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1.
Objective
To describe the clinical presentation, laboratory findings, and outcome of patients with Pneumocystis jiroveci pneumonia (PCP) and biopsy‐proven giant cell arteritis (GCA) seen at a tertiary referral center.Methods
Using International Classification of Diseases, Ninth Revision codes, all patients with GCA and PCP between January 1, 1976 and December 31, 2008 were identified. Medical records were reviewed. PCP was defined by the identification of Pneumocystis jiroveci organisms in the clinical setting of pneumonia.Results
We identified 7 patients with GCA (5 women and 2 men) who developed PCP (the mean ± SD age at diagnosis was 71.6 ± 6.1 years). The median time from GCA diagnosis to PCP diagnosis was 3 months (range 1–18 months). All patients were taking prednisone (the median dosage 50 mg/day [range 30–80]) when diagnosed as having PCP. No patients were receiving PCP prophylaxis. PCP was diagnosed by positive smear on bronchoalveolar lavage fluid in 6 patients (86%) and by positive sputum polymerase chain reaction in 1 patient. All the patients were hospitalized (median duration 17 days [range 12–39 days]). Four patients (57%) were admitted to the intensive care unit. Three patients (43%) required mechanical ventilation. Two patients (29%) died; both were on mechanical ventilation.Conclusion
Although PCP is rare among patients with GCA, this preventable infection is associated with significant morbidity and mortality. 相似文献2.
Yukiko Komano Masayoshi Harigai Ryuji Koike Haruhito Sugiyama Jun Ogawa Kazuyoshi Saito Naoya Sekiguchi Masayuki Inoo Ikuko Onishi Hiroyuki Ohashi Fujio Amamoto Masayuki Miyata Hideo Ohtsubo Kazuko Hiramatsu Masahiro Iwamoto Seiji Minota Naoki Matsuoka Goichi Kageyama Kazuyoshi Imaizumi Hitoshi Tokuda Yasumi Okochi Koichiro Kudo Yoshiya Tanaka Tsutomu Takeuchi Nobuyuki Miyasaka 《Arthritis care & research》2009,61(3):305-312
Objective
To establish proper management of Pneumocystis jiroveci pneumonia (PCP) in rheumatoid arthritis (RA) patients treated with infliximab. PCP has been observed in 0.4% of patients with RA treated with infliximab in Japan.Methods
Data from patients with RA (n = 21) who were diagnosed with PCP during infliximab treatment and from 102 patients with RA who did not develop PCP during infliximab therapy were collected from 14 rheumatology referral centers in Japan. A retrospective review of these patients and a case–control study to compare patients with and without PCP were performed.Results
The median length of time from the first infliximab infusion to the development of PCP was 8.5 weeks. At the onset of PCP, the median dosages of prednisolone and methotrexate were 7.5 mg/day and 8 mg/week, respectively. Pneumocystis jiroveci was microscopically identified in only 2 patients, although the polymerase chain reaction test for the organism was positive in 20 patients. The patients with PCP had significantly lower serum albumin levels (P < 0.001) and lower serum IgG levels (P < 0.001) than the patients without PCP. Computed tomography of the chest in all patients with PCP revealed ground‐glass opacity either with sharp demarcation by interlobular septa or without interlobular septal boundaries. Sixteen of the 21 patients with PCP developed acute respiratory failure, but all survived.Conclusion
PCP is a serious complication that may occur early in the course of infliximab therapy in patients with RA. For the proper clinical management of this infectious disease, physicians need to be aware of the possibility of PCP developing during infliximab therapy. 相似文献3.
Saba Radhi Travis Alexander Michelle Ukwu Samer Saleh Alison Morris 《BMC infectious diseases》2008,8(1):118
Background
Pneumocystis pneumonia (PCP) remains a leading cause of morbidity and mortality in HIV-infected persons. Epidemiology of PCP in the recent era of highly active antiretroviral therapy (HAART) is not well known and the impact of HAART on outcome of PCP has been debated. 相似文献4.
