Cases Of Severe Pneumonia Research Articles

A cytomegalovirus induced cavitary pneumonia case in a patient with idiopathic thrombocytopenic purpura under corticosteroid treatment

Objective: Cytomegalovirus infection is common in the neonatal period, during childhood, while in adults, it is encountered in immunosuppressed patients. CMV infection is a serious cause of mortality. CMV pneumonitis is seen most frequently in adults, even if ganciclovir treatment is given prophylactically after stem cell transplantation and it is seen at least after kidney transplantation. In this article, we present a case of severe cavitary pneumonia that develops in a patient with prolonged prednisolone therapy due to ITP.

Factors associated with severe childhood community-acquired pneumonia: a retrospective study from two hospitals

BackgroundCommunity-acquired pneumonia (CAP) is the leading cause of death in children globally. Indonesia is ranked 1st in South East Asia with the highest burden of pneumonia. Identification of risk factors is necessary for early intervention and better management. This study intended to describe CAP’s clinical signs and laboratory findings and explore the risk factors of severe CAP among children in Indonesia.MethodsThis was a retrospective study of childhood hospitalizations in Siloam General Hospitals and Siloam Hospitals Lippo Village from December 2015 to December 2019. Demographic data, clinical signs, and laboratory findings were collected and processed using IBM SPSS 26.0.ResultsThis study included 217 participants with 66 (30.4%) severe pneumonia cases. Multivariate analysis shows that fever that lasts more than 7 days (ORadj = 4.95; 95%CI 1.61–15.21, Padj = 0.005) and increase in respiratory rate (ORadj = 1.05, 95%CI 1.01–1.08, Padj = 0.009) are two predictors of severe pneumonia. Meanwhile, a normal hematocrit level (ORadj = 0.9; 95%CI 0.83–0.98, Padj = 0.011) and children with normal BMI (ORadj = 0.7; 95%CI 0.57–0.84, Padj < 0.001) are significant independent predictors of severe pneumonia. The Hosmer-Lemeshow test shows that this model is a good fit with a P-value of 0.281. The AUC for this model is 0.819 (95%CI = 0.746–0.891, P-value < 0.001) which shows that this model has good discrimination.ConclusionPediatric CAP hospitalizations with fever lasting > 7 days and tachypnea were at higher risk for progressing to severe pneumonia. A normal hematocrit level and a normal BMI are protective factors for severe pneumonia.

Pneumoscrotum, a Rare Presentation of Barotrauma Following Noninvasive Positive Pressure Ventilation in Patients with Severe COVID-19 Pneumonia:.

Patients with Coronavirus disease 2019 (COVID-19) pneumonia are at risk of hypoxemic respiratory failure. Hence, many patients may require noninvasive positive pressure ventilation (NIPPV) during their hospital course. Using mechanical ventilation such as bilevel positive airway pressure or a ventilator to provide NIPPV may result in adverse events, including barotrauma. We reported two cases (40- and 43-years-old men) of severe COVID-19 pneumonia and hypoxemic respiratory failure who underwent NIPPV for respiratory support. These cases were complicated with barotrauma in their course of hospital admission that manifested with pneumoscrotum. In the cases of pneumoscrotum, it is crucial to understand its underlying etiology and origin since this clinical finding may be the outcome of life-threatening illnesses requiring urgent treatment.

Comparative Study of Intravenous Dexamethasone and Methylprednisolone in Severe COVID -19 Patients Requiring Respiratory Support in Intensive Care Unit

