Severe <Emphasis Type="Italic">Chlamydophila psittaci</Emphasis> pneumonia rapidly diagnosed by detection of antigen in sputum with an immunochromatography assay

We report a case of severe Chlamydophila (Chlamydia) psittaci pneumonia rapidly diagnosed by detection of antigen in sputum with an immunochromatography assay. The patient was admitted to our hospital because of shock, disturbance of consciousness, accidental hypothermia, and multiple organ dysfunction syndrome, and he recovered after administration of intravenous erythromycin and high-dose methylpredonisolone therapy. Psittacosis was confirmed by detection of 16S rRNA gene of C.psittasi in sputum with multiplex-polymerase chain reaction analysis. Serological responses to C. psittasi, C. trachomatis, and C. pneumoniae were also evaluated, and serological cross-reactivity was observed between each species. We consider that the commercially available immunochromatography assay for Chlamydia species can be helpful for rapid diagnosis of Chlamydia infection of the respiratory tract. Hereafter, further examination will be necessary regarding pretreatment of specimens or detection sensitivity and specificity.     

<Emphasis Type="Italic">Pasteurella multocida</Emphasis> septicemia caused by close contact with a domestic cat: case report and literature review

We report here a case of Pasteurella multocida infection caused by cat exposure presenting with septic shock, sinusitis, and pneumonia. The patient was a febrile 20-year-old woman who had been experiencing disturbed consciousness progressively. She had close contact with a domestic cat and had received some scratches on both arms. A magnetic resonance imaging (MRI) scan of the head showed a high intensity in the paranasal cavity, and a computed tomographic (CT) scan of the chest showed bilateral lung consolidations. The pathogen was identified as P. multocida by the cultures from blood and nasal discharge. She was given intensive antibiotic therapy with ceftriaxone and piperacillin, continuous hemodiafiltration (CHDF) therapy, and anticoagulation therapy. Owing to these therapeutic regimens, the septic shock was successfully treated without complications. We also review the literature on P. multocida septicemia.     

Production of reactive oxygen species by central venous and arterial neutrophils in severe pneumonia and cardiac lung edema

Objective: In pneumonia the influx of neutrophils to the lungs is thought to be of primary importance with regard to host defence and to complications like the adult respiratory distress syndrome. We wanted to evaluate the neutrophil function in patients in acute respiratory failure who required admission to the intensive care unit. Design: We determined the luminol-enhanced chemiluminescence (CL) of neutrophils isolated both from central venous and arterial blood. In addition, the plasma-concentrations of α₁-proteinase inhibitor, (α₁PI), α₂-macroglobulin (α₂PI) and elastase-α₁PI-complex (elastase) were determined by chemiluminescence immunoassay, and the intracellular elastase content of blood neutrophils was determined using immuno activation assay. Patients: 28 Patients, 18 with acute pneumonia (group 1) and 10 with cardiac pulmonary edema (group 2). Measurements and results: In group 1, luminol enhanced CL was significantly higher than in group 2 (mean 87.7 vs 30.4×10⁶ counts per minute, p<0.01). The production of reactive oxygen species was significantly higher in central venous than in arterial neutrophils in the patients with pneumonia (p<0.03). In patients with pulmonary edema there was no such difference. The plasma concentration of elastase in group 1 was significantly higher than in group 2, that of α₂PI were significantly lower. The intracellular elastase content of neutrophils was lower in group 1 than in group 2. In group 1, there was a trend for a correlation between lower intracellular elastase content and a higher elastase plasma concentration. There were no central venous – arterial differences with regard to leukocyte count, cell differential or protein concentration in either group. Conclusion: The central venous – arterial differences in neutrophil production of reactive oxygen species support the concept of compartmentalization of activated neutrophils from the systemic to the pulmonary compartment. Received: 15 June 1995 Accepted: 18 September 1996     

免疫功能低下患者巨细胞病毒性肺炎的诊断和治疗

目的：探讨免疫功能低下患者巨细胞病毒（CMV）肺炎的诊断和治疗. 方法：对31例免疫功能低下患者CMV肺炎的临床资料进行回顾性分析.结果：均接受免疫抑制剂治疗.接受移植手术者27例,死亡7例,CMV肺炎相关病死率22.2%;患有免疫系统疾病者4例,死亡3例,CMV肺炎相关病死率75%.结论：对器官移植患者和长期接受免疫抑制剂治疗的免疫功能低下患者应加强对CMV的监测,早期诊断,及时应用以更昔洛韦为主的综合治疗.     

