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幼董能
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1 发热肺部感染 ARDS 首都医科大学急诊医学系首都医科大学附属北京朝阳医院急诊科何新华

2 一般情况男性,27 岁发热 10 天, 咳嗽咳痰伴左侧胸痛咳痰伴左侧胸痛 5 天血气 :PH H 7.531,PCO, mmHg,PO mmHg( 文丘里吸氧 10l/min,FiO 2 50%) 血常规 WBC /L N 80 1% 血常规 :WBC /L,N 80.1%, HGB 134g/L,PLT /L

3 HRCT 入院第1天

4 HRCT( 入院第 1 天 )

5 诊治经过肺部 CT 和化验检查, 考虑患者重症肺炎泰能 + 斯沃 + 利福平 + 希舒美初期治疗, 症状进一步加重气管插管接呼吸机辅助通气 FiO 2 100%,SpO 2 82%,PaO 2 55mmHg

7 诊治经过 PCT 0.26 ng/ml

8 诊治经过临床考虑 : 非细菌感染痰病毒核酸检验 : 腺病毒 (+) 血清病毒核酸 : 腺病毒 (+) 血清 G 试验 (-) 腺病毒肺炎诊断 :

9 诊治经过给予更昔洛韦抗病毒治疗应用丙种球蛋白胸腺肽免疫调节联合应用中药抗病毒治疗

10 诊治经过入院 2 天入院 6 天

11 诊治经过入院 8 天入院 11 天

12 HRCT 入院第16天

13 HRCT( 入院第 16 天 )

14 HRCT 入院第26天

15 HRCT( 入院第 26 天 )

16 出院前

17 From Canada

18 方式与方法时间 : 地点 :55 家医院, 前瞻性临床研究方法 : 细菌学培养血清学检查咽试子实验流感病毒人变性肺病毒呼吸道合孢病毒流感病毒人变性肺病毒呼吸道合孢病毒鼻病毒副流感病毒冠状病毒和腺病毒

19 结果 193 人入选, 平均 71 岁,51% 男性,47%SCAP 75(39%) 病源学其中病毒 29 例 (15%), 细菌 38 例 (20%),8 例混合感染 (4%) 流感 7, 人变性肺病毒 7, 呼吸道合孢 3, 腺病毒 2 肺链 37% 与细菌感染相比, 病毒感染者年龄更大 (76 vs 64,p=0.01), 同时合并基础疾病 (66% vs 32%,p=0.02) 02) 细菌和病毒感染在临床表现和预后方面没有差异

23 结论在 CAP 住院病人中呼吸道病毒感染是常见的病源学明确的患者中占 39%, 在所有观察病人中占 15% 流感病毒人变性肺病毒和呼吸道合孢病毒最为常见鉴别是否感染病毒仍然很困难建议此类病人常规行病毒学检查

24 Thorax 2008; 63: From New Zealand

25 Methods Adults admitted to Christchurch Hospital over a 1-year period with CAP were included in the study. Blood and sputum cultures, urinary antigen testing for Streptococcus pneumoniae and Legionella pneumophila, antibody detection in paired sera and detection of respiratory viruses in nasopharyngeal swabs by immunofluorescence, culture and PCR.

26 Results 304 patients with CAP, a viral diagnosis was made in 88 (29%), with rhinoviruses and influenza A being the most common. Two or more pathogens were detected in 49 (16%) patients, 45 of whom had mixed viral and bacterial infections. There were no reliable clinical predictors of viral pneumonia, although several variables were independently associated with some aetiologies. The presence of myalgia was associated with pneumonia caused by any respiratory virus (OR 3.62, 95% CI 1.29 to 10.12) and influenza pneumonia (OR , 95% CI 3.68 to ). Mixed rhinovirus/pneumococcal infection was associated with severe disease.

29 Conclusions Virus-associated CAP is common in adults. Polymicrobial infections involving bacterial and viral pathogens are frequent and may be associated with severe pneumonia.

30 From China

33 Conclusion M. pneumoniae and respiratory viruses (IFVA, PIV, AdV, hmpv) were the most frequent pathogens found in ambulatory adult CAP patients. Quinolones were better than β-lactams, macrolides, or β-lactams + macrolides in the resolution of fever of M. pneumoniae n pneumonia.

34 Current Opinion in Infectious Diseases 2009; 22: From Spain

35 Recent Finding Better quality diagnostic tests, such as nucleic acid amplification techniques, have markedly improved our ability to detect multiple viral pathogens. With these diagnostic tools, a viral cause can be established in more than half of patients with CAP. Influenza A and RSVs are the most frequent causes of viral pneumonia followed by adenovirus, parainfluenza virus types 1, 2, and 3, and influenza.

36 Although some clinical findings have been more frequent with viral infection,no clear-cut clinical signs have been shown to be predictive of specific cause. Of more interest is the association of mixed virus bacteria infection with poorer severity scores found in some studies. Unfortunately, there are no other licensed antivirals or vaccines against the large variety of clinically important respiratory viruses with the notable exception of influenza.

37 Summary Given the high rate of viral infection in CAP and its probable association with poorer prognosis in mixed virus bacteria infection, an extensive evaluation for virus in some populations seems appropriate. These findings can be useful for a more appropriate management of these patients.

38 小结病毒感染在 CAP 占有较高的发病率临床症状体征 X 线无特异性特异性病毒学检查可明确诊断无特异性治疗药物混合感染预后差老年人更易合并病毒感染

39 发热肺部感染病毒感染 ARDS

622 Prog Pharm Sci Aug Vol. 38 No. 8

622 Prog Pharm Sci Aug Vol. 38 No. 8 PROGRESS IN PHARMACEUTICAL SCIENCES 2014,38 8 :621-628 621 IMPORTANT AFFAIRS IN PHARMACEUTICAL WORLD Disease Briefing: Ebola Hemorrhagic Fever Thomson Reuters Ebola hemorrhagic fever is a severe hemorrhagic