ObjectiveTo analyze the clinical features of Legionella-associated cavitary pneumonia, and to explore the diagnosis, treatment planning, and clinical management of patients.MethodsThe data of a patient with severe Legionella-associated cavitary pneumonia were collected and analyzed. Databases including PubMed, Ovid, Wanfang, VIP and Chinese National Knowledge Infrastructure were searched for pertinent literatures, using the keyword "Legionella, lung abscess or cavitary pneumonia" in Chinese and English from Jan. 1990 to Jun. 2019. The related literature was reviewed.ResultsA 60-year-old male patient was admitted to hospital because of fever, cough, and expectoration for five days. On presentation, his temperature was 38.3 °C, and pulmonary auscultation revealed rales on the left side of the lungs. Culture of lower airway secretions obtained by bronchoscopy revealed Legionella pneumophila infection, and serotype 6. Chest computerized tomography showed a consolidation in the left lung and an abscess in the left upper lobe. The patient was discharged from the hospital after three months of anti-Legionella treatment (Mosfloxacin, Azithromycin, etc.). Fifteen manuscripts, including 18 cases, were retrieved from databases. With the addition of our case, a total of 19 cases were analyzed in detail. There were 15 males and four females, aged from 4 months to 73 years old. Most of them (14/19, 73.7%) were accompanied by multiple underlying diseases. Initial empiric antimicrobial therapy failed in 15 (78.9%) cases, and 7 (36.8%) patients required combination therapy. The courses of antimicrobial treatment were from 3 to 49 weeks. All except one patient were fully recovered and discharged from hospital.ConclusionsLegionella pneumonia with pulmonary abscess or cavity is rare and often presents with fever. Pulmonary imaging shows infiltration in the initial, but can be free of cavities or abscesses. Most patients have basic diseases. Severe patients often need to be treated in combination with antibiotics for long periods of time.
ObjectiveTo analyze the epidemiological and clinical characteristics of severe cases of coronavirus disease 2019 (COVID-19) in order to provide reference for clinical diagnosis and treatment.MethodThe epidemiological histories, clinical characteristics, laboratory examinations, chest images, and treatment outcomes of 20 confirmed cases of severe COVID-19 admitted to Public Health Clinical Center of Chengdu from January 16th to February 5th, 2020 were retrospectively analyzed.ResultsAmong the 20 patients with severe COVID-19, 12 were male and 8 were female. The age ranged from 34 to 84 years old, with an average of (57.4±16.5) years old. Thirteen patients (65.0%) had one or more co-existing diseases, such as hypertension (9 cases), diabetes (6 cases), and coronary atherosclerotic heart disease (4 cases). Eleven cases (55.0%) had a history of living or traveling in Wuhan, 4 cases (20.0%) had a history of living in non-Wuhan areas of Hubei Province, 3 cases (15.0%) had a history of contact with confirmed COVID-19 patients, while 2 cases had no above-mentioned epidemiological history, but had a history of traveling in non-epidemic areas. The main symptoms were fever (100.0%), cough (100.0%), shortness of breath (75.0%), and fatigue (65.0). Some patients developed into acute respiratory distress syndrome in 3-10 d after onset. The white blood cell count of the patients was normal or decreased, the hypersensitive C-reactive protein and serum amyloid protein significantly increased, while the CD4+ T lymphocyte count and CD56+ natural killer cell count significantly decreased. Sixteen patients (80.0%) were given transnasal hyperbaric oxygenation [among whom 6 patients (30.0%) were transferred to non-invasive ventilator after no improvement], 3 patients (15.0%) were given tracheal intubated ventilator, and 1 patient (5.0%) was treated by tracheal intubated ventilator combined with extracorporeal membrane oxygenation to support breathing. By April 8th, 2020, 3 patients died and the remaining 17 had been cured and discharged, with an average length of hospital stay of 21.4 d. The 3 death cases were all elderly with underlying diseases such as heart disease and pulmonary disease.ConclusionsSevere COVID-19 is associated with hypertension, diabetes, heart disease, and other basic diseases, and some patients develope acute respiratory distress syndrome. Respiratory support may help to improve prognosis.
