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目的对某部营区内的群发上呼吸道感染进行病因学研究,以明确诊断,控制并预防疫情扩散。方法采集32例住院患者的血清和咽拭子标本,其中4例有急性期及恢复期双份血清。血清标本采用欧蒙间接免疫荧光法(IFA)和ELISA法进行20种呼吸道相关病原IgM抗体筛查,双份血清进行滴度比较;咽拭子标本进行病毒分离培养和细菌培养。依据血清学结果对咽拭子进行相关病原DNA的提取、扩增及测序分析。结果血清ELISA检测结果显示32例患者中腺病毒IgM阳性12例,肺炎衣原体IgM阳性15例。IFA检测结果显示肺炎衣原体IgM阳性17例,肺炎支原体、流感A病毒、副流感病毒IgM阳性各1例。4例双份血清中肺炎衣原体和腺病毒IgM各有2例滴度呈4倍变化。细菌培养及病毒分离培养均阴性。1例高热患者咽拭子标本3对腺病毒相关引物PCR呈阳性,测序显示为腺病毒11型。采用大环内酯类抗生素进行治疗,大部分病例有效。结论结合临床特征及病原学分析结果,判断此次疫情的原因主要为腺病毒及肺炎衣原体的合并或交替感染。
OBJECTIVE To study the etiology of the group of upper respiratory tract infections in a certain battalion area so as to confirm the diagnosis, control and prevent the spread of the epidemic. Methods Serum and throat swab samples from 32 inpatients were collected, of which 4 had acute and convalescent serum. Serum samples were screened by indirect immunofluorescence assay (IFA) and ELISA for 20 IgM antibodies against respiratory tract-related pathogens. Titers of serum were compared between two serum samples. Throat swab specimens were isolated and cultured for virus isolation and culture. Based on the serological results, the throat swabs were extracted, amplified and sequenced. Results Serum ELISA test results showed that 32 cases of adenovirus IgM-positive in 12 cases, Chlamydia pneumoniae IgM-positive in 15 cases. IFA test results showed 17 cases of Chlamydia pneumoniae IgM positive, Mycoplasma pneumoniae, influenza A virus, parainfluenza virus IgM positive in 1 case. In 4 cases of double serum, Chlamydia pneumoniae and adenovirus IgM each had 2 times titer changes of 4 times. Bacterial culture and virus isolation and culture were negative. Thirteen cases of throat swabs were positive for adeno-associated virus (PCR) in one case of fever and sequenced as adenovirus type 11. Macrolide antibiotics for treatment, most cases effective. Conclusions According to the clinical features and etiological analysis, the main causes of the outbreak are adenovirus and Chlamydia pneumoniae infection.