Objective To investigate the clinical characteristics of patients with COVID-19 associated pulmonary aspergillosis (CAPA). Methods The clinical data of patients diagnosed with CAPA admitted to the First Affiliated Hospital of Soochow University from December 16, 2022 to February 2, 2023 were collected and analyzed. Results Among the 43 enrolled patients,16 patients required invasive mechanical ventilation, 44.19% (19/43) of them with critical novel coronavirus pneumonia, and 86.05% (37/43) had underlying diseases. The peak period of CAPA was 14 - 28 days after SARS-CoV-2 infection (48.84%, 21/43). In the laboratory results, 86.05% (37/43) of patients had varying degrees of lymphocyte reduction, with a lymphocyte count of 0.63 (0.33, 0.96) × 109/L, the median levels of procalcitonin, CRP, and erythrocyte sedimentation rate were all higher than the reference values. 38.89% (14/36) of patients tested positive for serum GM test, and 75.00% (9/12) of patients tested positive for bronchoalveolar lavage fluid GM test. Aspergillus fumigatus is the most common strain. Voriconazole is the most commonly used antifungal drug (86.05%), and other drugs used include caspofungin, posaconazole, isavuconazonium, and amphotericin B. Two patients received local treatment with amphotericin B under bronchoscopy. After treatment, 27 patients improved and were discharged. Conclusions The symptoms, signs, and imaging manifestations of CAPA are not significantly specific, and are prone to misdiagnosis and missed diagnosis. The mortality rate is high. For patients suspected of CAPA and those with CAPA risk factors, relevant examinations should be promptly improved to improve diagnosis and treatment efficiency.
Objective To evaluate the status of asthma control in asthmatic outpatients.Methods We performed an investigation by a questionnaire in a face-to-face setting from Feb 2006 to May 2006 in asthmatic outpatients of China-Japan Friendship Hospital.Results A total of 101 asthmatic patients were investigated with a mean age of 47±14.8 years and course of disease of 9.1±12.8 years.80.2% of the asthmatic patients had various social insurance.40.6% of the respondents had visited emergency department because of asthma exacerbation.The percentage of adults with lost workdays caused by asthma was 61.7% (29/47)，and which of children with lost schooldays was 75% (3/4).37.6% of asthmatic patients were completely controlled.Approximately three fourth of respondents (75.2%) was either well or completely controlled.72.3% of respondents had undergone a lung-function test during the past year.The one third of respondents (36.6%) owned oneself peak flowmeter.Only 12.9% reported kept regular use of peak flowmeter.87.1% of patients use inhaled corticosteroids (ICS) regularly.Conclusion With the implementation of patient education program and asthma guideline，the asthma control level has been further improved.
Objective To explore the characteristics of vibration response imaging ( VRI) among heavy smokers whose pulmonary function is normal. Methods 67 heavy smokers with normal pulmonary function, 60 healthy non-smokers, and 60 patients with COPD were recruited. History taking, physical examination, lung function test, chest X-ray, and VRI examination were performed. The difference of VRI dynamic imaging between the three groups was analyzed. Results VRI vibration energy curve which appeared low, flat, sunken-in, and single peak accounted for 43.3% , 16.4% , 16.4% , and 14.9% respectively in the heavy smokers, accounted for 6.7% , 3.3% ,0% , and 0% respectively in the healthy nonsmokers, accounted for 60% , 33.3% , 18.3% , and 16.7% respectively in the COPD patients. The results between the heavy smokers and the healthy non-smokers were significantly different. Compared with the heavy smokers, the COPD patients exhibited more low and flat in expiration period. The energy peak value ratio of inspiration and expiration phase in the heavy smokers, the healthy non-smokers, and the COPD patients were 0.56,0.74, and 0.54 respectively. There was no significant difference between the heavy smokers and the COPD patients in peak value ratio of inspiration and expiration phase. Conclusion The vibration energy curve of the VRI in heavy smokers with normal pulmonary function is significantly different fromhealthy nonsmokers, but there is no significant difference between heavy smokers and COPD patients.
ObjectiveTo investigate clinical characteristics and influencing factors of lower respiratory tract infection of Acinetobacter baumannii (AB-LRTI) in respiratory intensive care unit (RICU).MethodsClinical data were collected from 204 RICU patients who were isolated Acinetobacter baumannii (AB). The bacteriological specimens were derived from sputum, bronchoscopic endotracheal aspiration, bronchoalveolar lavage fluid, pleural effusion and blood. The definition of bacterial colonization was based on the responsible criteria from Centers for Disease Control and Prevention/National Medical Safety Network (CDC/NHSN). The patients were divided into three groups as follows, AB colonization group (only AB was isolated, n=40); simple AB-LRTI group (only AB was isolated and defined as infection, n=63), AB with another bacteria LRTI group (AB and another pathogen were isolated simultaneously, n=101). The epidemiology, clinical characteristics and influencing factors of each group were analyzed and compared. ResultsCompared with the AB colonization group, the AB with another bacteria LRTI group had higher proportion of patients with immunosuppression, specimens from sputum and bronchoalveolar lavage fluid, more than 4 invasive procedures, 90-day mortality, white blood cell count >10×109/L (or <4×109/L), neutrophil percent >75% (or <40%), lymphocyte count <1.1×109/L, platelet count <100×109/L, albumin <30 g/L, high sensitivity C-reactive protein >10 mg/L, and neutrophil-to-lymphocyte ratio (NLR). The frequency of bronchoscopy and days of infusing carbapenem within 90 days before isolating AB, the Acute Physiology and Chronic Health Evaluation Ⅱ score, the proportion of patients with invasive mechanical ventilation and the duration of invasive mechanical ventilation in the AB with another pathogen LRTI group were higher than those in the AB colonization group (all P<0.05). Days of infusing carbapenem and β-lactams/β-lactamase inhibitors within 90 days before isolating AB, proportion of septic shock, NLR and 90-day mortality of the patients from the AB with another pathogen LRTI group were more than those in the simple AB-LRTI group (all P<0.05). After regression analysis, more than 4 invasive procedures, or immunosuppression, or with more days of infusing carbapenem within 90 days before isolating AB were all the independent risk factors for AB-LRTI.ConclusionsThere are significant differences in epidemiology, clinical symptoms and laboratory indicators between simple AB-LRTI, AB with another pathogen LRTI and AB colonization in RICU patients. For RICU patients, who suffered more than 4 invasive procedures, immunosuppression, or with more days of infusing carbapenem within 90 days before isolating AB, are more susceptible to AB-LRTI.