ABSTRACT
A female patient, years of age 56, having no distinct inducement before 5 d but developed fever, coughing, and shortness of breath, presented in People′s Hospital of Zhongshan with community-acquired pneumonia on March 3rd, 2023. Influenza A virus infection was confirmed on March 11th after performing macro transcriptome sequencing with alveolar lavage fluid, and H3N8 was confirmed with influenza typing afterward, having declared dead on March 16th. This case is a patient with refractory multiple myeloma autologous stem cell transplantation and continuous chemotherapy with immune dysfunction. She has a history of chronic upper respiratory tract infection. Imaging showed a widespread distribution of plaques, solid lesions, and other pneumonia manifestations in both lungs, a severe decrease in the counts of white blood cells, platelets, neutrophils, and lymphocytes, and a significant increase in laboratory inflammation indicators. After the clinical consideration was an acute aggravation of chronic respiratory tract infection and poor effect of anti-bacterial treatment, fungal infection was considered, and antibiotic treatment was changed several times according to the condition. Still, the outcome was poor, and the disease progressed rapidly. Medical workers initiated Oseltamivir antiviral therapy immediately after the alveolar lavage fluid etiology confirmed A-H3N8 influenza. However, due to complex and varied systemic symptoms, including inflammatory storm, sepsis, acute respiratory failure, tachycardia, coagulopathy, and other extrapulmonary organ injuries, she died 19 days after signs due to severe respiratory failure and multiple organ failure.
ABSTRACT
Objective To investigate the application value of single detection and combined detection of 4 kinds of inflammatory indicators of procalcitonin (PCT ) ,high sensitivity C-reactive protein(hs-CRP) ,interleu-kin-6(IL-6) and white blood cell(WBC) in diagnosing type 2 diabetes mellitus(T2DM) bloodstream by analy-zing the levels of peripheral blood PCT ,hs-CRP ,IL-6 and WBC in the T2DM bloodstream infection group and T2DM non-bloodstream infection group .Methods The clinical data in 85 patients with T2DM bloodstream in-fection (T2DM bloodstream infection group ) and contemporaneous 80 cases of T2DM non-bloodstream infec-tion(T2DM non-bloodstream infection group) in this hospital from January 2013 to July 2016 were retrospec-tively analyzed .The levels of various inflammatory indicators in peripheral blood were analyzed .The receiver operating characteristic(ROC) curve of various inflammatory indicators was drawn ,the area under the curve (AUC) and the best cut-off value were calculated .The detection schemes included 24 kinds of schemes such as the single indicator ,2-indicator ,3-indicator and 4-indicator .Results The levels of PCT ,hs-CRP ,IL-6 and WBC in the T2DM bloodstream infection group were significantly higher than those in the T 2DM non-blood-stream infection group ,the difference was statistically significant (P<0 .05) .AUC of PCT ,hs-CRP ,IL-6 and WBC were 0 .909 ,0 .818 ,0 .838 and 0 .760 respectively ,with best cut-off values of 0 .493 ng/mL ,11 .19 ng/mL ,40 .95 pg/mL and 11 .87 × 109/L respectively .The Youden index of PCT was highest (0 .65) and the ac-curacy of IL-6 was highest (83 .33％ ) in the single indicator detection scheme .The Youden index and accuracy of the scheme of PCT/hs-CRP and PCT+hs-CRP+IL-6 were highest in the combined detection scheme .Con-clusion PCT detection has the prominent value in the assisted diagnosis of T 2DM bloodstream infection .Inthe combined detection scheme ,PCT/hs-CRP and PCT+hs-CRP+IL-6 have the highest value in the assisted diagnosis in T2DM bloodstream infection .