Introduction: Numerous steroids have been used to combat the intense cytokine storms in severe COVID pneumonia. The study compares the use methylprednisolone and dexamethasone as an adjuvant steroid therapy in severe COVID-19 pneumonia. Methods: Prospective comparative study including total of 190 COVID-19 severe pneumonia cases admitted in intensive care unit with 93 patients randomly allocated to receive dexamethasone 6 mg and 97 patients allocated to receive methylprednisolone 1mg/kg in two divided doses both by intravenous route for 7 days. Mortality was compared as primary objective while oxygenation parameters and inflammatory markers, need for invasive mechanical ventilation, duration of ventilation, length of ICU-stay, incidence of multiorgan failure were assessed as secondary variables. Results: At day zero, the patient in methylprednisolone group had significantly lower PaO2/FIO2 ratio (258.3950.36 vs 285.1868.62, P=0.002). At day seven, methylprednisolone significantly improved PaO2/FIO2 ratio (266.5260.73 vs 244.8175.36, P=0.029) and there was substantial decrease in inflammatory markers CRP, Ferritin (P&lt;0.05). PEEP requirement was significantly less with methylprednisolone (P=0.007). Methylprednisolone significantly reduced the incidence of multiorgan failure, need of invasive mechanical ventilation and duration of mechanical ventilation (P&lt;0.05). However, there was no significant difference in terms of duration of ICU stay and 30 days in hospital mortality between the two groups Conclusions: Intravenous methylprednisolone significantly improved the oxygenation of COVID -19 pneumonia patients and decreased the inflammatory reactions as compared to similar dose of dexamethasone when given for week duration. However, methylprednisolone did not seem to be superior to dexamethasone in terms of improving mortality.

Severe Klebsiella pneumoniae pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism: A case report

Klebsiella pneumoniae (K. pneumoniae) is a clinically common Gram-negative bacillus that can cause community- and hospital-acquired infections and lead to pneumonia, liver abscesses, bloodstream infections, and other infectious diseases; however, severe pneumonia caused by hypervirulent K. pneumoniae (hvKp) complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism is rarely seen in the clinical setting and has not been reported in the literature. A 51-year-old man was hospitalized with fever and dyspnea. Persistent mild pain in the middle and upper abdomen began at dawn on the 3rd day following admission and developed into persistent severe pain in the left upper abdomen 8 h later. Based on chest computed tomography (CT), bronchoscopy, bronchoalveolar lavage fluid metagenomic next-generation sequencing, abdominal aortic CT angiography (CTA), and culture of the superior mesenteric artery embolus, adult community-acquired severe hvKp pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism was diagnosed. Notably, he recovered and was discharged from the hospital after receiving effective meropenem anti-infection, endovascular contact thrombolytic, and systemic anticoagulant therapies and undergoing percutaneous thrombus aspiration. Ten days later, the patient returned to the hospital for abdominal CTA examination, which indicated blocked initial common pathway of the celiac trunk and superior mesenteric artery, and local stenosis. Therefore, celiac trunk artery stenting was performed in Chongqing Hospital, and postoperative recovery was good. We report a case of hvKp severe pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism and suggest that clinicians should consider the possibility of a Gram-negative bacillus infection and conduct effective pathogen detection in a timely fashion when managing patients with severe community-acquired pneumonia before obtaining bacteriologic and drug sensitivity results. At the same time, when patients have severe pulmonary infection complicated by severe abdominal pain, an acute mesenteric artery embolism should be considered to avoid delays in treatment.

The Etiology of Childhood Inpatient Pneumonias in Two Private, Tertiary, Metro Manila Hospitals from 1993-2021 Seen By One Pediatric Infectious Disease Specialist

Introduction: The scarce local data on the etiology of childhood pneumonia admitted in a hospital has come from a few urban and rural government hospitals. There is no data from private hospitals. Knowing the most likely etiology of pneumonia is of outmost importance as this has implications on the diagnostic modalities requested and the institution of therapy. Objectives: The purpose of this study is to identify clinical and microbiologic diagnoses of clinically- and radiographically-confirmed pediatric pneumonia cases admitted in a private hospital. Secondarily, a discussion of specific etiologies is made. Methodology: Each consecutive, inpatient, pneumonia referral/admission in either one of two private, urban, tertiary hospitals, of a child 18 years and below from 1993 to 2021 was logged into a computer daily by a single pediatric infectious disease specialist. Clinical, epidemiologic, diagnostic and therapeutic data were recorded. All pneumonia cases, except those seen in newborns before their discharge from the nursery, were included. Results: Of the 496 cases, there was a clinical and/or microbiologic etiology in 43% of cases. The bacteremia rate was 6.3%. The most common identifiable etiologies were Mycoplasma pneumoniae (11.9%), Mycobacterium tuberculosis (5.2%), and Staphylococcus aureus (4.2%), while bronchiolitis (5.5%) and measles (4.8%) were the most common clinical diagnoses. There were several cases of ventilator-associated pneumonia and Pneumocystis jirovecii pneumonia. Conclusions: Mycoplasma pneumoniae, tuberculosis, Staphylococcus aureus and Pneumocystis jirovecii are important pneumonia etiologies that have not been widely considered locally. The data presented here mirrors the practice of one pediatric infectious disease doctor in two hospitals where diagnostic and treatment options are readily available and utilized.