Isabelle Suárez Lisa Roderus Edeltraud van Gumpel Norma Jung Clara Lehmann Gerd Fätkenheuer Pia Hartmann Georg Plum Jan Rybniker 《Infection》2017,45(3):341-347
Background
Pneumocystis pneumonia (PCP) is an opportunistic and potentially life-threatening infection of immunocompromised individuals. A combination of trimethoprim–sulfamethoxazole is widely used for prophylaxis and treatment of PCP. Polymorphisms in the drug targets, the dihydropteroate synthase (DHPS) or the dihydrofolate reductase (DHFR) are presumably a reason for treatment failure.Methods
We retrospectively examined the prevalence of DHPS and DHFR mutations in Pneumocystis jirovecii isolates obtained from HIV-infected and non-HIV-infected PCP patients. DHFR and DHPS genes were amplified using semi-nested PCR followed by sequencing. Obtained data were correlated with clinical findings.Results
Sequencing of the DHPS gene was achieved in 81 out of 128 isolates (63%), the DHFR-gene was successfully sequenced in 96 isolates (75%). The vast majority of DHFR and DHPS sequences were either wild-type or showed synonymous single nucleotide polymorphisms. Only one sample contained a double mutation at DHPS codon 55 and codon 57 which was associated with treatment failure in some studies. No linkage of treatment failure to a DHFR or DHPS genotype was observed. In our cohort, 35 of 95 Patients (37%) were HIV-positive and 60 (63%) were HIV-negative. The overall mortality rate was 24% with a much higher rate among non-HIV patients.Conclusion
DHPS and DHFR mutations exist but are infrequent in our cohort. The contribution of gene polymorphisms to treatment failure needs further research. In immunocompromised HIV-negative patients PCP is associated with high mortality rates. Prophylactic treatment is warranted in this patient subset.5.
Background
Pneumocystis jiroveci (formerly known as P. carinii f.sp. hominis) is an opportunistic fungus that causes Pneumocystis pneumonia (PCP) in immunocompromised individuals. Pneumocystis jiroveci can be detected by polymerase chain reaction (PCR). To investigate the clinical importance of a positive Pneumocystis-PCR among HIV-uninfected patients suspected of bacterial pneumonia, a retrospective matched case-control study was conducted. 相似文献6.
Background
Pneumocystis pneumonia (PCP) is an increasing problem amongst patients on immunosuppression with autoimmune inflammatory disorders (AID). The disease presents acutely and its diagnosis requires bronchoalveolar lavage in most cases. Despite treatment with intravenous antibiotics, PCP carries a worse prognosis in AID patients than HIV positive patients. The overall incidence of PCP in patients with AID remains low, although patients with Wegener's granulomatosis are at particular risk. 相似文献7.
Georg Daeschlein William H Krüger Christian Selepko Markus Rochow Gottfried Dölken Axel Kramer 《BMC infectious diseases》2007,7(1):45
Background
Microbial safe tap water is crucial for the safety of immunosuppressed patients. 相似文献8.
N Asai S Motojima Y Ohkuni R Matsunuma K Nakasima T Iwasaki T Nakashita Y Otsuka N Kaneko 《Multidisciplinary respiratory medicine》2012,7(1):2
Background
Non-HIV Pneumocystis pneumonia (PCP) can occur in immunosuppressed patients having malignancy or on immunosuppressive agents. To classify severity, the A-DROP scale proposed by the Japanese Respiratory Society (JRS), the CURB-65 score of the British Respiratory Society (BTS) and the Pneumonia Severity Index (PSI) of the Infectious Diseases Society of America (IDSA) are widely used in patients with community-acquired pneumonia (CAP) in Japan. To evaluate how correctly these conventional prognostic guidelines for CAP reflect the severity of non-HIV PCP, we retrospectively analyzed 21 patients with non-HIV PCP.Methods
A total of 21 patients were diagnosed by conventional staining and polymerase chain reaction (PCR) for respiratory samples with chest x-ray and computed tomography (CT) findings. We compared the severity of 21 patients with PCP classified by A-DROP, CURB-65, and PSI. Also, patients’ characteristics, clinical pictures, laboratory results at first visit or admission and intervals from diagnosis to start of specific-PCP therapy were evaluated in both survivor and non-survivor groups.Results
Based on A-DROP, 18 patients were classified as mild or moderate; respiratory failure developed in 15 of these 18 (83.3%), and 7/15 (46.7%) died. Based on CURB-65, 19 patients were classified as mild or moderate; respiratory failure developed in 16/19 (84.2%), and 8 of the 16 (50%) died. In contrast, PSI classified 14 as severe or extremely severe; all of the 14 (100%) developed respiratory failure and 8/14 (57.1%) died. There were no significant differences in laboratory results in these groups. The time between the initial visit and diagnosis, and the time between the initial visit and starting of specific-PCP therapy were statistically shorter in the survivor group than in the non-survivor group.Conclusions
Conventional prognostic guidelines for CAP could underestimate the severity of non-HIV PCP, resulting in a therapeutic delay resulting in high mortality. The most important factor to improve the mortality of non-HIV PCP is early diagnosis and starting of specific-PCP therapy as soon as possible.9.
