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病毒性肺炎:病因与治疗。

Viral pneumonia: etiologies and treatment.

机构信息

Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.

Infectious Diseases Section (MS 111G), Michael E. DeBakey VAMC, Houston, Texas, USA.

出版信息

J Investig Med. 2018 Aug;66(6):957-965. doi: 10.1136/jim-2018-000712. Epub 2018 Apr 20.

Abstract

Viral pathogens are increasingly recognized as a cause of pneumonia, in immunocompetent patients and more commonly among immunocompromised. Viral pneumonia in adults could present as community-acquired pneumonia (CAP), ranging from mild disease to severe disease requiring hospital admission and mechanical ventilation. Moreover, the role of viruses in hospital-acquired pneumonia and ventilator-associated pneumonia as causative agents or as co-pathogens and the effect of virus detection on clinical outcome are being investigated.More than 20 viruses have been linked to CAP. Clinical presentation, laboratory findings, biomarkers, and radiographic patterns are not characteristic to specific viral etiology. Currently, laboratory confirmation is most commonly done by detection of viral nucleic acid by reverse transcription-PCR of respiratory secretions.Apart from the US Food and Drug Administration-approved medications for treatment of influenza pneumonia, the treatment of non-influenza respiratory viruses is limited. Moreover, the evidence supporting the use of available antivirals to treat immunocompromised patients is modest at best. With the widespread use of molecular diagnostics, an aging population, and advancement in cancer therapy, physicians will face a bigger challenge in managing viral respiratory tract infections. Emphasis on infection control measures to prevent the spread of respiratory viruses especially in healthcare settings is extremely important.

摘要

病毒病原体越来越被认为是肺炎的病因,在免疫功能正常的患者中更为常见,在免疫功能低下的患者中更为常见。成人病毒性肺炎可表现为社区获得性肺炎(CAP),从轻度疾病到需要住院和机械通气的严重疾病不等。此外,病毒在医院获得性肺炎和呼吸机相关性肺炎中的作用作为病原体或共病原体,以及病毒检测对临床结果的影响正在研究中。

已有 20 多种病毒与 CAP 相关。临床表现、实验室发现、生物标志物和影像学模式没有特定病毒病因的特征。目前,实验室确认最常见的方法是通过逆转录聚合酶链反应(RT-PCR)检测呼吸道分泌物中的病毒核酸。

除了美国食品和药物管理局批准用于治疗流感肺炎的药物外,非流感呼吸道病毒的治疗方法有限。此外,支持使用现有抗病毒药物治疗免疫功能低下患者的证据充其量只是适度的。随着分子诊断技术的广泛应用、人口老龄化和癌症治疗的进步,医生在管理病毒性呼吸道感染方面将面临更大的挑战。强调感染控制措施以防止呼吸道病毒的传播,特别是在医疗机构中,这一点极其重要。

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