ObjectiveTo improve the understanding of psittacosis, the clinical data of 8 cases are reviewed. The application of pathogen metagenomics next-generation sequencing (mNGS) in the diagnosis of nocardiosis is also investigated.MethodsThe clinical data of eight patients with psittacosis diagnosed by mNGS in Nanjing Drum Tower Hospital from January 2018 to May 2020 were reviewed. The clinical characteristics, laboratory examination characteristics and imaging changes were analyzed, and the treatment outcome was followed-up.ResultsAmong the eight cases, there were six males and two females, aged 43～83 years old, with an average age of 64±12 years old. Six of them had a clear history of poultry exposure. The major clinical manifestations were fever, cough, dyspnea, etc. Chest high-resolution computed tomography (HRCT) may have solid shadow, ground glass like shadow. Chlamydia psittaci was detected by mNGS in eight patients’ bronchoalveolar lavage fluid. Minocycline or moxifloxacin were administrated, six patients were discharged after their condition improved, and two patients died.ConclusionsThe incidence of psittacosis is low, and its clinical manifestations lack specificity. In the course of the disease, there may be different degrees of fever, cough, sputum, dyspnea and other symptoms. The lungs can be heard with wet rales, chest HRCT can be seen ground glass shadow, consolidation shadow, accompanied by air bronchogram. Chlamydia psittaci can be detected in alveolar lavage fluid by mNGS. The patients need to be treated for a long time, lasting at least 10 to 14 days. Tetracycline drugs should be the first choice, and can be combined with other antibiotics with activity against gram-positive and gram-negative bacteria in critical patients.
Objective To investigate changes of TLR2 mRNA expression in lung of a mouse model of Chlamydia Pneumoniae pneumonitis, and to explore the possible mechanism of signal transduction. Methods Ninety-six male C3H/HeJ mice were randomly divided into four groups as follows: a control group, a model group, a SB203580 intervened group, and a pyrrolidine dithiocarbamate( PDTC) intervened group. Chlamydia Pneumoniae pneumonitis was induced by intranasally inoculated with 4. 0 ×106 IFU/mL of C. Pneumoniae per mouse in the model group and two intervened groups. Then the intervened groups were intraperitoneally injected with the p38MAPK inhibitor SB203580 and nuclear factor kappa B ( NF-κB)inhibitor PDTC, respectively. Six mice in each group were randomly killed in 1st, 4th, 7th and 14th day. The expressional changes of TLR2 mRNA in the mice lung tissue were measured by semi-quantitative RT-PCR. The concentrations of TNF-α in the lung homogenate were measured by ELISA. Results TLR2 mRNA expression in the lung tissue significantly increased after C. Pneumoniae infection, peaking at 4th and 7th days, then decreased after 14th day. Tumor necrosis factor-α( TNF-α) was also elevated in the lung tissue after C. Pneumoniae challenging. Both SB203580 and PDTC treatment effectively inhibited TNF-αand TLR2 mRNA expressions in lung. The inhibitory effect was more obvious by SB203580 treatment. Conclusion C. Pneumoniae can upregulate the expressions of TLR2 and TNF-α in lung, and TLR2/MAPK and TLR2 /NF-κB signal pathways may be involved in Chlamydia Pneumoniae pneumonitis.