Boris Hugle Melinda Solomon Elizabeth Harvey Adrian James Anupma Wadhwa Reshma Amin Audrey Bell‐Peter Susanne Benseler 《Arthritis care & research》2010,62(11):1661-1664
Objective
Wegener's granulomatosis (WG) is a devastating small‐vessel vasculitis in children. Standard treatment consists of immunosuppressive medications with cyclophosphamide potentially associated with significant infectious side effects, including Pneumocystis jiroveci pneumonia (PCP). Recently, rituximab, a monoclonal antibody against B cells, has successfully been used in refractory disease.Methods
We describe the first pediatric patient with refractory WG with sinus and lung disease who developed PCP 6 months after treatment with rituximab, while being treated with methotrexate and prednisone. This 9‐year‐old child had no CD20+ B cells at time of infection, with normal lymphocyte and CD4 counts.Results
This study provides a review of the published literature, including current protocols, which suggest chemoprophylaxis only in WG patients receiving T cell–targeted immunosuppression such as cyclophosphamide. However, clinical and laboratory evidence points toward a possible role of B cells in the defense against PCP.Conclusion
Routine PCP chemoprophylaxis should be strongly considered in patients with WG treated with rituximab. 相似文献10.
Doron Boltin Alex Vilkin Zohar Levi Ori Elkayam Yaron Niv 《Digestive diseases and sciences》2010,55(7):1975-1981
Background
JC virus (JCV), a polyoma virus, is the etiological agent of progressive multifocal leukoencephalopathy in immunosuppressed patients. JCV T-Ag has proven oncogenic potential and is expressed in colonic polyps and carcinomas. We proposed that the prevalence of JCV T-Ag DNA is higher in the normal gastrointestinal (GI) mucosa of immunosuppressed patients compared with their immunocompetent counterparts. 相似文献11.
Background
The objective of this study was to review the effects of adjunctive corticosteroids on overall mortality and the need for mechanical ventilation in HIV-infected patients with Pneumocystis jiroveci pneumonia (PCP) and substantial hypoxemia (arterial oxygen partial pressure <70 mmHg or alveolar-arterial gradient >35 mmHg on room air). 相似文献12.
Milagros Gonzales Jacques Pepin Eric H Frost Julie C Carrier Stephanie Sirard Louis-Charles Fortier Louis Valiquette 《BMC infectious diseases》2010,10(1):363
Background
Oral vancomycin (125 mg qid) is recommended as treatment of severe Clostridium difficile infection (CDI). Higher doses (250 or 500 mg qid) are sometimes recommended for patients with very severe CDI, without supporting clinical evidence. We wished to determine to what extent faecal levels of vancomycin vary according to diarrhoea severity and dosage, and whether it is rational to administer high-dose vancomycin to selected patients. 相似文献13.
