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.
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 investigate the high-resolution computed tomography (HRCT) signs of patients diagnosed with the coronavirus disease 2019 (COVID-19) and explore its evolution features during hospitalization.MethodsFrom January 17, 2020 to February 26, 2020, HRCT images from 15 COVID-19 patients were analyzed. All the patients had positive nucleic acid test results of SARS-CoV-2. The imaging features of initial and follow-up of each patient were reviewed and graded based on the severity of lung lesions.ResultsAmong the 15 COVID-19 patients, ground-glass opacity (GGO) was found in 14 cases. Six patients presented with consolidation and 3 with fibrosis. Five patients had multi-lobe involvement. Subpleural distribution pattern was present in 12 patients (80.0%) and peribronchovascular distribution pattern was present in 2 patients (13.3%). The severity score on HRCT images at the follow-up was significantly higher than that at the initial (4.6±3.4 vs. 3.5±2.5, P=0.018 2). Increase of random distribution pattern (5 cases) were also noted at the follow-up.ConclusionsChest HRCT of COVID-19 patients is characterized with GGO mainly distributed in subpleural areas and a rapid progression within a short time interval. HRCT could provide a sensitive monitor to observe disease progression for COVID-19 patients.
ObjectiveTo explore the clinical value of next-generation sequencing (NGS) in the diagnosis of Pneumocystis jirovecii pneumonia (PCP).MethodsTwo patients with Pneumocystis jirovecii pneumonia after lung transplantation were detected by NGS in the sputum and bronchoalveolar lavage fluid. The clinical data, imaging features, laboratory examination and treatment of the two patients were reported. A systematic literature review was performed for similar published cases in PubMed database, using the keywords "lung transplantation/solid organ transplantation" and "Pneumocystis jirovecii".ResultsThere were six references based on the keywords of "lung transplantation " and " Pneumocystis jirovecii ", of which three were case report. Sixty-six lung transplant patients were complicated with Pneumocystis jirovecii in total. The clinical manifestations of Pneumocystis jirovecii pneumonia were fever and dyspnea of different degrees. The diffuse "ground glass" infiltration could be shown on imaging. Computer tomography scan of chest was a sensitive method to detect PCP. Combined immunofluorescence microscope/PCR/serum 3-β-D-glucan could effectively improve the accuracy of microbiology detection. In addition, NGS could quickly and accurately identify pathogenic bacteria, give guidance for treatment and improve prognosis so as to benefit patients well. Trimethoprim/sulfamethoxazole (TMP/SMZ) was the preferred choice for the treatment of PCP patients.ConclusionsPneumocystis jirovecii pneumonia is more common in patients with immunodeficiency or immunosuppression. NGS can help rapid and accurate diagnosis, and the treatment should be early and sufficient.
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.
Objective To investigate drug usage and costs of pneumonia inpatients in Karamay Central Hospital in 2014 and to provide baseline for evidence-based pharmacy study of single disease in respiratory system. Methods The information of drug use and expenditure of pneumonia inpatients were collected from the hospital information system (HIS). We analyzed the data including frequency, proportion and cumulative proportion by Excel 2007 software. Results A total of 309 inpatients were included, among the 78.96% were more than 60 years old. Among the antibiotics single therapy, the frequency of cefoperazone and sulbactam was the highest. Among the antibiotics combination therapy, the frequency of β-lactam antibiotics was the highest. Conclusion Pneumonia inpatients in Karamay Central Hospital are mainly older patients. The β-lactam antibiotics is used most in clinical practice.
ObjectiveTo analyze the clinical characteristics and related prognostic factors of post-renal transplantation pneumonia.MethodsThe clinical data of 89 patients with post-renal transplantation pneumonia in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from 1st January 2014 to 31st December 2015 were collected in the study. Kaplan-Meier method was used to calculate overall survival. Cox analysis was used to analyze the related prognostic factors.ResultsPost-renal transplantation pneumonia occurred mainly within 6 months after renal transplantation. The prominent clinical manifestations were cough (95.5%), fever (56.1%), and dyspnea (12.3%). The mortality of post-renal transplantation pneumonia was 11.2% and all death occurred within 5 months after transplantation. The overall survival rate significantly decreased in the patients with C-reactive protein (CRP) ≥40 mg/L (P<0.001), procalcitonin ≥1 ng/ml (P=0.002), brain natriuretic peptide >100 pg/ml (P<0.001), platelet ≤100×109/L (P<0.001), or those with occurrence time of pneumonia <180 days (P=0.013). Platelet ≤100×109/L could increase the risk of death by 66.6 times (RR=0.015, P=0.006), and CRP ≥ 40 mg/L could increase the risk of death by 20 times (RR=0.05, P=0.029).ConclusionsPost-renal transplantation pneumonia has prominent clinical characteristics. Platelet ≤100×109/L or CRP ≥40 mg/L can increase the risk of death and can be used as an independent prognoctic factor of post-renal transplatation pneumonia.
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.