目的分析医院内暴发性军团菌肺炎的临床特点、诊治过程及暴发原因。
方法回顾性分析6例医院内暴发性军团菌肺炎的临床资料、诊疗过程及暴发原因。
结果6例患者均为武警后勤学院附属医院呼吸与重症医学科医护人员，年龄23～27岁，男1例，女5例，通过尿军团菌1型抗原检测阳性而确诊，感染源系医院空调系统水被军团菌污染所致。6例均发热，体温为37.5～39 ℃，咳嗽及咳痰，1例有纳差、胸闷、胸痛，3例伴头痛，3例肺部可闻及湿性啰音。胸部CT表现为单发或多发小斑片状阴影。无相对缓脉、低钠血症、低磷血症及腹泻等典型消化道症状，也未出现肾脏以及神经系统等的典型肺外表现。
结论本组资料提示，军团菌肺炎临床表现为轻度肺炎，实验室检查电解质在正常范围，影像学表现为双肺或单肺多发小斑片状阴影，与病毒性肺炎易混淆，应注意鉴别。军团菌可来自中央空调系统、热水管道系统，通过呼吸道传播而暴发，应加强医院空调系统的病原菌监测及清洁，防控军团菌医院内感染的暴发。
ObjectivesTo describe the clinical characteristics, diagnosis, treatment and the causes of outbreak of nosocomial pneumonia due to Legionella pneumophila.
MethodsThe medical records of 6 cases of nosocomial Legionella pneumophila pneumonia were retrospectively reviewed, and the clinical data of clinical presentation, treatment, and etiologic diagnosis were analyzed.
ResultsThe 6 patients were health care providers of the Department of Respiratory and Critical Care Medicine of the Affiliated Hospital of Logistics University of PAPF. There were 5 female and 1 male patients, aged 23 to 27 years. The diagnosis of Legionella pneumonia was made based on a positive Legionella urinary I antigen test. In all the 6 cases, the disease was attributable to inhaling contaminated aerosols produced by the air conditioning system in our hospital. All the 6 patients presented with fever of 37.5-39 ℃, and productive cough. One patient had anorexia, dyspnoea, and pleuritic chest pain, while headache was reported in 3 patients. Physical examinations revealed lung rales in 3 patients. Single or multiple patchy infiltrates were found on Chest CT in all patients. However, the typical extrapulmonary manifestations of Legionnaires' disease, including relative bradycardia, hyponatremia, hypophosphatemia and diarrhea, were not present in the 6 patients. Neither neurological abnormalities nor renal involvement were observed.
ConclusionsOur data demonstrated that Legionella pneumonia may be mild with atypical laboratory findings and clinical manifestations, with fever, cough, chest tightness, headache, etc. The radiologic manifestations of Legionella pneumonia were single or multiple patchy infiltrates, similar to those of viral pneumonia, and therefore their differential diagnosis was needed. Legionella pneumophila can outbreak through the respiratory tract, in public places with central air-conditioning system, hot water piping systems and hospitals, and therefore microbiological monitoring, cleaning and disinfection of the water system was required for prevention of the outbreaks of Legionnaires' disease.
李嫣,张玉华,樊毫军,等. 医院内军团菌肺炎暴发六例分析[J]. 中华结核和呼吸杂志,2015,38(4)：294-297.
DOI:10.3760/cma.j.issn.1001-0939.2015.04.013版权归中华医学会所有。
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