Effector memory T cell subset CD45RA−CCR7−CD27−CD28−EM3 increases in direct proportion to the disease severity of COVID‐19

COVID‐19, which emerged in December 2019 and continues to wreak havoc, has led to the death of many people around the world. In this study, we aimed to uncover the variables underlying the exacerbation of the disease by considering the changes in T cell subsets in adults and juveniles with different disease severity of COVID‐19. Peripheral blood samples of 193 patients (128 adults and 65 juveniles) diagnosed with COVID‐19 were evaluated in a flow cytometer, and a broad T cell profile was revealed by examining T cell subsets in terms of exhaustion and senescence. We found remarkable differences in the effector memory (EM; CD45RA‐CCR7‐) cell subsets of severe pneumonia cases. The frequencies of EM2 CD4+ T, EM3 CD4+ T, EM3 CD8+ T, EM2 DN T and EM3 DN T cells were found to increase in severe pneumonia cases. Consistently, these cells were found in juveniles and uncomplicated adults in similar or lower proportions to healthy controls. The findings of our study provide a view of the T cell profile that may underlie differences in the course of COVID‐19 cases in juveniles and adults, and may provide new insights into the development of effective treatment strategies.

Sensitivity, Specificity and Predictive Values of Chest Indrawing in the Diagnosis of Severe Pneumonia

Background: Pneumonia is a recognized leading killer disease in under 5 children not only in Bangladesh but also in all developing countries. The presence of lower chest indrawing means that the child has severe pneumonia. This study aimed to determine the sensitivity, specificity and predictive values of chest indrawing in the diagnosis of severe pneumonia. Methods: This analytical study was conducted in the department of pediatrics, Sher-e-Bangla Medical College Hospital, Barisal, from January 2015 to December 2015. A total of 100 cases of severe pneumonia aged from 2 months to 5 years and similar numbers of suitably matched controls who fulfilled inclusion criteria were enrolled in this study. A detailed history was taken, a thorough physical examination was done, data were recorded in a preformed questionnaire and were analyzed using a scientific calculator. Results: Out of 100 cases, 80 (80%) and 100 controls, 72 (72%) were in the age group of 2 months to 1 year. Fast breathing was present in 98 (98%) cases and 88 (88%) controls. Chest indrawing was present in 56 (56%) cases and 42 (42%) controls. Roentgenographically, 44 (44%) cases revealed labor/segmental consolidation, and bilateral patchy consolidation was present in 56 (56%) cases. Among the control group, 28 (28%) patients had hyperlucency of peripheral lung fields in their chest X-rays. In this study, it was found that sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of chest indrawing in the diagnosis of severe pneumonia was 56%, 58%, 57.1% and 56.8% respectively. Conclusion: Chest indrawing alone is not a highly sensitive tool to predict severe pneumonia but in rural areas where X-ray facilities are not available, chest indrawing may play an important role in identifying children with possible severe pneumonia. Mediscope 2022;9(2): 54-59

SARS CoV-2 infections in animals, two years into the pandemic.

In December 2019, several cases of pneumonia caused by a novel coronavirus, later identified as SARS-CoV-2, were detected in the Chinese city of Wuhan. Due to its rapid worldwide spread, on 11 March 2020 the World Health Organization declared a pandemic state. Since this new virus is genetically similar to the coronaviruses of bats, SARS-CoV-2 was hypothesized to have a zoonotic origin. Within a year of the appearance of SARS-CoV-2, several cases of infection were also reported in animals, suggesting human-to-animal and animal-to-animal transmission among mammals. Natural infection has been found in companion animals as well as captive animals such as lions, tigers, and gorillas. Among farm animals, so far, minks have been found to be susceptible to SARS-CoV-2 infection, whereas not all the relevant studies agree on the susceptibility of pigs. Experimental infections have documented the susceptibility to SARS-CoV-2 of further animal species, including mice, hamsters, cats, dogs, ferrets, raccoon dogs, cattle, and non-human primates. Experimental infections have proven crucial for clarifying the role of animals in transmission and developing models for viral pathogenesis and immunotherapy. On the whole, this review aims to update and critically revise the current information on natural and experimental SARS-CoV-2 infections in animals.