氨溴索雾化吸入治疗新生儿肺炎的疗效观察

目的探讨氨溴索雾化吸入对新生儿肺炎的疗效。方法选择我院诊断为新生儿肺炎的患儿144例,随机分为治疗组和对照组,对照组给予常规治疗,治疗组在常规治疗基础上加用氨溴索雾化吸入。比较两组治疗前后体温、呼吸频率、心率、总有效率和不良反应发生率。结果与治疗前比较,两组T、RR和HR明显降低,差异有统计学意义,P〈0．05;与对照组比较,治疗组RR和HR明显降低,差异有统计学意义（P〈0．05）。治疗组总有效率明显高于对照组,差异有统计学意义（P〈0．05）。两组均无特殊不良反应发生。结论氨溴索雾化吸入治疗新生儿肺炎安全、有效。     

炎性肿块肺纤维化组织中miR-21和TGFβ1的表达变化

[目的]观察炎性肿块肺纤维化组织中miR-21和转化生长因子β1(transforming growth factorβ1,TGFβ1)的表达变化,探讨两者的表达变化是否与肺纤维化形成有关.[方法]选择10例炎性肺部肿块标本,每例分别按纤维化组织和旁近正常肺组织配对留取,所有标本均采用Real-time PCR方法检测组织中miR-21和TGFβ1的表达量变化,分析其表达是否与肺纤维化有关.[结果]肺纤维化组织中miR-21和TGFβ1的表达明显高于正常旁近肺组织,且两者相比较差异均有显著性(P＜0.01).[结论]miR-21和TGFβ1在炎性肿块肺纤维化组织中高表达,其高表达与炎症导致的肺纤维化形成有关.     

多层螺旋CT后处理技术在局灶性肺炎的临床应用

目的探讨多层螺旋CT后处理技术对局灶性肺炎的诊断价值。方法多层螺旋CT扫描经病理证实的局灶性肺炎35例,分析薄层重建、多平面重建(MPR)及容积显示技术(VRT)对局灶性肺炎征象的显示及价值,并与常规横断面对比分析。结果35例病灶均位于肺野周边部,病变以宽基底与胸膜相连26例,病变边缘呈锯齿状或有粗长毛刺28例,具有周围血管充血聚拢25例,多层螺旋CT薄层重建、MPR及VRT在显示局灶性肺炎的形态、支气管血管集束征及与胸膜的关系方面优于常规横断面。结论多层螺旋CT通过薄层重建配合MPR、VRT能够克服横断扫描限制,在不增加病人辐射剂量的情况下,能够更加直观、立体地显示局灶性肺炎的基本征象,为局灶性肺炎的诊断提供更多信息。     

Poster 31: Community-acquired pneumonia in veterans with spinal cord injury

Objective: To describe the characteristics of community-acquired pneumonia (CAP) in persons with spinal cord injury (SCI) and how management is related to outcomes. Design: Cross-sectional retrospective review of administrative and clinical data. Setting: Department of Veterans Affairs (VA) facilities, and for substudy, 3 VA SCI centers (October 1998-September 2000). Participants: Veterans with SCI: 260 inpatients with CAP; in the substudy, 41 inpatients and outpatients with CAP from 3 sites. Interventions: Not applicable. Main Outcome Measures: Percentage of patients with an etiologic diagnosis, mortality rate, mean length of stay (LOS), and number and types of procedures and treatments. Results: Of the 260 inpatients with SCI identified from administrative data with CAP, only 24% had an etiologic diagnosis. Etiologic diagnosis was not associated with mortality after adjusting for several factors (OR=1.38; CI, 0.45-4.20), however, it was associated with an increase in LOS (P=.024). For the substudy, almost 75% of the 41 patients were hospitalized (mean LOS=16.3d) and 3 patients died. Most received chest radiographs (85%), but up to 54% did not receive other tests standard for management of CAP during the first day of care (eg, blood cultures, CHEM 7). Of the 16 patients with sputum cultures, an organism was identified in 44% through microbiology testing. Over 90% received antibiotics within 24 hours of admission. Conclusions: Many patients do not receive the minimum recommended testing. Empiric treatment appears to have been the predominant type of management used in this population. Further research to assess the relationship between clinical characteristics and management with patient outcomes is     

