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Introduction: Although Legionella is not the most common pathogen of community-acquired pneumonia, the epidemiological distribution of pneumonia pathogens has changed in recent years, with a gradual increase in some rare pathogens. For example, pneumonia that occurs after water source contamination is mostly caused by Legionella infection. This paper reports the diagnosis and treatment process of a patient after Legionella infection, who had misdiagnosis at the beginning, rapidly progressed to severe disease and combined with fungal infection. This article focuses on the timely and effective treatment of rapidly progressing Legionella pneumonia, in anticipation of a better understanding of the diagnosis and treatment of the disease. Case Presentation: Here, we report a case of legionella infection with the nausea, vomiting as the first symptoms accompanied by weakness, chills, dizziness, abdominal discomfort in a 75-year-old female. The patient had a history of type 2 diabetes for 30 years, diabetic peripheral neuropathy for more than 20 years, arterial hypertension for 10 years, bone hyperplasia for more than 5 years, resection of right-sided thyroid cystadenoma in 1990. The patient had firstly been diagnosed with cholecystitis and gallbladder neck stones, diet abstinence, metronidazole, cefoperazone sulbactam, and rehydration were given. The patient responded poorly to these empiric treatments. The patient was given moxifloxacin in combination with azithromycin after the onset of respiratory symptoms, but the condition continued to deteriorate, and tigecycline was subsequently added. After the mechanical ventilation and the treatment plan adjusting, she improved significantly. Conclusion: Immunocompromised patient combined with underlying diseases are more susceptible to infection in an environment contaminated with Legionella, and the rapid onset and atypical respiratory symptoms make it easy to misdiagnose the disease, thus delaying treatment and leading to further deterioration. Timely diagnosis, early mechanical ventilation and rational drug administration were fundamental to treat Legionella pneumonia.
RESUMO
The purpose of our study was to evaluate the application value of the GOAL questionnaire in screening obstructive sleep apnea (OSA) and to compare it with the other three questionnaires in sleep clinics. A cross-sectional study was conducted in 436 patients who had undergone nocturnal polysomnography in the sleep unit of the First Hospital of Shanxi Medical University between September 2021 and May 2022, and all patients completed the four questionnaires (GOAL questionnaire, STOP-Bang questionnaire, NoSAS score and No-Apnea score) truthfully, and the patients were divided into 3 groups: AHI ≥ 5 events/h group, AHI ≥ 15 events/h group and AHI ≥ 30 events/h group. The predictive effect of the questionnaire on different AHI cut-off values was calculated, and performance of four questionnaires was assessed by the discriminatory ability. This study ultimately included 410 patients, and there were statistically significant differences in gender, age, BMI, neck circumference, clinical symptoms, hypertension, diabetes, AHI, and minimum oxygen saturation between OSA and non-OSA groups (P < 0.05). The AUC for No-Apnea score was 0.79, the AUC for STOP-Bang questionnaire was 0.86, the AUC for NoSAS score was 0.81, and the AUC for GOAL questionnaire was 0.77. These four questionnaires were effective in screening OSA when AHI ≥ 15 events/h. Similar to No-Apnea score, STOP-Bang score and NoSAS score, GOAL questionnaire has a good predictive value for OSA, which is a questionnaire suitable for primary health-care centers and clinics.