Objective To investigate the clinical features of pnuemonia in renal transplant recipients in order to improve the clinical diagnostic and treatment efficacy.Methods The clinical data of 29 recipients with pneumonia following renal transplantation in Peking University People’s Hospital from January 1,1999 to July 31,2006 were collected and analyzed retrospectively.Results Of the 29 cases with pneumonia，one case（3.4%，1/29）were diagnosed as nosocomial acquired pneumonia and twenty eight cases（96.6%，28/29）as community acquired pneumonia.Of the total,cytomegalovirus （CMV） pneumonia were validated in 19 cases, bacteria pneumonia in 10 cases, fungus pneumonia in 3 cases,and Pneumocystis Carini infection in one case while none pathogen were confirmed in 5 cases with pneumonia.37.5%（9/24）cases with pneumonia which pathogen were ascertained were resulted from multiple pathogen infection.Opportunistic organism is the main pathogen of pneumonia in renal transplant recipients and the disease commonly manifested as interstitial pneumonia. 27 cases（93.1%）developed to severe pneumonia in which 15 cases were deteriorated to acute respiratory distress syndrome.Excluding 5 cases who withdrew from the hospital,4 cases （16.7%，4/24）died and 20（83.3%，20/24） cases were cured.During the second to the sixth month especially the second to the thrid month after renal transplantation the recipients were at higher-risk of pneumonia.Conclusions The majority of pneumonia in kidney recipients were severe community acquired pneumonia caused by multiple pathogens.CMV pneumonia and bacteria pneumonia are the most common types and major causes of mortality.Mortality of fungus pneumonia and CMV pneumonia are highest.Proper diagnostic procedures and therapeutic strategies are critical to improve survival rate.
ObjectiveTo analyze the clinical characteristics of coronavirus disease 2019 (COVID-19), identify the high-risk factors which promoted the disease progression into severe or critical cases, and provide clinical guidance.MethodsNinety-six cases of clinically diagnosed coronavirus disease 2019 were collected and analyzed from General Hospital of the Yangtse River Shipping from January 20 to February 14, 2020. According to clinical classification, those cases were divided into two groups: mild group, including common and mild cases, and severe group including severe and critical cases.ResultsThere were more than half of patients ages>60 years old and severe or critical illness (61.5%, 56.3%), and obese patients accounts for 45.8%, the complication of hypertension accounts for 52.1%. The average time from onset to hospitalization was (6.1±2.6) days, and the average hospitalization days were (15.7±6.3) days. Compared with the mild group, the number of male patients in the severe group was more (57.4% vs. 35.7%, P<0.05), the numbers of elderly patients were larger (77.8% vs. 40.5%, P<0.01), and more obese peoples (55.6% vs. 33.3%, P<0.05). Cough symptom was more common in clinical presentation in the severe group (81.5% vs. 61.9%, P< 0.05). Patients with the complication of hypertension or diabetes occupied a higher proportion in the severe group, which were 64.8% vs. 35.7% and 35.2% vs. 14.3% (P< 0.05), respectively. And the rate of hypoxemia in admission of the severe group was significantly higher (79.6% vs. 9.5%, P< 0.01).ConclusionsThe cases of ages>60 years old and severe or critical illness in coronavirus disease 2019 occupy a higher proportion, and the complication of hypertension accounts for high proportion. Men, ages>60 years old, obese, coughing symptoms, with hypertension and / or diabetes, hypoxemia upon admission are high risk factors for progression into severe and critical cases.
After the occurrence of public health emergencies, as the most direct front position, how to carry out medical treatment orderly, effectively, rapidly and safely in a short time has become the focus and difficulty of epidemic control. After the outbreak of 2019 novel coronavirus pneumonia (2019-nCoV), West China Hospital of Sichuan University, as a large-scale general hospital under the supervision of the CPC central committee, put people's life safety and health first, and attach great importance to the prevention and control of the epidemic. This paper introduces the ten measures taken by West China Hospital of Sichuan University to fight against the 2019-nCoV pneumonia, in order to provide reference for other hospitals.
