Shen L, Tian X J, Liang R Z, Cheng Y, Kong X L, He F, Zhang C, Wang G A, Li S H, Lu H D, Sun S Q
Department of Pulmonary and Critical Care Medicine, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
Department of Infectious Disease, the First People's Hospital of Xiaoshan District, Hangzhou 311201, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2021 Oct 12;44(10):886-891. doi: 10.3760/cma.j.cn112147-20210127-00082.
To explore the clinical characteristics, imaging findings, laboratory tests and treatment strategies for pneumonia. From January 1, 2019 to January 20, 2021, 48 cases of Psittacosis from 11 hospitals in China were diagnosed via metagenomic next-generation sequencing(mNGS). The data of all patients on occupational history, clinical manifestations, laboratory tests, chest computed tomography(CT)findings, treatment outcomes and prognosis were retrospectively analyzed. Among the 48 patients, there were 29 males and 19 females, with a mean age of (57.1±10.3) years. Thirty patients had a confirmed history of exposure to poultry. The onset to admission interval was (6.5±3.2) days, and hospital stay was (12.4±4.8) days. Clinical manifestations included fever (100%, 48/48), relative bradycardia (71%, 34/48), cough (54.2%, 26/48), sputum (27.1%, 13/48), fatigue (16.7%, 8/48), headache and delirium (20.8%, 9/48), and gastrointestinal symptoms (16.7%, 8/48). Laboratory data showed that white blood cells were (8.0±3.8)×10/L, and the proportion of neutrophils increased in 44 patients. The level of C-reactive protein was (155.3±74.1)mg/L, and that of procalcitonin (PCT)in 59.5% of patients was more than 0.5 μg/L. Percentages of patients with increased lactate dehydrogenase and creatine kinase were 82.9% and 45.2%, respectively. Chest CT scans showed unilateral lung involvement in 34 cases(70.8%) and single lobe involvement in 27 cases(56.3%).The most common imaging change was consolidation, with 38 cases (79.2%) showing lobar consolidation. In terms of treatment, 25 patients were treated with fluoroquinolones alone, 6 patients with doxycycline alone, and 13 patients with combined treatment. The combined-treatment group and the doxycycline alone group were similar in the course of defervescence. The combined treatment group and the doxycycline alone group were both superior to the fluoroquinolones alone group. However, 11 patients were admitted to ICU, all of them received artificial ventilation, and 5 cases developed shock, and one died. pneumonia is an animal-derived infectious disease with unique features in clinical symptoms, laboratory tests and chest imaging. Appropriate treatment is able to significantly shorten the course of disease and improve the prognosis.
探讨肺炎的临床特征、影像学表现、实验室检查及治疗策略。2019年1月1日至2021年1月20日，中国11家医院通过宏基因组二代测序（mNGS）诊断出48例鹦鹉热病例。对所有患者的职业史、临床表现、实验室检查、胸部计算机断层扫描（CT）结果、治疗效果及预后数据进行回顾性分析。48例患者中，男性29例，女性19例，平均年龄（57.1±10.3）岁。30例患者有明确的禽类接触史。发病至入院间隔为（6.5±3.2）天，住院时间为（12.4±4.8）天。临床表现包括发热（100%，48/48）、相对缓脉（71%，34/48）、咳嗽（54.2%，26/48）、咳痰（27.1%，13/48）、乏力（16.7%，8/48）、头痛及谵妄（20.8%，9/48）和胃肠道症状（16.7%，8/48）。实验室数据显示白细胞为（8.0±3.8）×10/L，44例患者中性粒细胞比例升高。C反应蛋白水平为（155.3±74.1）mg/L，59.5%的患者降钙素原（PCT）水平超过0.5μg/L。乳酸脱氢酶和肌酸激酶升高的患者百分比分别为82.9%和45.2%。胸部CT扫描显示34例（70.8%）为单侧肺受累，27例（56.3%）为单叶受累。最常见的影像学改变为实变，38例（79.2%）表现为大叶实变。治疗方面，25例患者单独使用氟喹诺酮类药物治疗，6例患者单独使用多西环素治疗，13例患者联合治疗。联合治疗组和单独使用多西环素组在退热过程方面相似。联合治疗组和单独使用多西环素组均优于单独使用氟喹诺酮类药物组。然而，11例患者入住重症监护病房，均接受了人工通气，5例发生休克，1例死亡。肺炎是一种动物源性传染病，在临床症状、实验室检查及胸部影像学方面具有独特特征。恰当治疗能够显著缩短病程并改善预后。