Janett Fischer Eleni Koukoulioti Tobias Müller Renate Heyne Mohammed Eslam Jacob George Fabian Finkelmeier Oliver Waidmann Thomas Berg Florian van Bömmel 《Hepatology research》2023,53(12):1156-1168
Aim
Interleukin (IL)-10 and IL-12 contribute to immune responses against hepatitis B virus (HBV) infection. Polymorphisms in the IL-10 and IL-12A genes might affect the clinical outcome of HBV infection. We evaluated the association of IL-10 rs1800896 and rs3024490, and IL-12A rs568408 and rs2243115 with the progression of HBV infection and development of severe liver disease stages in a white European population.Method
A total of 636 white European patients with chronic HBV infection, 239 individuals with spontaneous HBV surface antigen seroclearance, and 254 healthy controls were enrolled. The chronic HBV infection group included patients with hepatitis B envelope antigen (HBeAg) negative chronic hepatitis B (n = 255), with HBeAg positive chronic hepatitis B (n = 99) and with HBeAg negative HBV infection (n = 228). A total of 104 chronically infected patients were diagnosed with liver cirrhosis. Serum levels of cytokines were measured in patients with HBV infection (n = 195) and in healthy controls (n = 160).Results
In adjusted multivariate analysis, the IL-10 rs1800896 AG/GG genotypes were significantly associated with an increased probability of HBV surface antigen seroclearance (OR = 1.75, 95% CI 1.04–2.94, p = 0.034), with an increased likelihood of HBeAg negative chronic infection (OR = 1.93, 95% CI 1.05–3.54, p = 0.034) and with increased serum cytokines levels in female patients. In contrast, the IL-12A rs568408 AG/AA genotypes were independently associated with an increased risk to develop liver cirrhosis, with an OR of 1.90 (95% CI 1.07–3.39, p = 0.029) in male patients.Conclusion
The current study shows a sex-related association of the IL-10 single-nucleotide polymorphism rs1800896 and IL-12A single-nucleotide polymorphism rs568408 with different stages of HBV infection and with HBV-related liver cirrhosis in white European patients. 相似文献14.
No indication of increased infection rates using low‐dose alemtuzumab instead of anti‐thymocyte globulin as graft‐versus‐host disease prophylaxis before allogeneic stem cell transplantation
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Thomas Neumann Laila Schneidewind Thomas Thiele Daniel Pink Meike Schulze Christian Schmidt William Krüger 《Transplant infectious disease》2018,20(1)
Background
Alemtuzumab as part of the conditioning protocol is effective in reducing graft‐versus‐host disease (GvHD), but may be associated with increased infection rates, especially when using high doses (ie, 100 mg).Methods
We performed a retrospective, single‐center, case‐control study analyzing the rates of neutropenic fever, cytomegalovirus (CMV) reactivation, Epstein‐Barr virus (EBV) reactivation, clinical manifest toxoplasmosis, and clinical manifest human herpesvirus‐6 (HHV6) infection using low‐dose alemtuzumab in comparison with anti‐thymocyte globulin (ATG) as GvHD prophylaxis before allogeneic stem cell transplantation. Forty‐four patients transplanted from unrelated donors between 2001 and 2012 were matched by age, diagnosis, and conditioning regimen and treated either with alemtuzumab 10 mg at day ?2 (respectively, 20 mg in case of mismatch transplantation) or ATG. ATG Fresenius (10 mg/kg for 3 days) or Thymoglobulin (2 mg/kg for 3 days) were used.Results
Rates of CMV reactivation, EBV reactivation, and clinical manifest HHV6 infection or toxoplasmosis did not differ significantly between both groups until 2 years after transplantation. No case of post‐transplant lymphoproliferative disorder was observed. Also, rates of neutropenic fever during inpatient treatment after transplantation did not differ significantly in both groups.Conclusion
We saw no indication of increased infections rates when using low‐dose alemtuzumab as GvHD prophylaxis before allogeneic stem cell transplantation in this retrospective analysis. 相似文献15.
Michi Tanaka Ryoko Sakai Ryuji Koike Yukiko Komano Toshihiro Nanki Fumikazu Sakai Haruhito Sugiyama Hidekazu Matsushima Toshihisa Kojima Shuji Ohta Yoji Ishibe Takuya Sawabe Yasuhiro Ota Kazuhisa Ohishi Hajime Miyazato Yoshinori Nonomura Kazuyoshi Saito Yoshiya Tanaka Hayato Nagasawa Tsutomu Takeuchi Ayako Nakajima Hideo Ohtsubo Makoto Onishi Yoshinori Goto Hiroaki Dobashi Nobuyuki Miyasaka Masayoshi Harigai 《Modern rheumatology / the Japan Rheumatism Association》2012,22(6):849-858
Objectives
The association of anti-tumor necrosis factor therapy with opportunistic infections in rheumatoid arthritis (RA) patients has been reported. The goal of this study was to clarify the clinical characteristics and the risk factors of RA patients who developed Pneumocystis jirovecii pneumonia (PCP) during etanercept therapy.Methods
We conducted a multicenter, case–control study in which 15 RA patients who developed PCP were compared with 74 RA patients who did not develop PCP during etanercept therapy.Results
PCP developed within 26?weeks following the first injection of etanercept in 86.7% of the patients. All PCP patients presented with a rapid and severe clinical course and the overall mortality was 6.7%. Independent risk factors were identified using multivariate analysis and included age ≥65?years [hazard ratio (HR) 3.35, p?=?0.037], coexisting lung disease (HR 4.48, p?=?0.009), and concomitant methotrexate treatment (HR 4.68, p?=?0.005). In patients having a larger number of risk factors, the cumulative probability of developing PCP was significantly higher (p?<?0.001 for patients with two or more risk factors vs. those with no risk factor, and p?=?0.001 for patients with one risk factor vs. those with no risk factor).Conclusion
Physicians must consider the possibility of PCP developing during etanercept therapy in RA patients, particularly if one or more risk factors are present. 相似文献16.