SUCCESSFUL TREATMENT OF SEVERE ADENOVIRUS PNEUMONIA WITH CIDOFOVIR IN A IMMUNOCOMPETENT PATIENT

SUCCESSFUL TREATMENT OF SEVERE ADENOVIRUS PNEUMONIA WITH CIDOFOVIR IN A IMMUNOCOMPETENT PATIENT

Epidemiology and ventilation characteristics of confirmed cases of severe COVID-19 pneumonia admitted in intensive care unit (EPIC19): A multicentre observational study.

Coronavirus disease (COVID)-19 has spread across the globe. For a country like India with limited resources and a high population, it is worth knowing how these patients were managed. This prospective study was aimed to evaluate the patient characteristics and risk factors associated with mortality. The study was conducted from 15 June 2020 to 31 December 2020 in four centres across India. Patients above 18 years of age admitted in the intensive care unit (ICU) with severe COVID-19 pneumonia were included. Details of oxygen therapy and ventilator characteristics were collected for seven days. Of 667 patients included in the study, the average age was 57 (standard deviation (SD) = 15) years and 70.46% were male. The ICU mortality was 60%. Acute physiology, age and chronic health evaluation (APACHE II) score was 29.8 (SD = 6.1). Among various significant risk factors, the need for invasive ventilator support on day 1 [odds ratio (OR): 3.11, 95% confidence interval (CI) (1.91-5.08)] and the development of arrhythmia [OR 3.85 CI (1.69,8.77) confidence interval (CI) (1.69, 8.77)] had higher odds of mortality. PF ratio [partial pressure of arterial oxygen/fraction of inspired oxygen] was 109.31 (77.79-187.26), maximum positive end-expiratory pressure was 10.29 (3.5) cmH2O, driving pressure was 18.22 (6.16) cmH2O, static compliance was 24.20 (8.57) ml/cmH2O and dynamic compliance was 17.55 (5.18) ml/cmH2O on day 1. Proning was used in 67 (22.41%) intubated patients and 44 (11.96%) awake patients. In this cohort of patients, ICU mortality was 60%. The reason for higher mortality could be the severity of illness as suggested by day 1 PF ratio and APACHE II score.

The Additional Value of Lower Respiratory Tract Sampling in the Diagnosis of COVID-19: A Real-Life Observational Study.

Background: Since December 2019, SARS-CoV-2 has been causing cases of severe pneumonia in China and has spread all over the world, putting great pressure on health systems. Nasopharyngeal swab (NPS) sensitivity is suboptimal. When the SARS-CoV-2 infection is suspected despite negative NPSs, other tests may help to rule out the infection. Objectives: To evaluate the yield of the lower respiratory tract (LRT) isolation of SARS-CoV-2. To evaluate the correlations between SARS-CoV-2 detection and clinical symptoms, and laboratory values and RSNA CT review scores in suspect patients after two negative NPSs. To assess the safety of bronchoscopy in this scenario. Method: A retrospective analysis of data from LRT sampling (blind nasotracheal aspiration or bronchial washing) for suspected COVID-19 after two negative NPS. Chest CT scans were reviewed by two radiologists using the RSNA imaging classification. Results: SARS-CoV-2 was detected in 14/99 patients (14.1%). A correlation was found between SARS-CoV2 detection on the LRT and the presence of a cough as well as with typical CT features. Typical CT resulted in 57.1% sensitivity, 80.8% accuracy and 92.3% NPV. Neither severe complications nor infections in the personnel were reported. Conclusions: In suspect cases after two negative swabs, CT scan revision can help to rule out COVID-19. In selected cases, with consistent CT features above all, LRT sampling can be of help in confirming COVID-19.

The Low Expression of Fc-Gamma Receptor III (CD16) and High Expression of Fc-Gamma Receptor I (CD64) on Neutrophil Granulocytes Mark Severe COVID-19 Pneumonia.