Risk factors for late-onset ventilator-associated pneumonia in trauma patients receiving selective digestive decontamination

Objective To determine the independent risk factors for late-onset ventilator-associated pneumonia (VAP) in trauma patients receiving selective digestive decontamination (SDD).Design A 4-year, prospective cohort study of trauma patients meeting the following criteria: injury severity score >15, and duration of mechanical ventilation >5 days. Predictors of late-onset VAP occurrence were assessed by logistic regression analysis.Population All patients received SDD consisting of polymixin E, gentamicin, and amphotericin B applied in nostrils, mouth, and gut with a 3-day course of parenteral cefazolin. VAP was suspected on clinical and radiological signs, and confirmed by the presence of at least one microorganism at a concentration of at least 10⁴ CFU/ml on the broncho-alveolar lavage.Measurement Independent risk factors for late-onset VAP.Results A late-onset VAP was diagnosed in 90 (56%) out of 159 patients. Predicting factors for late-onset VAP were: use of non-depolarizing muscle relaxant agents for intubation [3.4 (CI 1.08–10.73)], duration of intubation [1.06 (CI 1.01–1.17)], length of intensive care unit (ICU) stay [1.05 (CI 1.02–1.09)], and prior tracheal colonization [1.03 (CI 1.02–1.21)]. Exposure to prior antimicrobial treatment, except SDD, conferred protection [0.3 (0.12–0.74)].Conclusion This study confirms the role of duration of intubation, length of ICU stay, and prior tracheal colonization in the development of late-onset VAP. The results also highlight the importance of the initial management on the development of late-onset VAP. The type of neuromuscular blocking agents to intubate trauma patients should be evaluated in future studies.     

肾移植术后肺炎48例诊治分析

目的总结肾移植术后肺炎的诊治经验。方法回顾性分析48例肾移植术后肺炎患者的临床资料。结果 48例肾移植术后肺炎患者的发病时间为术后7d～2年3个月,其中术后1～4个月发病占75%(36/48)。重症肺炎12例(25%),4例(8%)在发病后迅速发展为急性呼吸窘迫综合征(ARDS)。肺炎患者早期临床症状不突出,发热是最早或主要表现,有时是唯一的表现,部分病例有干咳、咯黄白色黏液痰,混合细菌或真菌感染时痰量增多。肺部体征多不明显。移植3个月内以巨细胞病毒(CMV)肺炎为主,并常混合其他微生物感染,3个月后以细菌感染为主。影像学检查结果主要表现为间质性肺炎。2007年6月至2008年6月发生感染的患者,只给予麦考酚吗乙酯(MMF)或钙调磷酸酶抑制剂(CNI)减量。2008年6月以后,诊断肺部感染的患者,确诊后完全停用MMF和CNI减量。3例患者使用免疫球蛋白500mg/(kg.d)。酌情使用甲泼尼龙20mg或40mg,每日2次。在无确切临床病原学资料时,给予广谱抗生素、抗病毒联合治疗。病原学明确后,给予针对性抗感染治疗。43例(90%)治疗有效,3例转外院,1例并发脑出血放弃治疗,1例死于急性呼吸衰竭。结论肾移植受者肺炎起病大多隐匿,病程进展快。病原体以CMV和细菌为主,多表现为多重感染及重症肺炎。肾移植术后第1～4个月是肺炎发生和死亡的危险时期。及时调整机体免疫抑制状态,明确肺部感染的病原体,采用针对性抗感染治疗,有助于提高肾移植术后肺炎治愈率和降低病死率。