Application of prone position in severe ARDS caused by pneumocystis jirovecii pneumonia after kidney transplantation / 器官移植

Objective To investigate the improvement of oxygenation after the treatment of prone position in patients with severe acute respiratory distress syndrome (ARDS) caused by pneumocystis jirovecii pneumonia (PJP) after kidney transplantation. Methods Clinical data of 5 cases of moderate and severe ARDS caused by PJP after kidney transplantation were analyzed retrospectively, and clinical characteristics, treatment regimen and prognosis were summarized. Results Clinical manifestations of 5 patients were fever, dry cough, chest tightness, shortness ofbreath,sweating and fatigue, and body temperature fluctuated between 38 ℃ and 39 ℃, percutaneous arterial oxygen saturation(SpO2) was gradually decreased, and respiratory distress symptoms were worsened. Pulmonary CT scan showed diffuse ground-glass shadow. After transfer to intensive care unit (ICU), immunosuppressive drugs were terminated, and all patients were given with compound sulfamethoxazole, caspofungin, low-dose glucocorticoids against pneumocystis jirovecii (PJ), oxygen therapy and other symptomatic supportive treatments. Four patients diagnosed with severe ARDS upon admission to ICU were treated in a prone position. One patient with moderate ARDS was not kept in a prone position. At 1 d after treatment in a prone position, partial pressure of arterial oxygen (PaO2) and oxygenation index were increased, whereas alveolar-arterial oxygen difference (A-aDO2) was decreased compared with before treatment (allP<0.05). Compared with 1 d after treatment, SpO2, PaO2 and oxygenation index were all increased, while A-aDO2 was decreased at 4 d after treatment (all P<0.05). Box diagram showed that oxygenation index showed an overall upward trend after prone-position treatment, whereas A-aDO2 showed an overall downward trend. The length of ICU stay of 5 patients was 14 (8, 29) d. All patients in a prone position did not develop complications, such as skin pressure sore, tube detachment and tube displacement, etc. Among 5 patients, 4 patients were mitigated, and 1 patient died of septic shock and multiple organ failure. Conclusions For both conscious and intubated patients, a prone position may significantly improve oxygenation and prognosis of patients with severe ARDS caused by PJP after kidney transplantation. Early diagnosis and accurate and standardized treatment play a pivotal role in enhancing cure rate.

Therapeutic effect of clindamycin combined with compound sulfamethox-azole tablets on pneumocystis pneumonia associated with acquired immuno-deficiency syndrome / 中国感染控制杂志

Objective To understand the therapeutic effect of clindamycin combined with compound sulfamethoxazole tablets on pneumocystis pneumonia(PCP)associated with acquired immunodeficiency syndrome (AIDS).Methods 97 AIDS patients with PCP in a hospital from January 2014 to March 2015 were randomly divided into control group (n=49,received compound sulfamethoxazole )and trial group(n=48,received clindamycin on the basis of com-pound sulfamethoxazole ),levels of partial pressure of oxygen in arterial blood (PaO2 ),arterial blood oxygen satu-ration(SaO2 ),serum albumin(ALB),and lactic dehydrogenase (LDH)in two groups of patients before and after treatment were recorded.Results Levels of PaO2 ,SaO2 ,ALB,and LDH between two groups of patients before treatment was not significantly different(all P >0.05).After treatment,PaO2 in control group and trial group were (73.01 ±4.62)mmHg and(84.92 ±5.34)mmHg respectively,SaO2 were (75.81 ±4.28)% and(90.86 ±5.94)%respectively,ALB were (32.62±4.41 )g/L and(43.95 ±5.03)g/L respectively,LDH were(416.53 ±30.77)U/L and(331 .58±20.86)U/L respectively,levels of PaO2 and SaO2 in trial group were both higher than control group , difference in ALB and LDH between two groups of patients after treatment were both statistically significant(both P <0.05).The total effective rate of trial group was 89.58% (n=43),which was higher than 69.39%(n=34)in control group (χ2 =6.04,P =0.014).Conclusion Clindamycin combined with compound sulfamethoxazole tablets has good therapeutic effect on AIDS and PCP,which is worthy of clinical popularization and application.

