論文No1950
The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children: a case–control study
Mejbah Uddin Bhuiyan, Thomas L Snelling, Rachel West, Jurissa Lang, Tasmina Rahman, Caitlyn Granland, Camilla de Gier, Meredith L Borland, Ruth BThornton, Lea-Ann S Kirkham, Chisha Sikazwe, Andrew C Martin, Peter C Richmond, David W Smith, Adam Jaffe, Christopher C Blyth
Thorax 2019;74:261-269.
＜背景＞
小児肺炎の呼吸器病原体はしばしば健康な小児の上気道でも検出され、
肺炎の診断を困難にする。
我々は肺炎の主な病原体を無症状での検出率で補正をし、
将来の診断、治療、予防に役立てようとした。
＜方法＞
ケースコントロール研究を西オーストラリアのパースで18歳未満の小児を対象に行った。
放射線で肺炎と確定した入院小児患者で、コントロールは外来や予防接種外来の健康な小児である。
鼻咽腔スワブを採取し、14種類の呼吸器ウイルスと6種類の細菌種にPCRを行った。
それぞれの病原体に、多変量回帰分析を用いて補正オッズ比(aOR; 95% CI)を行い、
肺炎の人口寄与部分(95% CI)を評価した。
＜結果＞
2015年5月から2017年10月まで、230名のケースと230名のコントロールを登録した。
最低１つの呼吸器ウイルスはケースの57%、コントロールの29%で検出された(aOR: 4.7; 95% CI: 2.8 to 7.8)。
最低１つの細菌種はケースの72%、コントロールの80% で検出された(aOR: 0.7; 95% CI: 0.4 to 1.2)。
RSVウイルスの検出は最も強く肺炎と相関していた(aOR: 58.4; 95% CI: 15.6 to 217.5)。
マイコプラズマ肺炎は肺炎と関連した唯一の細菌であった(aOR: 14.5; 95% CI: 2.2 to 94.8)。
我々は、RSV、ヒトメタニューモウイルス(HMPV)、インフルエンザ、アデノウィルス、マイコプラズマは
それぞれ20.2% (95% CI: 14.6 to 25.5), 9.8% (5.6% to 13.7%), 6.2% (2.5% to 9.7%),
4% (1.1% to 7.1%) and 7.2% (3.5% to 10.8%)の小児入院肺炎の病原体と評価した。
＜感想＞
小児で入院するような肺炎には、RSウイルスやヒトメタニューモウイルスの関与が大きく、
マイコプラズマも関与しているようです（オーストラリア）。
Introduction Respiratory pathogens associated with childhood pneumonia are often detected in the upper respiratory tract of healthy children, making their contribution to pneumonia difficult to determine. We aimed to determine the contribution of common pathogens to pneumonia adjusting for rates of asymptomatic detection to inform future diagnosis, treatment and preventive strategies.
Methods A case–control study was conducted among children <18 years in Perth, Western Australia. Cases were children hospitalised with radiologically confirmed pneumonia; controls were healthy children identified from outpatient and local immunisation clinics. Nasopharyngeal swabs were collected and tested for 14 respiratory viruses and 6 bacterial species by Polymerase chain reaction (PCR). For each pathogen, adjusted odds ratio (aOR; 95% CI) was calculated using multivariate logistic regression and population-attributable fraction (95% CI) for pneumonia was estimated.
Results From May 2015 to October 2017, 230 cases and 230 controls were enrolled. At least one respiratory virus was identified in 57% of cases and 29% of controls (aOR: 4.7; 95% CI: 2.8 to 7.8). At least one bacterial species was detected in 72% of cases and 80% of controls (aOR: 0.7; 95% CI: 0.4 to 1.2). Respiratory syncytial virus (RSV) detection was most strongly associated with pneumonia (aOR: 58.4; 95% CI: 15.6 to 217.5). Mycoplasma pneumoniae was the only bacteria associated with pneumonia (aOR: 14.5; 95% CI: 2.2 to 94.8). We estimated that RSV, human metapneumovirus (HMPV), influenza, adenovirus and Mycoplasma pneumoniae were responsible for 20.2% (95% CI: 14.6 to 25.5), 9.8% (5.6% to 13.7%), 6.2% (2.5% to 9.7%), 4% (1.1% to 7.1%) and 7.2% (3.5% to 10.8%) of hospitalisations for childhood pneumonia, respectively.
Conclusions Respiratory viruses, particularly RSV and HMPV, are major contributors to pneumonia in Australian children.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.