Objective To analyze morbility，risk factors，etiology，treatment and outcome of nosocomial pulmonary fungal infections in respiratory intensive care unit（RICU）.Methods Forty-seven respiratory RICU patients with nosocomial pulmonary fungal infections between July 2000 and June 2005 were retrospectively analyzed.Results All of the 47 cases were clinically diagnosed as probable nosocomial pulmonary fungal infections，with the morbidity of 10.8% significantly higher than general wards（1.8%，Plt;0.005）.COPD and bacterial pneumonia were the major underlying diseases of respiratory system with a percent of 38.30% and 36.17%，respectively.Forty-one patients (87.2%) had risk factors for fungal infections.Compared with general wards，the proportion of Aspergillosis was higher in RICU without significant difference (Pgt;0.1)；the proportions of Candida glabrata and Candida tropicalis were higher too，but that of Candida krusei was relatively low.The effective rate of antifungal treatment was 79.1% and fluconazol was the most common used antifungal agents.The mortality of fungal infection in RICU was higher than that of general wards but without significant difference（Pgt;0.1）.Conclusion The morbidity of nosocomial pulmonary fungal infection in respiratory RICU is higher than that in general wards.The proportions of infection caused by Aspergilli and some Candida resistant to fluconazol is relatively high.Early and effective treatment is needed in these patients considering the poor prognosis.
ObjectiveTo investigate the positive rates of virulence genes ply, lytA and nanA in Streptococcus pneumoniae (SP) strains isolated from different sources and the pathogenesis.MethodsA total of 147 and 24 strains of SP were isolated from sputum and blood samples of hospitalized children in Tongji Hospital of Wuhan from 2015 to 2016, respectively. Such strains of SP were analyzed by automated microbial analyzer VITEK Compact-2 and confirmed by its specific gene pbp2B using regular polymerase chain reaction (PCR) method. Then PCR method was used to detect the carriers of the virulence genes ply, lytA and nanA, and calculated the fatality and hospitalization days of patients.ResultsPositive rates of virulence genes ply, lytA and nanA were 95.9%, 96.6% and 88.4% respectively for 147 strains isolated from sputum, and were 100.0%, 100.0% and 79.2% respectively for those from blood. Between the 147 children with pneumonia and 24 children with septicemia, there was no statistically significant difference in fatality [ 8.3% (2/24) vs. 0.7% (1/147), P=0.052], but there was a significant difference in length of hospital stay [(14.2±2.4) vs. (6.4±1.5) d; t=21.303, P<0.001].ConclusionsThe positive rate of SP virulence gene nanA is lower than those of ply and lytA. The positive rates of SP virulence genes ply, lytA and nanA are similar from different sources. Significant difference may be found for hospitalization days among different types of SP infections.
ObjectiveTo investigate the effect of Gasdermin D(GSDMD) gene knockout on lung injury and reactive oxygen species (ROS)/nod-like receptor protein 3 (NLRP3)/cysteinyl aspartate specific proteinase-1(caspase-1) pyroptosis pathway of pneumonia mice. Methods20 wild-type (WT) male C57BL/6J mice were randomly divided into WT control group and WT model group. 20 GSDMD gene knockout (KO) mice were randomly divided into KO control group and KO model group, each group consisted of 10 animals. The pneumonia model was induced by puncturing the nasal mucosa with a sterile needle and slowly instilling Streptococcus pneumoniae suspension in WT model group and KO model group. Serum and bronchoalveolar lavage fluid (BALF) were collected 7 days after modeling, and the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected; the lung tissues were collected and the dry wet ratio (W/D), pathological changes, the levels of malondialdehyde (MDA), total antioxidant capacity (T-AOC), superoxide dismutase (SOD), ROS activity, and the protein expression levels of GSDMD, GSDMD-N, NLRP3, Caspase-1 were detected. ResultsThe lung tissue of WT model group showed cell infiltration with alveolar septal thickening, the ratio of W/d in lung tissue, the levels of IL-1β, IL-6 and TNF-α in serum and BALF, the levels of MDA, ROS, NLRP3 and Caspase-1 in lung tissue were all higher than those in WT control group, the levels of T-AOC and SOD in lung tissue were lower than those in WT control group (P<0.05), and the levels of serum, BALF and lung tissue in KO control group were not significantly different from those in WT control group (P>0.05) There was no expression of GSDMD-N in the lung tissue of KO model group, lung tissue w/d ratio, serum and BALF levels of IL-1β, IL-6, TNF-α, MDA, ROS activity, GSDMD-N, NLRP3 and Caspase-1 protein expression were lower than those in WT model group, the levels of T-AOC and SOD in lung tissue were higher than those in WT Model Group (P<0.05). ConclusionGSDMD gene knockout attenuates lung injury and inhibits ROS/NLRP3/Caspase-1 pathway in pneumonia mice.