Risk factors of hypersensitivity induced by prophylactic compound sulfamethoxazole in patients with human immunodeficiency virus infection / 中华传染病杂志

Objective To investigate the risk factors of hypersensitivity induced by compound sulfamethoxazole (Co-SMZ)in patients with human immunodeficiency virus (HIV)infection.Methods A retrospective study was performed in 111 patients with HIV infection receiving prophylactic Co-SMZ at the Department of Infectious Diseases,the Third People′s Hospital of Nantong City,Jiangsu Province from January 2014 to December 2014.Data including age,gender,interval time from diagnosis of HIV infection to hospitalization,history of drug allergy,and the counts of CD3 + T cell,CD4 + T cell,CD8 + T cell and natural killer (NK)cell on the day when the medicine was administrated for the first time were recorded. All the patients were followed up for two months.Student t test was used in data with normal distribution or approximate normal distribution.Rank sum test was used in data with skew distribution.The count materials were examined byχ2 test.Results Among the 111 patients with HIV infection,there were 107 males and 4 females with average age of (45 .7±11 .1)years old.The interval time from taking Co-SMZ to hypersensitivity was (14.0±7.6)d.There were differences in the counts of CD4 + T cell and NK cell between patients with hypersensitivity and without hypersensitivity (both P <0.05).Multivariate analysis showed that NK cell was a risk factor for inducing hypersensitivity (OR=1 .010,95 %CI :1 .005 -1 .017, P =0.001).The area under of receiver operating characteristic curve predicting hypersensitivity induced by Co-SMZ was 0.748 (95 %CI :0.647-0.850,Z =4.701 ,P =0.001).The best predictor was 109.80/μL with sensitivity of 63.2% and specificity of 84.7%.Conclusion In patients with HIV infection,NK cell might be associated with hypersensitivity induced by Co-SMZ.

Clinical analysis of 23 cases of Pneumocystis pneumonia in patients with acquired immunodeficiency syndrome / 中国感染控制杂志

Objective To investigate the clinical characteristics,diagnosis and therapeutic prognosis of Pneumocystis pneumonia(PCP)in patients with acquired immunodeficiency syndrome (AIDS).Methods AIDS patients with PCP were searched through computer medical record information system,clinical data were analyzed retrospectively,patients were divided into respiratory failure group (n= 1 1 )and non-respiratory failure group (n= 1 2 ),partial pressure of oxygen in arterial blood(PaO2 ),degree of blood oxygen saturation(SaO2 ),CD4+T lymphocyte,and lactate dehydrogenase(LDH) between two groups were compared. Results 23 patients generally had the symptoms of weight loss,oral leukoplakia, shortness of breath,dyspnea,fever,cough,and expectoration. PaO2 value in 23 patients was (78.65±30.85)mmHg,partial pressure of carbon dioxide(PaCO2)was (24.42±5.60)mmHg,pH value was(7.43±0.79),SaO2 was (91.16±9.55)% ;SaO2 and PaO2 in respiratory failure group was lower than non-respiratory failure group,the difference was significant (both P<0.05).Lung computed tomography (CT)scans showed bilateral pulmonary ground-glass-like change. 21 patients used compound sulfamethoxazole tablets,1 patient used compound sulfamethoxazole tablets plus clindamycin,1 patient used only clindamycin,17 patients used glucocorticoid in addition to compound sulfamethoxazole;after treatment,20 patients improved,2 died,and 1 gave up treatment.Conclusion Subacute progressive dyspnea,fever,dry cough,and lung ground-glass-like shadow are common symptoms of PCP in AIDS patients,compound sulfamethoxazole or compound sulfamethoxazole with clindamycin can be used for treatment,glucocorticoid can obviously alleviate the symptoms of patients.

Clinical efficacy observation of compound sulfamethoxazole combined with conventional atomization in treatment of bronchial tuberculosis / 中国生化药物杂志

Objective To explore clinical efficacy of compound sulfamethoxazole combined with conventional atomization in treatment of bronchial tuberculosis.Methods 190 cases were selected from January 2012 to October 2013 who diagnosised bronchial tuberculosis treated in minda hospital affiliated of Hubei institute for Nationalities,then the patiens were randomly divided into two groups(n=95 ),the control group underwent conventional spray treatment,the observation group row treatment on the basis of atomization,while giving sulfamethoxazole treatment,observation and comparison of two groups clinical outcomes and adverse reactions. Result After continuous treatment for 4~6 months in the observation group therapy effective rate of 70.5%,total effective rate was 89.5%in the control group significant efficiency and total efficiency of 48.4%and 76.8%,respectively,two groups of significant efficiency and total efficiency,there were significant differences(P<0.05 );bacterial turn negative time indicator on the observation group and the control group were respectively(2.6 ±0.9)months and(4.2 ±1.1)months,there was significant difference(P<0.05);adverse reactions in observation group and control group was 7.4% and 11.6%,respectively,which compared no significant difference.Conclusion Application of compound sulfamethoxazole combined with conventional atomization in treatment of bronchial tuberculosis,has quickly and significantly effect,and bacterial clearance time is short,with low adverse reactions,safety and reliable.