Objective To investigate the clinical manifestations, diagnosis, treatment and prognosis of psittacosis patients. Methods The clinical features, treatment and prognosis of severe pneumonia caused by Chlamydia psittaci were analyzed and relevant literatures were reviewed. Results An 83-year-old male with a history of type 2 diabetes mellitus was admitted to the hospital for "fever, cough for 5 days and dyspnea for 3 days". Chest CT showed a large mass of increased density in the right lung; CD4+ T lymphocytes had an absolute value of 23 cells/μL; Blood gas analysis showed type Ⅰ respiratory failure; Chlamydia psittaci was detected by metagenomic next-generation sequencing. The patient was diagnosed of severe pneumonia (Chlamydia psittaci), type 2 diabetes mellitus, suspected central nervous system infection. This patient was treated with doxycycline and macrolides antibiotics and discharged from hospital after complete recovery. Literature review showed that patients got infected from contacting sick bird, manifested with multiple system involvement. Respiratory symptoms were common, while central nervous system infection seemed to be rare. The diagnosis of psittacosis depended on serology, nucleic acid detection, pathogen isolation and culture. Metagenomic next-generation sequencing had superiority in the diagnosis of psittacosis. Tetracyclines were the preferable treatment, such as doxycycline or tetracycline, with a duration of at least 10 to 14 days. The prognosis of psittacosis was well, and most of the severe and even life-threatening cases were caused by unclear diagnosis and delayed treatment, and the overall mortality rate was about 1%. Conclusions Psittacosis is one kind of zoonoses. History of poultry exposure is helpful in diagnosis, and metagenomic next-generation sequencing has advantages in diagnosing psittacosis. Tetracyclines are preferred with adequate course of treatment. The overall prognosis is good.
Objective To explore the effects of Metabolic Syndrome (MS) and its components on the condition and prognosis of patients with Severe Pneumonia. Methods 306 patients with severe pneumonia admitted to the intensive care unit of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2020 to July 2023 were included as study subjects.The patients were divided into MS and non-MS groups according to whether they were combined with MS,and into survival and death groups according to 28-day prognosis,and the general data, laboratory indexes, condition and prognostic indexes of the two groups were compared; multifactorial logistic regression was used to analyze the independent risk factors for the prognosis of patients with severe pneumonia. ResultsThe levels of test indicators such as body mass index (BMI), fasting blood glucose (FBG), triglyceride (TG), blood lactate,white blood cell count(WBC),urea phosphate (Urea), creatinine (SCr),as well as the incidence of acute respiratory distress syndrome (ARDS), shock,multiple organ dysfunction syndrome (MODS), rate of endotracheal intubation and mortality, ICU treatment cost,and total treatment cost of the MS group were significantly higher than those of the non-MS group; the levels of high-density lipoprotein cholesterol (HDL-C) and oxygenation index (OI) of the MS group were significantly lower than those of the non-MS group (P<0.05).Multifactorial logistic regression analysis showed that the risk of death from severe pneumonia was 1.276 times higher in combined MS than in no combined MS (95%CI: 1.013, 5.114, P=0.047). Subgroup analyses also showed that the risk of death from non-viral severe pneumonia was 2.147 times higher in those with MS than those without (95%CI: 1.175, 8.428, P=0.023). ConclusionSevere pneumonia with MS may be more severe and may have a worse prognosis.
Objective To develop and validate a nomogram for predicting the risk of weaning failure in elderly patients with severe pneumonia undergoing mechanical ventilation. Methods A retrospective analysis was conducted on the clinical data of 330 elderly patients with severe pneumonia undergoing mechanical ventilation who were hospitalized in our hospital from July 2021 to July 2023. According to their weaning outcomes, they were divided into a successful group (n=213 ) and a failure group (n=117). Univariate analysis and multivariate non-conditional logistic regression analysis were used to explore the factors influencing the weaning failure of mechanical ventilation in elderly patients with severe pneumonia. Results Univariate analysis showed that there were significant differences in age, smoking status, chronic obstructive pulmonary disease, ventilation time, albumin, D-dimer, and oxygenation index levels between the two groups (all P<0.05). Multivariate logistic regression analysis revealed that age ≥65 years, smoking, presence of chronic obstructive pulmonary disease, ventilation time ≥7 days, D-dimer ≥2 000 μg/L, and reduced oxygenation index were risk factors for weaning failure in the elderly patients with severe pneumonia. The nomogram model constructed based on these factors had an area under ROC curve of 0.970 (95%CI 0.952 - 0.989), and the calibration curve demonstrated good agreement between predicted and observed values. Conclusions Age, smoking status, chronic obstructive pulmonary disease, ventilation time, D-dimer, and oxygenation index are influencing factors for weaning failure in elderly patients with severe pneumonia receiving mechanical ventilation. The nomogram model constructed based on these factors exhibits good discrimination and accuracy.