Kaori Watanabe Ryoko Sakai Ryuji Koike Fumikazu Sakai Haruhito Sugiyama Michi Tanaka Yukiko Komano Yuji Akiyama Toshihide Mimura Motohide Kaneko Hitoshi Tokuda Takenobu Iso Mitsuru Motegi Kei Ikeda Hiroshi Nakajima Hirofumi Taki Tetsuo Kubota Hirotaka Kodama Shoji Sugii Takashi Kuroiwa Yasushi Nawata Kazuko Shiozawa Atsushi Ogata Shigemasa Sawada Yoshihiro Matsukawa Takahiro Okazaki Masaya Mukai Mitsuhiro Iwahashi Kazuyoshi Saito Yoshiya Tanaka Toshihiro Nanki Nobuyuki Miyasaka Masayoshi Harigai 《Modern rheumatology / the Japan Rheumatism Association》2013,23(6):1085-1093
Objectives
To investigate the clinical characteristics and risk factors of Pneumocystis jirovecii pneumonia (PCP) in rheumatoid arthritis (RA) patients treated with adalimumab.Methods
We conducted a multicenter, retrospective, case–control study to compare RA patients treated with adalimumab with and without PCP. Data from 17 RA patients who were diagnosed with PCP and from 89 RA patients who did not develop PCP during adalimumab treatment were collected.Results
For the PCP patients, the median age was 68 years old, with a median RA disease duration of eight years. The median length of time from the first adalimumab injection to the development of PCP was 12 weeks. At the onset of PCP, the median dosages of prednisolone and methotrexate were 5.0 mg/day and 8.0 mg/week, respectively. The patients with PCP were significantly older (p < 0.05) and had more structural changes (p < 0.05) than the patients without PCP. Computed tomography of the chest revealed ground-glass opacity without interlobular septal boundaries in the majority of the patients with PCP. Three PCP patients died.Conclusions
PCP may occur early in the course of adalimumab therapy in patients with RA. Careful monitoring, early diagnosis, and proper management are mandatory to secure a good prognosis for these patients. 相似文献17.
D. Parra Y. Mekki I. Durieu C. Broussolle P. Sève 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2014
Purpose
Parvovirus B19 causes erythema infectiosum in children, transient aplastic anemia in patients with hemoglobinopathies, pur red cell aplasia in immunocompromised persons and hydrops fetalis in pregnancy. The spectrum of clinical and biological manifestations in immunocompetent adult continues to grow up.Methods
We report on a case series of 26 patients with primary parvovirus B19 infection in immunocompetent adults. This is a retrospective study over the period 2000 to 2010 in two departments of internal medecine. The diagnostic was clinical, serological or molecular.Results
There was a female predominance (sex-ratio 3.33/1). Median patient age at diagnostic was 38.8 years (range: 18–68). The predominant symptoms were fever (65%), peripheral and symmetrical polyarthralgia (62%) and skin rash (58%). Two patients had neurological manifestations (sixth cranial nerve palsy, distal paresthesia) and one patient had myocarditis. Abnormal laboratory values included increased acute phase reactants (73%), thrombocytopenia (43%), lymphopenia (38%) and elevated liver enzymes (37%). Antinuclear (19%), anti-DNA (28%) and anti-phospholipids antibodies (14%), and hypocomplementemia (32%) were observed. False reaction with anti-CMV and anti-EBV IgM positivity was documented in 27% of cases. Two patients had persistent parvovirus B19 infection.Conclusion
The diversity of the clinical manifestations of parvovirus B19 infection may be misleading for the clinician. However, the diagnosis should be suspected in immunocompetent adults to limit the risk of transmission to the patients who could develop a severe infection such as pregnant women or immunocompromised patients. 相似文献18.
