled for Chlamydia. Sera were drawn for Chlamydia, Mycoplasma and adenovirus serology. Cell culture (Hep-2) and 3 different serological methods-microimmunofluorescence (MIF), enzyme immunoassay with a recombinant glycoconjugate antigen (r-EIA) and immunoperoxidase assay (IPA)-were used. Cell culture was found to have too low a sensitivity to be of diagnostic value. Acute infection was demonstrated in 13% by MIF IgM and in an additional 21% by MIF IgG (titre rises). Enzyme immunoassay IgM was found in 17% and IPA IgM in 19% of individuals without MIF IgM antibodies. Microimmunofluorescence was found to be the most useful test for serodiagnosis. The combination of serological methods showed that 40 out of 52 (76.9%) had an acute infection with possible chlamydial aetiology. In conclusion, methodological improvements are necessary for the aetiological diagnosis of chlamydial respiratory infections.
本调查的目的是确定肺炎衣原体是否与新兵呼吸道疾病暴发有关。如果92名患者（平均年龄20.1岁）出现咽痛或咳嗽超过1周，则将其纳入研究。除咽痛和咳嗽外，疲劳、头痛、呼吸困难和眩晕是最常见的症状。患者接受标准治疗，口服100mg强力霉素，每日2次，共14天。38.8%的病例在治疗1-2周后症状缓解，22.4%的病例在治疗2-3周后症状缓解。采集治疗前的咽洗液和血清用于检测衣原体。采集血清用于检测衣原体、支原体和腺病毒血清学。采用细胞培养（Hep-2）和3种不同的血清学方法——微量免疫荧光法（MIF）、重组糖缀合物抗原酶免疫法（r-EIA）和免疫过氧化物酶法（IPA）。发现细胞培养的敏感性过低，无诊断价值。MIF IgM检测出13%的患者为急性感染，另外21%的患者通过MIF IgG（滴度升高）检测为急性感染。在无MIF IgM抗体的个体中，17%检测到酶免疫法IgM，19%检测到IPA IgM。发现微量免疫荧光法是血清学诊断最有用的检测方法。血清学方法联合检测显示，52例中有40例（76.9%）存在可能由衣原体引起的急性感染。总之，衣原体呼吸道感染的病因诊断需要改进方法。