Objective To establish a model for prognosis analysis of severe community-acquired pneumonia in order to find the independent risk factors for mortality. Methods The data of 88 patients with severe community-acquired pneumonia enrolled from 533 community-acquired pneumonia patients in Fujian Provincial Hospital from April 2012 to December 2015 were analyzed, they were divided into a survival group and a death group according to prognosis. The clinical materials of basic data of the population, clinical manifestation, treatment and prognosis and pulmonary severity indexes were collected. Then univariate analysis was used to screen risk factors of death before logistic multivaritae regression was applied to explore independent risk factors. Results The different pathogen groups including viral, bacterial, mixed infection, negative and other groups were compared and no differences were found in mortality (all P>0.05). Univariate analysis revealed antibiotics treatment before admission, higher APACHEⅡ score, higher Chalison's score, septicopyemia, and higher level of procalcitonin, blood urea nitrogen (BUN), blood glucose, lactate could increase death risk for the patients. While antiviral treatment and no invasive mechanical ventilation were determined as protective factors. Logistic multivaritae regression showed three factors including higher lactate and higher serum BUN and higher heart rates were independent death risk factors [OR values were 4.704 (95%CI 0.966-22.907), 1.264 (95%CI 0.994-1.606), and 1.081 (95%CI 1.003-1.165), respectively]. Whereas no invasive mechanical ventilation was protective factor (OR=0.033, 95%CI 0.001-0.764). Conclusion The patients with higher lactate and BUN, higher heart rate and accepting invasive mechanical ventilation have poor prognosis.
ObjectiveTo systematically review the effectiveness of Xuebijing injection combined with routine therapy versus routine therapy alone in treating severe pneumonia. MethodsDatabases including PubMed (1990-2013.4), EMbase (1990-2013.4), The Cochran Library (Issue 4, 2013), CNKI (1982-2013.4), WangFang Data (1990-2013.4), VIP (1989-2013.4) and CBM (1978-2013.4) were searched from inception to April, 2013, for randomized controlled trials (RCTs) on Xuebijing injection for severe pneumonia. Studies were screened according to the inclusion and exclusion criteria, data were extracted, and methodological quality was evaluated. Meta-analysis was then performed using RevMan 5.2 software. ResultsA total of 12 studies involving 860 patients were included. The results of meta-analysis showed that, routine therapy plus Xuebijing injection had higher total effective and excellent rates, and the combined therapy reduced the average hospitalization days, and they had better improvement in WBC, CRP, CPIS, IL-6, IL-8, TNF-α. ConclusionThis current evidence shows that Xuebijing injection has a better clinical efficacy in treating severe pneumonia. Traditional Chinese herbs with the function of "promoting blood circulation to remove blood stasis" may exert their pharmacological effects via a multi-target way in treating severe pneumonia, which have a great potential for both clinical work and scientific research. Due to the limited quality and quantity of the included studies, better designed RCTs are needed to support Xuebijing's clinical efficacy in the treatment of severe pneumonia.
Severe pneumonia remains a critical global concern. The immune and cytokine imbalance mediated by lymphocytes are related to the severe transformation and tissue damage of pneumonia, and are expected to become potential therapeutic targets for severe pneumonia. This article elaborates on the protection and pathogenic mechanism of lymphocyte in severe pneumonia, and further introduces the clinical application and research status of host-directed immunotherapy in severe pneumonia from two aspects: enhancing host immunity and improving immunopathological damage. It also introduces the challenges faced by immunotherapy in the future clinical translational application, aiming to provide new thinking directions for its clinical diagnosis, treatment, and research.