Heiskanen-Kosma T, Korppi M, Jokinen C, Kurki S, Heiskanen L, Juvonen H, Kallinen S, Stén M, Tarkiainen A, Rönnberg P R, Kleemola M, Mäkelä P H, Leinonen M
Department of Pediatrics, Kuopio University Hospital, Finland.
Pediatr Infect Dis J. 1998 Nov;17(11):986-91. doi: 10.1097/00006454-199811000-00004.
To investigate the etiology of pediatric community-acquired pneumonia, we conducted a prospective, population-based study covering the total population <15 years of age (n = 8851) in 4 municipalities in eastern Finland.
The number of patients was 201; chest radiographs were available for all cases and paired sera for serologic assays were available for >90% of cases. The methods included assays for antibody response to 3 pneumococcal antigens, specific pneumococcal immune complex assays and conventional antibody tests for mycoplasmal, chlamydial and viral infections.
Serologic evidence of specific microbial etiology was obtained in 133 (66%) of the pneumonia patients. Bacterial infection was diagnosed in 102 cases (51%) and viral infection in 51 cases (25%). Streptococcus pneumoniae was the most common agent (57 cases; 28%), followed by Mycoplasma pneumoniae (44; 22%), respiratory syncytial virus (43; 21%) and Chlamydia spp. (29; 14%). Haemophilus influenzae was identified in only 6% and Moraxella catarrhalis in only 3% of the children. More than one specific infection was found in 51 patients (25%). The proportion of pneumococcal cases varied from 24 to 36% by age. Mycoplasma infections were seen mostly in patients > or =5 years and Chlamydia infections in patients > or =10 years of age.
The results of our prospective, strictly population-based study confirm the importance of S. pneumoniae in the etiology of community-acquired pneumonia in children of all ages. M. pneumoniae and Chlamydia pneumoniae are important from the age of 5 years onwards.
为了研究儿童社区获得性肺炎的病因，我们在芬兰东部4个直辖市开展了一项基于人群的前瞻性研究，涵盖了所有15岁以下的人群（n = 8851）。
患者数量为201例；所有病例均有胸部X光片，超过90%的病例有用于血清学检测的配对血清。方法包括检测对3种肺炎球菌抗原的抗体反应、特异性肺炎球菌免疫复合物检测以及针对支原体、衣原体和病毒感染的传统抗体检测。
133例（66%）肺炎患者获得了特定微生物病因的血清学证据。102例（51%）诊断为细菌感染，51例（25%）诊断为病毒感染。肺炎链球菌是最常见的病原体（57例；28%），其次是肺炎支原体（44例；22%）、呼吸道合胞病毒（43例；21%）和衣原体属（29例；14%）。仅6%的儿童中发现了流感嗜血杆菌，仅3%的儿童中发现了卡他莫拉菌。51例患者（25%）发现了不止一种特定感染。肺炎球菌病例的比例随年龄从24%到36%不等。支原体感染多见于5岁及以上患者，衣原体感染多见于10岁及以上患者。
我们这项严格基于人群的前瞻性研究结果证实了肺炎链球菌在各年龄段儿童社区获得性肺炎病因中的重要性。5岁起，肺炎支原体和肺炎衣原体就很重要。