Objective To assess the effectiveness and safety of an aerosol inhalation of ambroxol in accessory treatment of pneumonia. Methods Biomedical databases, including MEDLINE, EMbase, The Cochrane Central Register of Controlled Trials (CENTRAL), CBM-disk and CNKI were searched. Randomized controlled trials (RCTs) and quasi-RCTs that compare aerosol inhalation of ambroxol with placebo or other aerosol inhalation regimens were collected. A critical quality assessment and Meta-analysis were performed for included studies. Results Thirteen RCTs were included and all of them were carried out in China. None of the trials described the method of randomization, allocation concealment, blind, and follow-up. With Juni scales, 13 trials scored C degree. Compared with the control group, aerosol inhalation of ambroxol improved total improvement rate and symptoms, and shortened hospital stay. Although statistical difference was not found in some comparisons, all trials showed beneficial tendency. We didn’t find any RCTs describing the safety of ambroxol aerosol inhalation. Conclusion Because of the low quality of RCTs on ambroxol aerosol inhalation for pneumonia, no reliable conclusion can be drawn from our Meta-analysis. Well-designed RCTs and economic evaluation are urgently needed to evaluate the value and safety of aerosol inhalation of ambroxol in treating pneumonia.
ObjectiveTo compare the clinical effectiveness of Chinese medicine with that of integrated Chinese medicine and antimicrobial drugs in the treatment of pneumonia. MethodsThe electronic medical record (EMR) of patients with pneumonia who were admitted to the Classical Department of Chinese Medicine of Guangdong Hospital of Traditional Chinese Medicine from November 29, 2012 to June 17, 2022 were retrospectively collected. The patients were divided into two groups according to whether they were treated with antimicrobial drugs on the basis of Chinese medicine treatment. The non-exposed group was the traditional Chinese medicine group, and the exposed group was the integrated Chinese medicine and antimicrobial drugs group. Propensity score matching method was used to balance possible confounding factors. COX regression analysis was performed on the matched cohort to compare death rates among the groups, and Kaplan-Meier curve was drawn to evaluate the survival probability during hospitalization. The proportion of maximum oxygen concentration and duration of fever remission were compared between the two groups. ResultsThis study included a total of 898 cases, with the majority (over 95%) falling within the range of mild to moderate severity. After propensity score matching,180 patients remained in each group, among whom the baseline characteristics were comparable. The primary outcome indicators showed that the risk of death during hospitalization was same in the integrated Chinese medicine and antimicrobial drugs group and in the Chinese medicine group (HR=1.52, 95%CI 0.36 to 6.39, P=0.566), the subgroup analysis was consistent with the overall trend of the results, and the differences were not statistically significant. The results indicate that during the hospitalization, the overall and subgroup mortality rates were similar between the two groups. The treatment effectiveness on the disappearance of major symptoms such as fever, cough, sputum production, fatigue, shortness of breath, and chest pain were comparable in both groups. The secondary outcome indicators showed that there was no statistical significance in the comparison of the proportion of maximum oxygen therapy concentration and the stable duration of fever remission between the two groups. ConclusionIn the treatment of patients with mainly mild to moderate pneumonia, the effectiveness of the Chinese medicine group and the integrated Chinese medicine and antimicrobial drugs group in the hospitalization mortality, the disappearance of major symptoms, the proportion of maximum oxygen therapy concentration and the stable duration of fever remission are similar. Chinese medicine has a positive significance in reducing the use of antimicrobials in patients with pneumonia.