Hyperinflammation through neutrophil granulocytes contributes to disease severity in COVID-19 pneumonia and promotes acute lung failure. Understanding the mechanisms of the dysregulations within the myeloid cell compartment may help to improve therapies for severe COVID-19 infection. Here, we investigated the immunopathological characteristics of circulating neutrophil granulocytes and monocytes in 16 patients with COVID-19 pneumonia by multiparameter flow cytometry in comparison to 9 patients with pulmonary infiltrates but without COVID-19. We correlated the immunophenotypes with the scores of the severity-of-disease classification system, APACHE-II. We found that the mean fluorescence intensity (MFI) of CD15, which is important for the transendothelial migration, was significantly reduced in the patients with COVID-19 (difference ± SD; 295.70 ± 117.50 MFI; p = 0.02). In addition, the granularity was significantly lower in the neutrophil granulocytes of patients with COVID-19 (difference ± SD; 1.11 ± 0.43 side-scatter ratio; p = 0.02). Moreover, the Fc-gamma receptor III (CD16) and Fc-gamma receptor I (CD64) on the neutrophil granulocytes were expressed discordantly with COVID-19 severity. CD16 correlated as inversely proportional (ρ = (−)0.72; 95% CI (−)0.92–(−)0.23; p = 0.01) and CD64 as proportional (ρ = 0.76; 95% CI 0.31–0.93; p = 0.01) with the APACHE-II scores of the patients. We conclude that the deviant expression of the Fc-gamma receptors might play role in a dysregulated antibody-mediated phagocytosis in severe cases of COVID-19 pneumonia.

Thoracic Intervention of Post-Coronavirus Empyema: A Single Centre’s Experience

Introduction: Since December 2019, several cases of unknown-origin pneumonia started to be diagnosed in Wuhan, China. One month later, The World Health Organization (WHO) recognized the responsible pathogen as the 2019 novel coronavirus and the global catastrophe has since been a major mortality cause up until today. We report the first surgical series of five patients with COVID-19 who had empyema thoracic after bilateral interstitial COVID-19 pneumonia, presenting a complex medical challenge in Malaysia. Method: Single centre, retrospective study and collection of data done via EHIS system on 5 patients in cardiothoracic surgery department in 2021. Conclusion: This report highlights the importance of rare complications such as empyema after COVID-19 pneumonia and the need for continued monitoring for this complication in patients who fail to improve during their hospital stay clinically. COVID-19 pneumonia appeared as typical viral pneumonia on thin-section CT. Accurate identification of CT imaging manifestations may help in the precise staging of the disease for clinical diagnosis and treatment. The outcome of these effusions is related to the interval between the onset of clinical symptoms and presentation to the physician, comorbidities, and time management. The primary treatment of pleural empyema is a course of a single or a combination of antibiotics. However, an early antibiotic treatment alone is usually not enough if it progresses to a complicated PPE and empyema. The majority of cases require surgical treatment with drainage of the pleural cavity.

Application of Metagenomic Next-Generation Sequencing in the Diagnosis of Pneumonia Caused by Chlamydia psittaci.

ABSTRACTPsittacosis is an uncommon disease which mainly presents as community-acquired pneumonia (CAP). We aim to apply metagenomic next-generation sequencing (mNGS) as a promising tool in the diagnosis of psittacosis pneumonia and to describe its clinical spectrum to provide physicians with a better understanding and recognition of this disease. Thirteen cases of psittacosis pneumonia were diagnosed by using mNGS. A retrospective analysis of the data on clinical manifestations, laboratory data, computed tomography (CT) images, new diagnosis tools, treatments, and outcomes was summarized. These patients had common symptoms of fever and weakness; some had poor appetite, cough, myalgia, and headache. Ten patients developed acute respiratory distress syndrome (ARDS), among which six patients were severe pneumonia cases and needed ventilator therapy. Most patients got psittacosis pneumonia during the cold season. Ten cases were sporadic, but three were family clustering. All of the 13 patients were traced to an exposure history to birds, cat, or poultry, among which 2 only touched the innards of killed poultry before cooking, which may be an atypical exposure history not been reported before, to our knowledge. Most patients had various degrees of liver dysfunction. Air-space consolidations, along with ground-glass opacities and reticular shadows, were detected on chest CT scan. mNGS takes 48 to 72 h to provide results and helps to diagnose psittacosis. After being diagnosed by mNGS, with effective medicines, all patients finally had complete recoveries. The use of mNGS can improve the diagnostic rate of psittacosis pneumonia and shorten the course of disease control. IMPORTANCE Psittacosis pneumonia is easily underdiagnosed and misdiagnosed. In this study, we use mNGS in the diagnosis of psittacosis pneumonia. We found this disease is prone in the cold season, and touching the innards of killed poultry during cooking may be an atypical exposure history which has not been reported before to our knowledge. There are sporadic cases and family outbreak cases as well. Except for typical symptoms of fever and weakness, headache may be the main and only symptom in some patients. The rate of severe pneumonia is high among inpatients with psittacosis pneumonia, and the incidence of hepatic involvements is also high. Psittacosis pneumonia can be cured if the diagnosis is accurate and in time, even if it is severe pneumonia on admission. Some problems worthy of our attention about psittacosis pneumonia were put forward, such as its sick season, special exposure history, the rate of severe disease, and the high cure rate. mNGS can quickly and objectively detect more rare pathogenic microorganisms in clinical specimens without the need for specific amplification and has an advantage in the diagnosis of rare pathogenic bacteria in difficult cases such as psittacosis pneumonia. The use of mNGS can improve the accuracy and reduce the delay in the diagnosis of psittacosis, which shortens the course of disease control.

