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The man had a dry cough but no fever and was suddenly sent to the emergency room! The Shanghai doctor saw... rare pneumonia!
Xinmin Evening News2024-04-29 15:44
A week ago, 31-year-old Xiao Zhang
Suddenly suffocating and unable to breathe
at Shanghai Jiao Tong University School of Medicine
Affiliated Xinhua Hospital Emergency Room
Several key indicators made doctors worry about him:
The blood oxygen saturation is only 84% under oxygen inhalation conditions
(Normal standards are generally 95%-100%)
Heart rate 147 beats/min, respiratory distress
Chest CT findings
His lungs showed "pulmonary edema"-like symptoms
So, does he have pulmonary edema?
Is it "pulmonary edema"?
After careful medical history
With more than 20 years of experience in emergency and critical care treatment
Deputy Director of the Emergency Department of Xinhua Hospital,
Ge Qinmin, Chief Physician of EICU, Emergency Intensive Care Unit
A rare type of pneumonia immediately flashed into my mind
——Pneumocystis jiroveci pneumonia
This fungal lung infection is coming with a vengeance
Xiao Zhang came to Shanghai to apply for a job a month ago. He had been suffering from dry cough before. Since he did not have a fever, he did not take it seriously, did not take any medicine, and did not go to the hospital. Unexpectedly, his condition suddenly changed and he was sent to the emergency room.
"You probably have a fungal infection in your lungs!" The emergency department of Xinhua Hospital immediately opened a green channel and admitted Xiao Zhang to the EICU and provided assisted respiratory support.
After Xiao Zhang was admitted to hospital, his fungal glucan levels were as high as 397.8pg/mL, and his lactate dehydrogenase was also much higher than the normal value. Imaging and blood biochemistry all pointed to Pneumocystis jiroveci pneumonia, which was severe.
On the day of the rescue, experts based on clinical experience used a therapeutic dose of compound sulfamethoxazole. On the 4th day after admission, the doctor found Pneumocystis jiroveci in the alveolar lavage fluid collected through bronchoscopy, with a sequence number of 21,403, finally verifying the clinical diagnosis.
Fortunately, due to the immediate use of compound sulfamethoxazole for treatment, the patient's respiratory failure symptoms and inflammatory response have gradually improved. A week later, Xiao Zhang was weaned from high-flow assisted breathing and switched to a common nasal cannula for oxygen inhalation.
The incidence is gradually increasing in non-HIV-infected immunocompromised patients
So, where did this bacteria come from, and why did it appear in this young man's body? In recent years, the incidence has indeed gradually increased among non-HIV-infected immunocompromised patients.
"This is not the first case we have encountered in the emergency department." Ge Qinmin revealed that Pneumocystis jiroveci is an opportunistic pathogen. This fungus will attach to type I alveolar cells in the lungs. When the immune function When it is low or defective, Pneumocystis jiroveci will multiply and overt infection will eventually occur.
Pneumocystis jiroveci is a menacing disease. It is not an infection unique to AIDS. It is difficult to diagnose in the early stages of the disease, but the condition worsens quickly. If not diagnosed and treated in time, the mortality rate of non-HIV infected people is as high as 90% to 100%.
Among patients treated, non-HIV-infected patients generally have worse outcomes than HIV-infected patients, with mortality rates ranging from 35% to 50%, with mortality rates higher in severe cases.
So, who are the high-risk groups? The risk depends on the degree of cell-mediated immunodeficiency. Hematopoietic stem cell transplant or solid organ transplant recipients, cancer patients, especially hematological malignancies, are all high-risk groups.
Prevention is important for high-risk groups
Ge Qinmin introduced that in recent years, more and more drugs have been associated with an increased risk of infection, such as glucocorticoids, chemotherapy drugs and other immunosuppressants.
Xiao Zhang was diagnosed with minimal change glomerulonephritis in April 2023. Due to poor proteinuria control and recurrent illness, in addition to oral hormone (prednisone) treatment, he began to be treated in a local hospital in mid-February this year. Rituximab was added weekly for 4 weeks.
Before discharge, the local doctor ordered Xiao Zhang to take compound sulfamethoxazole orally . Xiao Zhang checked online and found that this drug was used to treat Pneumocystis carinii pneumonia, and his chest CT during hospitalization was completely normal, so he did not comply. Take an oral prophylactic dose as directed by your doctor.
The doctor reminded: "Prevention for high-risk groups is very important."
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