ABSTRACT
The clinical features, laboratory tests, imaging findings, treatment and outcomes of 26 non-HIV infection patients with Pneumocystis jirovecii pneumonia (PJP) diagnosed in our hospital from January 2017 to February 2022 were retrospectively analyzed. There were 19 males and 7 females, with an average age of 44(30, 51)years. All patients had underlying diseases of immunosuppression. The main symptoms included fever in 18 cases (69.2%), cough in 15 cases (57.7%), shortness of breath in 11 cases(42.3%). The laboratory test results showed elevated levels of CRP in 22 cases (95.7%), PCT in 18 cases (78.3%), lactate dehydrogenase in 17 cases (17/19), G test in 14 cases (14/20), and decreased CD4 +T cell count in 14 cases (14/19). Pneumocystis jirovecii pathogen was detected in bronchoalveolar lavage fluid in 16 cases (61.5%), in blood samples in 10 cases (38.5%). Pneumocystis jirovecii was not detected in sputum or bronchoalveolar lavage fluid using smear microscopy. Chest CT showed ground-glass opacity in 25 cases (96.1%). All patients received compound sulfamethoxazole tablet, 21 patients (80.8%) were also treated with other anti-fungal drugs. Among the 26 patients, 1 case (3.9%) received extra-corporeal membrane oxygenation (ECMO), 5 cases (19.2%) received non-invasive ventilation, 7 cases (27.0%) received invasive ventilation, and 13 cases (50.0%) received nasal cannula oxygen therapy. Of the 26 cases, 19 cases(73.1%)developed severe pneumonia. Finally, 21 patients (80.8%) improved and discharged, and 5 patients (19.2%) died. In conclusion, non-HIV infection patients with Pneumocystis jirovecii pneumonia were mainly middle-aged or elderly people with underlying diseases of immunosuppression. The clinical symptoms are mainly fever, cough, and shortness of breath. The imaging manifestations are mainly ground-glass opacity and consolidation opacity. Laboratory tests show elevated CRP, PCT, LDH, and G tests, and decreased CD4 +T cells. Compound sulfamethoxazole-based comprehensive treatment is effective for PJP. The disease is characterized by high proportion of severe pneumonia, fast remission and high risk of mortality.
ABSTRACT
Objective:To analyze the clinical characteristics and pathogenic distribution of severe pneumonia in adults in order to provide basis for clinical diagnosis and treatment.Methods:From June 2021 to April 2022, 145 patients with pneumonia admitted to the Department of Respiratory and Critical Care Medicine of the Second People's Hospital of Guangdong Province. According to whether they meet the diagnostic criteria for severe pneumonia, they were divided into severe ( n=63) and mild ( n=82) groups, and the clinical features between the two groups were compared. At the same time, the role of FilmArray detection in severe pneumonia was discussed. The measurement data were tested using independent sample t test or Mann-Whitney U test, and the counting data were tested using Chi-square test or Fisher exact probability method. Results:The age of the patients in the severe group was (72.67±1.71) years, male patients accounted for 84.1%, and the median hospitalization time was 16 days. Nine patients died in hospital; most of them had fever, shortness of breath, and change of consciousness, accompanied by hypertension, diabetes, cerebrovascular disease, chronic kidney disease, and tumor history. Compared with the mild group, the total number of leukocytes, neutrophil ratio, procalcitonin, and C-reactive protein were higher in the severe group, but the CD3 +, CD4 +, and CD8 + cell counts were lower ( P<0.05). The positive rate of FilmArray detection in the severe group was 81%, and the mixed infection of multiple bacteria accounted for 50%, which was higher than that of traditional culture ( P<0.05). The top four pathogens in severe group were Pseudomonas aeruginosa, Acinetobacter baumannii complex, Klebsiella pneumoniae, and Staphylococcus aureus, which were significantly higher than that in the mild group ( P<0.05). Resistance genes were detected in patients with severe disease, which was significantly higher than that in patients with mild disease (70.7% vs. 17.5%, P<0.05). Conclusions:Severe pneumonia is more common in elderly men, with more basic diseases and poor immunity. FilmArray has a high positive rate and can detect multiple pathogens, which may have a role in the rapid diagnosis of severe pneumonia.
ABSTRACT
Objective To observe the Th17 and regulatory T cells(Tr) equilibrium state as well as their changes of tuberculosis patients in six-month's anti-Tuberculosis treatment.Methods Select thirty-two tuberculosis patients received anti-Tuberculosis treatment while thirty-two healthy volunteers as controls.Flow cytometry was used to analyze Th17 and Tr cells in venous blood at the time of pre-therapy,3th,6th month.Results The ratio of Th17 cells in CD4 cells in tuberculosis patients and volunteers were (1.10±0.39)％,(2.50±1.03) ％,(3.90±1.34) ％,(4.50±1.52)％,respectively; the ratio of Tr cells were (9.17±3.26)％,(6.85±2.73)％,(5.46±1.69)％,(4.35±0.86)％,respectively.Conclusion Tuberculosis could make Th17 cells and Tr cells lost their balance,but the immune equilibrium state may gradually recover after anti-tuberculosis.The change of the amount of immune cells was likely to be the reference indexes to observe the progress of tuberculosis and the treatment effect of anti-tuberculosis.