A case of severe COVID-19 pneumonia in pregnancy managed with tofacitinib and review of literature

A case of severe COVID-19 pneumonia in pregnancy managed with tofacitinib and review of literature

Cost-effectiveness of pulse oximetry and integrated management of childhood illness for diagnosing severe pneumonia.

Pneumonia is a major killer of children younger than five years old. In resource constrained health facilities, the capacity to diagnose severe pneumonia is low. Therefore, it is important to identify technologies that improve the diagnosis of severe pneumonia at the lowest incremental cost. The objective of this study was to conduct a health economic evaluation of standard integrated management of childhood illnesses (IMCI) guideline alone and combined use of standard IMCI guideline and pulse oximetry in diagnosing childhood pneumonia. This is a cluster-randomized controlled trial conducted in health centres in southern Ethiopia. Two methods of diagnosing pneumonia in children younger than five years old at 24 health centres are analysed. In the intervention arm, combined use of the pulse oximetry and standard IMCI guideline was used. In the control arm, the standard IMCI guideline alone was used. The primary outcome was cases of diagnosed severe pneumonia. Provider and patient costs were collected. A probabilistic decision tree was used in analysis of primary trial data to get incremental cost per case of diagnosed severe pneumonia. The proportion of children diagnosed with severe pneumonia was 148/928 (16.0%) in the intervention arm and 34/876 (4.0%) in the control arm. The average cost per diagnosed severe pneumonia case was USD 25.74 for combined use of pulse oximetry and standard IMCI guideline and USD 17.98 for standard IMCI guideline alone. The incremental cost of combined use of IMCI and pulse oximetry was USD 29 per extra diagnosed severe pneumonia case compared to standard IMCI guideline alone. Adding pulse oximetry to the diagnostic toolkit in the standard IMCI guideline could detect and treat one more child with severe pneumonia for an additional investment of USD 29. Better diagnostic tools for lower respiratory infections are important in resource-constrained settings, especially now during the COVID-19 pandemic.

Mesenchymal stromal cell treatment improves outcomes in children with pneumonia post-hematopoietic stem cell transplantation: a retrospective cohort study

