Læknablaðið - 15.02.1989, Blaðsíða 18

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LÆKNABLAÐIÐ
Af þremur algengustu orsökum lungnabólgu í
rannsókninni var dánarhlutfall hæst af völdum
H. influenzae en lægst af völdum Legionella spp
og rennir það frekari stoðum undir þá kenningu
að legionellosis komi oft fyrir sem væg
lungnabólga (19, 20). Mun hærra dánarhlutfall
var meðal sjúklinga sem veiktust af lungnabólgu
meðan á dvöl á sjúkrahúsinu stóð en innlagðra
sjúklinga og á það vafalaust rætur að rekja til
undirliggjandi sjúkdóma. Sjúklingar sem létust af
völdum candida albicans sýkingar og
cytomegaloveiru sýkingar höfðu hlotið
mótefnabælandi meðferð vegna illkynja
sjúkdóms.
Flest tilfelli lungnabólgu greindust yfir
vetrarmánuðina og á það jafnt við um
inniliggjandi sjúklinga sem innlagða. Þessi
árstíðasveifla var svipuð fyrir Streptococcus
pneumoniae, Haemophilus influenzae og
Legionella spp. Árstíðasveifla fyrir legionellosis
líkist frekar því sem lýst hefur verið í Danmörku
(19) og Englandi (2) heldur en í Bandaríkjunum
(25) þar sem dátapest er algengust á sumrin og
haustin.
Við meðhöndlun sjúklinga með lungnabólgu er
nauðsynlegt að hafa í huga að Streptococcus
pneumoniae, Haemophilus influenzae og
Legionella spp greindust í meira en helmingi
lungnabólgusjúklinga á Borgarspítalanum og að
Staphylococcus aureus fannst eingöngu í
sjúklingum eldri en 70 ára.
SUMMARY
In order to investigate the epidemiology and etiology of
pneumonia in adult Icelandic patients a prospective
study was performed on the medical department of
Reykjavík City Hospital. Pneumonia was diagnosed on
105 occations in 97 patients during a period of 12
months, community acquired on 82 occations and
hospital acquired on 23 occations. Etiologic agents were
found in 65% of the cases and mixed infections were
found in 11% of the patients. Most often Streptococcus
pneumoniae (26%), Haemophilus influenzae (15%) and
Legionella spp (14%) were found and no significant
difference was noted in community and hospital
acquired pneumonias regarding these three bacteria.
Staphylococcus aureus and gram negative
enterobacteriae were found in 6% and 5% of the cases
respectively. The patients’ median age was 71 years
(range 16-94 years) and case fatality ratio was 15% for
community acquired pneumonias and 35% for hospital
acquired pneumonias.
HEIMILDIR
1. Sullivan RJ, Dawdle WR, Marine WM, Hierholzer
JC et al. Adult pneumonia in a general hospital.
Arch Intern Med 1972; 129: 935-42.
2. MacFarlane JT, Finch RG, Ward MJ, Macgraf AD
et al: Hospital study of adult community acquired
pneumonia. Lancet 1982; ii: 255-8.
3. Guðbjörnsson B, Þorsteinsson SB, Kristinsson KG
et al. Lungnabólga - orsakir og gildi
greiningaraðferða. Læknablaðið 1987; 73: 359-63.
4. Simmons BP, Wong ES. Guideline for prevention
of nosocomial pneumonia. Infection control 1982;
3: 327-32.
5. Murray PR, Washington II JA. Microscopic and
bacteriologic analysis of expectorated sputum.
Mayo Clinic Proc 1975; 50: 339-44.
6. Kalin M, Lindberg AA, Tunevall G. Etiological
diagnosis of bacterial pneumonia by Gram stain
and quantitative culture of expectorates. Scand J
Infect Dis 1983; 15: 153-60.
7. Collins MT, Cho SN, Reif JS. Prevalence of
antibodies to Legionella pneumophilia in animal
populations. J Clin Microbiol 1982; 15: 130-6.
8. Farshy CE, Cruce DD, Klein Gc, Wilkinson HW,
Feeley JC. Immunoglobulin Specificity of the
Microagglutination Test for the Legionnaires’
Disease Bacterium. Ann Intern Med 1979; 90: 690.
9. Woodhead MA, MacFarlane JT, MacCracken JS,
Rose DH, Finch RG et al. Prospective study of the
aetiology and outcome of pneumonia in the
community. Lancet 1987; i: 671-4.
10. McNabb WR, Shanson DC, Williams TDM, Lant
AF et al. Adult community-acquired pneumonia in
central London. J R Soc Med 1984; 77: 550-5.
11. Davies AJ, Dyas A. Hospital-acquired infection
with Streptococcus pneumoniae. J Hosp Inf 1985;
6: 98-101.
12. Hirshmann JV, Everett ED. Haemophilus
influenzae infection in adults: Report of nine cases
and review of the litterature. Medicine 1979; 58:
80-91.
13. Berk SL, Holtsclaw SA, Wiener SL, Smith JK et al.
Nontypable Haemophilus influenzae in the elderly.
Arch Int Med 1982; 142: 537-39.
14. Levin DC, Schwartz MI, Matthay RA, LaForce FM
et al. Bacteremic Haemophilus influenzae
pneumonia in adults. A report of 24 cases and a
review of the litterature. Am J Med 1977; 62:
219-23.
15. Everett ED, Rahm AE, Adaniya R, Stevens DL,
McNitt TR et al. Haemophilus influenzae
pneumonia in adults. JAMA 1977; 238-321.
16. Musher DM, Kubitschek KR, Crennan J, Baughn
RE et al. Pneumonia and acute febrile
tracheobronchitis due to Haemophilus influenzae.
Ann Intern Med 1983; 99: 444-50.
17. Editorial. How common is Legionnaires’ disease?
Lancet 1983; 1: 103-4.
18. Winn WC, Jr. Legionella and Legionnaires’
disease: A review with emphasis on environmental
studies and laboratory diagnosis. CRC Crit Rev
Clin Lab Sci 1985; 21: 323-81.
19. Friis-Mller A, Rechnitzer C, Black FT, Collins MT,
Lind K, Aalund O et al. Prevalence of
Legionnaires’ disease in pneumonia patients
admitted to a danish department of infectious
diseases. Scand J Infect Dis 1986; 18: 321-8.
20. Yu VL, Kroboth FJ, Shonnard J, Brown A,
McDearman S, Magnussen M et al. Legionnaires’
disease: A new clinical perspective from a