Lesobre V, Azarian R, Gagnadoux F, Harzic M, Pangon B, Petitpretz P
Service de Pneumologie, Centre Hospitalier de Versailles, Le Chesnay.
Presse Med. 1999 Jan 16;28(2):59-66.
Describe the different features of a common disease: Mycoplasma pneumoniae pneumonia.
The hospital files of 10 consecutive patients with microbiologically proven Mycoplasma pneumoniae pneumonia were reviewed retrospectively. These 10 patients were hospitalized over a 15-month period among 150 patients admitted to the Versailles general hospital for community-acquired pneumonia. We compared our series with data in the literature.
Most of the patients with Mycoplasma pneumoniae pneumonia were young apparently healthy adults. A bronchial risk factor (smoking, allergy) was however found in 60% of the patients. The principle symptom was persistent cough (100%), with fever and joint pain, or sometimes headache and signs of ENT involvement. Dyspnea was frequent, related more to associated bronchospasticity than to the severity of the pneumonia. Radiographic findings were quite variable. In one case hemolytic anemia and cold agglutinins suggested the diagnosis. Certain diagnosis was based on positive serology after hospitalization due to the long delay between symptom onset and hospitalization. The prehospital period was characterized by a succession of ineffective empirical antibiotic regimens. In routine practice, macrolides or fluoroquinolones administered for 2 to 3 weeks are the empirical antibiotics of choice. Outcome is generally favorable with rapid clinical and radiological improvement. Antibiotic therapy is not however sufficient alone to achieve improvement in the respiratory impairment: bronchodilators and corticosteroids are necessary to treat the bronchospasticity.
Despite the benign nature of community-acquired pneumonia due to Mycoplasma pneumoniae, clinical manifestations, particularly bronchial inflammation may have important consequences.
描述常见疾病——肺炎支原体肺炎的不同特征。
回顾性分析连续10例经微生物学证实为肺炎支原体肺炎患者的医院病历。这10例患者在15个月期间于凡尔赛综合医院因社区获得性肺炎住院的150例患者中。我们将我们的系列病例与文献中的数据进行了比较。
大多数肺炎支原体肺炎患者为年轻的看似健康的成年人。然而,60%的患者存在支气管危险因素(吸烟、过敏)。主要症状为持续性咳嗽(100%),伴有发热和关节疼痛,或有时伴有头痛和耳鼻喉受累体征。呼吸困难很常见,更多与相关的支气管痉挛有关,而非肺炎的严重程度。影像学表现差异很大。1例患者出现溶血性贫血和冷凝集素提示诊断。由于症状出现与住院之间延迟时间长,确诊基于住院后血清学阳性。院前阶段的特点是一系列经验性抗生素治疗方案无效。在常规实践中,给予2至3周的大环内酯类或氟喹诺酮类药物是经验性选择的抗生素。总体预后良好,临床和影像学迅速改善。然而,抗生素治疗 alone不足以改善呼吸功能损害:支气管扩张剂和皮质类固醇对于治疗支气管痉挛是必要的。
尽管肺炎支原体所致社区获得性肺炎性质良性,但临床表现,尤其是支气管炎症可能产生重要后果。