BackgroundHematopoietic stem cell transplantation (HSCT) is a standard therapy strategy for most malignant disorders in children. However, transplant-related pneumonia remains a major therapy challenge and mesenchymal stromal cells (MSCs) are rarely reported in HSCT-related pneumonia. The aim of our study was to assess the efficacy of MSC for HSCT-related pneumonia in children.MethodsWe retrospectively retrieved HSCT-related (severe and non-severe) pneumonia cases (aged < 18 years), which underwent MSC treatment (MSC group) or non-MSC treatment (non-MSC group) in Guangzhou Women and Children’s Medical Center, from December 2017 to December 2019. We investigated outcomes of the two different treatments among severe cases and non-severe cases, respectively. The primary endpoints were differences in overall cure rate and time to cure between MSC and non-MSC groups. The secondary endpoints were 180-day overall survival and cumulative cure rate.ResultsFinally, 31 severe pneumonia cases (16 in MSC group, 15 in non-MSC group) and 76 non-severe cases (31 in MSC group, 45 in non-MSC group) were enrolled in this study. Among severe pneumonia cases, overall cure rate in MSC group was significant higher than that in non-MSC group (12[75.0%] vs. 5[33.3%]; OR = 6.00, 95% CI [1.26–28.5]; p = 0.020); the time (days) to cure in MSC group was dramatically reduced compared with that in non-MSC group (36 [19–52] vs. 62 [42–81]; OR = 0.32, 95% CI [0.12–0.88]; p = 0.009); the 180-day overall survival in MSC group was better than that in non-MSC group (74.5% [45.4–89.6] vs. 33.3% [12.2–56.4]; p = 0.013). Among non-severe pneumonia cases, the time (days) to cure in MSC group was notably decreased compared with that in non-MSC group (28 [24–31] vs. 33 [26–39]; OR = 0.31, 95% CI [0.18–0.56]; p = 0.003). Compared with non-MSC group, MSC-treated patients achieved significant improvements of cumulative cure rate not only in severe pneumonia cases (p = 0.027), but also in non-severe cases (p < 0.001).ConclusionsThis study revealed that MSC treatment could contribute to improving outcomes in children with pneumonia post-HSCT, especially in severe cases. These findings suggest MSC treatment as a promising therapy for HSCT-related pneumonia in children.

Clinical characteristics of 14 cases of severe Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing: A case series.

Introduction:The objective of this study was to explore the clinical, laboratory, and imaging features of severe Chlamydia psittaci pneumonia in order to improve early diagnosis and treatment success rates.Methods:We conducted a retrospective record review of 14 cases of severe Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing technology in our hospital. We extracted and analyzed data on the clinical symptoms and signs, contact history, laboratory investigations, chest computed tomography, treatment, and clinical outcomes.Results:Of the 14 patients, 12 (86%) were male and two (14%) were female, with a mean age of 57 years (SD: 7 years). Eleven patients (79%) had a history of poultry contact. The main clinical manifestations were fever (n = 14, 100%), flu-like symptoms (n = 10, 71%), cough, sputum (n = 9, 64%), and dyspnea (n = 5, 36%). Blood tests revealed marked elevation of neutrophil percentage, C-reactive protein, procalcitonin, brain natriuretic peptide, and creatine kinase levels; slight elevation of aspartate aminotransferase, creatinine, urea, fibrinogen, and D-dimer levels; and decreased albumin, sodium, and calcium levels. Chest computed tomography showed bilateral lesions (n = 7, 50%), middle-lower lobe lesions (n = 10, 71%), lesions in multiple lobes (n = 9, 64%), consolidation shadows (n = 11, 79%), and pleural effusions (n = 11, 79%). The median time from disease onset to hospital admission was 4.5 days (interquartile range: 1–17 days); the mean length of hospital stay was 20.9 ± 8.5 days, and the mean time from admission to diagnosis was 5.1 ± 2.6 days. After diagnosis, patients were either treated with doxycycline alone or doxycycline combined with quinolones. All 14 patients developed respiratory failure and received invasive mechanical ventilation; two (14%) received veno-venous extracorporeal membrane oxygenation, four (29%) received continuous renal replacement therapy, and three (21%) died.Discussion and conclusion:A poultry contact history and typical flu-like symptoms are early indicators of Chlamydia psittaci pneumonia. Substantial elevations in procalcitonin, creatine kinase, and brain natriuretic peptide indicate severe disease. Metagenomic next-generation sequencing is useful for diagnosis. Early empirical antibiotic therapy with quinolones can reduce the mortality in critically ill patients.

Pemodelan Pneumonia Berat Menggunakan Regresi Zero Inflated Negative Binomial di Gorontalo

In certain cases, the response variable has an excess zero that causes overdispersion. Therefore, to overcome overdispersion because excess zero Zero-inflated negative binomial regression can be used. The purpose of this study is to apply Zero inflated negative binomial regression to model the case of severe pneumonia in Bone Bolango and on the city of Gorontalo. Based on the result of ZINB Regression, it was found that there are 3 (three) factors that are significant that is ASI, Vitamin A, and low birth weight.