ABSTRACT
Objective:To analyze the epidemiological and clinical features of patients with visceral leishmaniasis (VL), and to improve the understanding of the disease and standardize the diagnosis and treatment.Methods:The clinical data and diagnosis and treatment process of 62 patients with VL admitted to The First Hospital of Lanzhou University from January 2010 to December 2020 were retrospectively analyzed. The clinical symptoms and laboratory data, including aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and procalcitonin (PCT) were compared between children and adults. Chi-square test was used for statistical analysis.Results:Of the 62 patients, 31(50.0%) patients were males, 38(61.3%) patients were children and 24(38.7%) were adults. There were 32 cases (51.6%) living in Longnan City, and 11 cases (17.7%) living in Gannan Tibetan Autonomous Prefecture. Forty-seven cases (75.8%) had a delay over 30 days from onset to diagnosis. All patients had fever and chills, 34 cases (54.8%) had fatigue and poor appetite, 30(48.4%) had cough and expectoration, 10 cases (16.1%) had headache and dizziness, 45 cases (72.6%) had splenomegaly, 40 cases (64.5%) had anemia, and 29 cases (46.8%) had hepatomegaly. There were 32 cases (51.6%) accompanied with respiratory infection, 11 cases (17.7%) accompanied with hemophagocytic lymphohistiocytosis and 10 cases (16.1%) accompanied with abnormal liver function. Of the 60 patients who received treatment, 14 were recurrent cases who had received at least one course of pentavalent antimony monotherapy before admission. Forty-six patients received standard antimony monotherapy, 14 patients received standard antimony combined with amphotericin B therapy. Thirteen patients discontinued amphotericin B due to impaired renal function, and 50 patients were followed up for half a year without recurrence. The proportions of splenomegaly and hepatomegaly in children were 86.8%(33/38) and 65.8%(25/38), respectively, and the corresponding numbers in adults were 50.0%(12/24) and 16.7%(4/24), respectively. The differences were statistically significant ( χ2=10.03 and 14.26, respectively, both P<0.050). Thirty-three cases (86.8%) in children and 14 cases (58.3%) in adults had a delay over 30 days from onset to diagnosis. The difference was statistically significant ( χ2=6.52, P=0.011). The proportions of patients who had elevated AST, LDH and PCT were 76.3%(29/38), 94.3%(33/35) and 73.9%(17/23) in children, respectively, while 45.8%(11/24), 71.4%(15/21) and 5/17 in adults, respectively, and the differences were all statistically significant ( χ2=5.97, 3.89 and 7.82, respectively, all P<0.050). Conclusions:Patients with VL are tend to have complications and be severe. Early diagnosis and standardized treatment are important measures to improve the prognosis. Patients who have failed antimony treatment can be treated with amphotericin B or combination therapy, but kidney injury and other adverse reactions should be closely monitored.
ABSTRACT
Objective:To analyze the clinical characteristics of patients with nocardiosis, so as to improve the diagnosis and treatment of nocardia infection in the future.Methods:From May 2016 to October 2020, 24 patients with nocardiosis in Xiangya Hospital, Central South University were enrolled, and their clinical data including clinical features, laboratory examinations, imaging findings, diagnosis and treatment process, and outcome were retrospectively analyzed.Results:Among the 24 patients with nocardiosis, 18 cases (75.0%) were males, and the median age was 54.5 years.Twenty-three patients had underlying diseases, of which the most common disease was antineutrophil cytoplasmic antibody-related vasculitis (16.7%(4/24)). Of nine species of Nocardia identified from the 24 patients, Nocardia farcinica was the most common species (seven cases). The lesion sites were mainly lungs (70.8%(17/24)), skin and soft tissues (42.0%(10/24)), brain (25.0%(6/24)) and blood system (17.0%(4/24)). There were 12 cases (50.0%) of patients with more than two lesion sites. The clinical manifestations, imaging examinations and laboratory tests of the 24 patients were not specific. The diagnosis depended on the etiology. Nineteen patients received trimethoprim-sulfamethoxazole-based combination therapy, and two were discontinued due to adverse reactions of sulfa drugs. After treatment, 19 cases (79.2%) were improved and five cases (20.8%) died. Conclusions:Patients with nocardiosis often have atypical clinical manifestations, and multiple organs are easily affected.Early and accurate identification and rapid and effective anti-biotic therapy are the keys to improve the overall prognosis of these patients.