Barde C Piguet V Pechère M Masouye I Saurat JH Wunderli W Kaiser L Toutous Trellu L 《HIV medicine》2011,12(6):367-373
Background
The use of highly active antiretroviral therapy (HAART) has been associated with a marked decrease in the prevalence of opportunistic infections in HIV‐infected patients. However, chronic mucocutaneous herpes simplex virus (HSV) infection remains a difficult clinical challenge.Objective
The aim of the study was to optimize the diagnosis and follow‐up of chronic HSV‐2 infection in HIV‐infected patients and to correlate clinical data with CD4 cell count, in vitro HSV virological resistance and histology.Methods
A retrospective case series was collected from a specialist out‐patient clinic providing consultations to patients with infectious skin diseases. Clinical, biological, virological and histological data were analysed.Results
Seven HIV‐infected patients with genital and perianal herpes simplex infection were followed over 10 years. Ulcerative and pseudo‐tumoral forms were observed. Lesions occurred at various stages of immune suppression (CD4 counts from 1 to 449 cells/μL). Clinical resistance to conventional anti‐herpetic drugs was correlated with the in vitro resistance of HSV in 70% of cases.Conclusions
Chronic mucocutaneous HSV infection in AIDS patients remains a rare but regularly observed infection in very immunosuppressed patients or those with unstable immunity during HAART. Virological results obtained from mucocutaneous samples were in most cases found to be correlated with clinical evolution and should therefore be used in making decisions on treatment. Despite efficient antiviral therapy, mucocutaneous healing is slow in the majority of cases. 相似文献19.
Factors associated with recovery delay in a sample of patients diagnosed by MERS‐CoV rRT‐PCR: A Saudi Arabian multicenter retrospective study
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Anwar E. Ahmed Hamdan Al‐Jahdali Mody Alaqeel Salma S. Siddiq Hanan A. Alsaab Ezzeldin A. Sakr Hamed A. Alyahya Munzir M. Alandonisi Alaa T. Subedar Yosra Z. Ali Hazza Al Otaibi Nouf M. Aloudah Salim Baharoon Sameera Al Johani Mohammed G. Alghamdi 《Influenza and other respiratory viruses》2018,12(5):656-661
Background
Research evidence exists that poor prognosis is common in Middle East respiratory syndrome coronavirus (MERS‐CoV) patients.Objectives
This study estimates recovery delay intervals and identifies associated factors in a sample of Saudi Arabian patients admitted for suspected MERS‐CoV and diagnosed by rRT‐PCR assay.Methods
A multicenter retrospective study was conducted on 829 patients admitted between September 2012 and June 2016 and diagnosed by rRT‐PCR procedures to have MERS‐CoV and non‐MERS‐CoV infection in which 396 achieved recovery. Detailed medical charts were reviewed for each patient who achieved recovery. Time intervals in days were calculated from presentation to the initial rRT‐PCR diagnosis (diagnosis delay) and from the initial rRT‐PCR diagnosis to recovery (recovery delay).Results
The median recovery delay in our sample was 5 days. According to the multivariate negative binomial model, elderly (age ≥ 65), MERS‐CoV infection, ICU admission, and abnormal radiology findings were associated with longer recovery delay (adjusted relative risk (aRR): 1.741, 2.138, 2.048, and 1.473, respectively). Camel contact and the presence of respiratory symptoms at presentation were associated with a shorter recovery delay (expedited recovery) (aRR: 0.267 and 0.537, respectively). Diagnosis delay is a positive predictor for recovery delay (r = .421; P = .001).Conclusions
The study evidence supports that longer recovery delay was seen in patients of older age, MERS‐CoV infection, ICU admission, and abnormal radiology findings. Shorter recovery delay was found in patients who had camel contact and respiratory symptoms at presentation. These findings may help us understand clinical decision making on directing hospital resources toward prompt screening, monitoring, and implementing clinical recovery and treatment strategies. 相似文献20.