Клиническая микробиология и антимикробная химиотерапия (May 2018)
Etiology of community-acquired pneumonia in the military personnel
Abstract
Objective. To assess the etiology of community-acquired pneumonia (CAP) in the army recruits using a polymerase chain reaction (PCR) assay. Materials and Methods. Sputum, blood, bronchoalveolar lavage samples and oropharyngeal swabs collected from 255 hospitalized army recruits with radiographically confirmed diagnosis of CAP were tested by PCR assay. The comparator group included 270 otherwise healthy recruits. Detection of Streptococcus pneumoniae, Haemophilus influenzaе, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydophila psittaci, Legionella pneumophila, adenoviruses, Herpes simplex virus I/II, cytomegalovirus was performed by PCR using commercial AmpliSens kits and GenPak DNA PCR test. Results. The specific causative agent of CAP was determined in 94.1% of the enrolled military personnel. S. pneumoniae was a predominant pathogen of CAP. The high S. pneumoniae carriage rate (86.3%) among the military personnel was found. The incidence rates of M. pneumoniae and C. pneumoniae were 14.5±2.2% and 13.7±2.2%, respectively. The highest rates of C. pneumoniae and M. pneumoniae were observed in patients with non-severe CAP (16.2±2.6% and 16.7±2.7%, respectively) compared to significantly lower rates in patients with severe CAP (5.3±3.0% and 7.0±3.4%, respectively; p<0.05). The significance of L. pneumophila and C. psittaci as a cause of CAP in the military personnel was negligible. The adenoviruses were detected in 14.1±2.2% of patients, particularly those with severe CAP (36.8±6.4%). There was found the high incidence of associations between bacterial and bacterial or viral pathogens. Conclusions. PCR is a highly effective method for determining CAP etiology in military personnel, especially during the periods of increased morbidity. The high S. pneumoniae carriage rate among military personnel and its predominant role in the CAP etiology indicate a need for pneumococcal immunization of recruits. The significant proportion of M. pneumoniae and C. pneumoniae among pathogens causing CAP confirms a need to include these pathogens in the algorithm for examination of patients with CAP.
