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社区中一例非免疫抑制患者因真菌感染引起的严重肺炎,抗真菌治疗反应良好。

An Unusual Case of Severe Pneumonia Caused Due With a Favorable Clinical Response to Antifungals in a Nonimmunocompromised Patient From the Community.

机构信息

Universidad de Las Americas, Quito, Ecuador.

Ecuadorian Institute of Social Security, Babahoyo, Ecuador.

出版信息

J Investig Med High Impact Case Rep. 2023 Jan-Dec;11:23247096231154652. doi: 10.1177/23247096231154652.

Abstract

Severe pneumonia due to infection mainly occurs in immunosuppressed patients or those currently receiving broad-spectrum antibiotics. Herein, we report a case of severe pneumonia caused due to in an elderly patient. A 72-year-old man with a previous history of hypertension, ischemic stroke, and facial paralysis sequelae treated with the botulinic toxin, was admitted to the hospital for dyspnea. Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection was negative. Computed tomography of the chest revealed bilateral consolidation with left predominance. A bronchoalveolar lavage sample was sent to molecular biology, but no microorganisms were detected using a FilmArray respiratory panel. However, mamanocandidas test for candida was 166 pg/mL (positive), and fungal structures were identified by the MALDI-TOF Biotyper mass spectrometry and attributed to . Antifungal therapy was started using caspofungin 75 mg as the initial dose followed by 50 mg daily. After 10 days of treatment, ventilatory weaning was achieved. By day 14, the patient was decannulated from the tracheostomy. Oral antifungal treatment with voriconazole was continued, and he was discharged from intensive care in good clinical condition. Severe pneumonia due to might occur in specific cases, especially in those patients with risk factors, and must thus be considered when approaching such cases.

摘要

感染引起的重症肺炎主要发生于免疫抑制患者或正在接受广谱抗生素治疗的患者。在此,我们报告一例老年患者因感染导致的重症肺炎。患者为 72 岁男性,既往有高血压、缺血性脑卒中及面瘫后遗症病史,曾接受肉毒毒素治疗,因呼吸困难入院。严重急性呼吸综合征冠状病毒 2(SARS-COV-2)感染检测结果为阴性。胸部计算机断层扫描显示双侧实变,以左侧为主。进行了支气管肺泡灌洗检查并送检分子生物学检测,但 FilmArray 呼吸道Panel 未检测到微生物。然而,甘露聚糖检测提示念珠菌为 166 pg/mL(阳性),MALDI-TOF Biotyper 质谱鉴定为。开始使用首剂 75 mg 卡泊芬净,随后每天 50 mg 进行抗真菌治疗。治疗 10 天后,患者成功撤机。第 14 天,患者从气管切开处拔管。继续给予伏立康唑口服抗真菌治疗,患者临床状况良好,从重症监护病房出院。在特定情况下,尤其是存在危险因素的患者中,可能会发生由 引起的重症肺炎,因此在处理此类病例时应考虑到这一点。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1050/9909080/9a0dbcb1f6ef/10.1177_23247096231154652-fig1.jpg

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