摘要
目的分析重症鹦鹉热衣原体肺炎患者的临床特点并分享其诊治经验。方法通过回顾性分析2020年4月至12月宁德师范学院附属宁德市医院呼吸与危重症医学科收治的5例重症鹦鹉热衣原体肺炎患者的临床资料,包括临床表现、实验室检查、影像学特征、病原学、治疗过程及结局,总结鹦鹉热衣原体肺炎的临床特征。结果5例患者以发热、咳嗽和气喘为主要表现,均有禽类或鸟类接触史,心脏、肝脏均有损害,肾脏损害较轻,5例降钙素原(PCT)和C-反应蛋白(CRP)水平升高,2例白细胞计数(WBC)升高,4例癌胚抗原(CEA)一过性升高。胸部CT表现为肺部渗出和实变,进展快,多肺叶为主。5例患者均通过病原微生物宏基因二代测序诊断(mNGS);治疗上莫西沙星疗效欠佳,对多西环素敏感,加用多西环素48~72 h后体温降至正常。呼吸支持方面2例使用有创机械通气,1例使用无创通气,2例应用经鼻高流量氧疗(HFNC);所有患者均病情好转出院。结论mNGS有助于重症鹦鹉热衣原体肺炎的早期诊治,多西环素对重症鹦鹉热衣原体肺炎效果好,患者的预后良好。
Objective To analyze the clinical features of patients with severe chlamydia psittaci pneumonia and share their experience in diagnosis and treatment.Methods The clinical data of 5 cases of severe chlamydia psittaci pneumonia admitted to Ningde Municipal Hospital of Ningde Normal University from April 2020 to December 2020 were retrospectively analyzed,including the clinical manifestations,laboratory examination,imaging features,etiology,treatment process,and prognosis,to summarize the clinical features of chlamydia psittaci pneumonia.Results The main symptoms of the 5 patients were high fever,cough,and dyspnea,and all of them had a history of exposure to poultry or birds.There were heart and liver damage but mild kidney damage in 5 cases.Procalcitonin(PCT)and C-reactive protein(CRP)were elevated in 5 cases,white blood cell count(WBC)levels were elevated in 2 cases and carcinoembryonic antigen(CEA)in 4 cases showed a transient increase.Chest computed tomography(CT)of 5 cases showed pulmonary exudation and consolidation,mainly with multiple lobes.All 5 cases were diagnosed by metagenomic next-generation sequencing(mNGS)of pathogenic microorganism.Doxycycline was found to be effective in the treatment of chlamydia psittaci pneumonia.But moxifloxacin was found to be ineffective.When doxycycline was given to patients after 48-72 hours,the body temperature of the patients dropped to normal.In terms of respiratory support,2 cases were treated with invasive mechanical ventilation,1 case with noninvasive positive pressure ventilation,and 2 cases with high-flow nasal cannula oxygen therapy.All patients were discharged with improvement.Conclusions Implementation of mNGS is helpful for the early diagnosis of severe chlamydia psittaci pneumonia.Patients who are treated with doxycycline in time have a good prognosis.
作者
张灿辉
吴建辉
汪滔
彭志文
成英
Zhang Canhui;Wu Jianhui;Wang Tao;Peng Zhiwen;Cheng Ying(Department of Pulmonary and Critical Care Medicine,Ningde Municipal Hospital of Ningde Normal University,Ningde 352100,Fujian,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2022年第6期730-733,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
福建省自然科学基金面上项目(2018J01228)
关键词
鹦鹉热衣原体
重症肺炎
疾病特征
宏基因组二代测序
多西环素
Chlamydia psittaci
Severe pneumonia
Disease attibutes
Metagenomic next-generation sequencing
Doxycycline
作者简介
通信作者:成英,Email:4720523@163.com
