| Objective The purpose of this prospective study to understand the pathogens in patientswith pneumonia of unkown aetiology in Anhui, to analyze factors that may influencethe distribution of pathogens, to summary the clinical characteristics and the factors ofclinical outcome in patients with unexplained pneumonia, to preliminary explore thedetection process about pneumonia of unkown aetiology, at the same time to understandthe relationship between unexplained penumonia and public wealth emergencies, toaccumulate information regarding the prevention and control in patients withpneumonia of unkown aetiology in Anhui.Methods A multicentre prospective study was performed on60consecutive adultpatients with pneumonia of unkown aetiology (observation group) from August2010toJuly2011in Anhui.The clinical character, therapy and prognosis of the patients withpneumonia of unkown aetiology was recorded.Sputum samples in all patients werecollected for bacteria culture and acid-fast staining, blood samples in patients with highfever were collected for bacteria culture. Throat swab and sputum samples werecollected to deteceted nucleic acid of influenza virus, SARS coronavirus by RT-PCRmethod and to deteceted nucleic acid of Mycoplasma pneumoniae, Chlamydiapneumoniae and Legionella pneumophilia by PCR method. Antibodies of the serumsamples to Respiratory syncytial virus, Influenza virus A/B, Adenovirus, Parainfluenzavirus, Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophiliaantigen in urine were detected by ELISA method.60cases of healthy persons were ascontrol group during the same period. Results We selected544patients with community-acquired pneumonia, there are60patients with pneumonia of unkown aetiology among544patients. We did not findunexplaind-pneumonia. Pathogen detection results: the rate of virus infection is23.3%,H1N1influenza virus (50.0%) is the most common pathogen, followed by Parainfluenzavirus and Respiratory syncytial virus (14.2%), the rate of infection is atypical pathogensinfection is15.0%, Mycoplasma pneumoniae is the most common pathogen, followedby Chlamydia pneumoniae, there is no Legionella pneumophilia, the rate of is fungiinfection is10.0%(pneumocystis3cases, aspergillus2cases, cryptococcal1case), therate of is bacterial infection is5.0%(mycobacterium tuberculosis2cases,staphylococcus aureus1case), we also detected tsutsugamushirickettsia,schistosomiasis and toxoplasma each1cases, we did not SARS coronavirusand Avian influenza H5N1virus, Mixed infection is6cases (10.0%),31cases were notdetected in the pathogen (51.7%).The impact of pathogen distribution in patients: Therate of pathogen detection is different in different seasons (P>0.05), The virus is mainlydistributed in the winter and spring, The bacteria is mainly distributed in the winter,Atypial patogens and fungi are not significant in the distributiong in the four seasons(P>0.05). The distribution of pathogens is similar to the different pneumonia riskstratification, different ages and different geographical areas (Hefei region andsurrouding areas) in patients with pneumonia of unkown aetiology (P>0.05).60cassesof patients with pneumonia of unkown aetiology admitted to hospital use ofantimicrobial agents, macrolide combined β-lactams had the largest proportion,followed by theβ-lactams combined quinolone, accoutting for30.0%,23cases ofpatients with antimicrobial drug use unreasonable.40cases of patients with pneumoniaof unkown aetiology are effective treatment in60cases patients, neffective in14cases,6cases with non-assessment, patients with underlying diseases than the unconsolidateunderlying diseases in patients with poor clinical efficancy (P<0.05), single use ofantimicrobial agents and joint drug efficacy (P>0.05), rational use of antibiotics compared to the irrational use of good clinical efficacy of antibacterial drugs (P<0.05).There is significant difference between nucleic acid detection and serum ELISA(P>0.05).Conclusion Mycoplasma pneumoniae and H1N1influenza virus remain the mostcommon pathogens in patients with pneumonia of unkown aetiology in Anhui. Mixedinfection shoud not only be ignored, fungal infections is increasing, such as parasite,rickettsia are rare pathogens in patients with pneumonia of unkown aetiology. SARScoronavirus and avian influenza H5N1virus infections were not found in one year studyin Anhui. The distribution of pathogens is unrelated with age, severity and region whilerelated to season. Underlying disease and antimicrobial agents are closely related toclinical efficacy in patients with pneumonia of unkown aetiology. There is significantdifference between nucleic acid detection with serum ELISA in the positive rate ofdetection of pathogens. |
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