Trains of Thought in Treating Infectious Atypical Pneumonia with Integrative Chinese and Western Medicine Approach

EDITORIAL Severe Acute Respiratory Syndrome(SARS)is a new intractable disease worldwide,itsonset is acute,its infectivity and mortality is high,the knowledge about its etiology and pathogenesis is in-sufficient,the experience on SARS treatment awaits accumulation.Following pilot experiences of applyingICWM in fighting SARS is most valuable with scientific significance.

Measurement of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome and its clinical significance

Objective To investigate the changes of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome (SARS) and its clinical significance.Methods Subgroups of blood T lymphocytes in 93 patients with SARS were detected by flow cytometer. The results detected in 64 normal subjects and 50 patients with AIDS served as controls.Results The numbers of CD3 +, CD4 +, and CD8 + lymphocytes all significantly decreased in acute phase of patients with SARS [(722±533)/μl, (438 ±353)/μl, (307±217)/μl)] compared with those in normal controls [ (1527±470)/μl, (787±257)/μl, (633±280)/μl, all P<0. 01) ], which was different from what we observed in patients with AIDS who had decreased CD4 + [ (296±298)/μl] but increased CD8 + [ (818 ±566)/μl counts. The counts of CD3+, CD4+, and CD8 + lymphocytes decreased more apparently in patients with severe SARS. All the five patients who died had CD4 + counts less than 200/μl. As the patients' condition improved, CD3 +, CD4 +, and CD8 + counts gradually returned to normal ranges.Conclusion The damage of cellular immunity is probably an important mechanism of pathogenesis of SARS.

The chest X-ray image features of patients with severe SARS: a preliminary study

Objective To study the chest X ray image features of patients with severe SARS Methods Chest X ray image features in 36 patients with severe SARS were retrospectively analyzed The image characteristics were compared with those of 224 patients with common SARS Results The important chest X ray imaging features of 36 patients with severe SARS included small patch of infiltration (n=27, 75 0%), large patch of infiltration (n=22, 61 1%), large area of lung consolidation (n=10, 27 3%), interstitial lung lesion (n=26, 72 2%), ground glass shadow (n=28, 77 8%), irregular linear opacity (n=15, 41 7%), diffuse lung lesion (n=12, 33 3%), with single lung involved (n=9, 25 0%), and both lungs involved (n=32, 88 9%) The rates of large patch of infiltration, large area of lung consolidation, ground glass shadow, diffuse lung lesion and involvement of both lungs in patients with severe SARS were significantly higher than those in patients with common type of SARS (all P <0 01) Out of the 11 severe SARS patients who died, nine had large area of ground glass shadow with air bronchogram in both lungs before death Conclusions Large patch of infiltration, large area of consolidation, ground glass shadow, diffuse lung lesion and involvement of both lungs were the main X ray image characteristics of patients with severe SARS Large area of ground glass shadow with air bronchogram in both lungs indicated a bad prognosis

A retrospective study of 78 patients with severe acute respiratory syndrome

Objective To summarize the clinical features of severe acute respiratory syndrome (SARS) and to discuss diagnosis and management of the disease.Methods A retrospective study was conducted on 78 cases of SARS referred to the Guangzhou Institute of Respiratory Diseases (GIRD) between December 22, 2002 and near the end of March 2003. Items reviewed cover all data concerning clinical manifestations, laboratory investigation and radiology.Results The patients in the study consisted of 42 males and 36 females, aged 20 -75 yrs (mean age 37. 5±11. 6 yrs), including 44 affected health-care professionals. Clinical symptoms seen in the group were fever (100.0%), cough (88.5%), and dyspnea (79.5%). There were 12 cases (15. 3%) with WBCs <4. 0 x109/L, 49 cases (62. 8%) ranging between (4. 0-10. 0) ×10~9/L and 17 cases (21. 8%) over 10. 0×10~9/L. The average was(7. 58 ?. 96) x 109/L, with 0. 75±0.14 (neutrophil) and 0.18±0.11 (lymphocyte). Chest films and CT scanning revealed changes related to pneumonia. The transmission of the disease was likely via close contact with contagious droplets. The prevalences of acute lung injury (ALI, in 37cases) and acute respiratory distress syndrome (ARDS, 21 out of 37 cases) were considerably high among the patients. Seven patients who developed ARDS complicated with multiple organs dysfunction syndrome (MODS) died.Conclusions A history of close contact, fever, sign of pneumonia by X-ray and normal-to-lowered WBC counts are favorable for the diagnosis of SARS. Recognition of ALI as the important index for critical SARS and comprehensive supportive management are of paramount in decreasing the mortality of the disease.

Clinical analysis of 45 patients with severe acute respiratory syndrome

Objective To explore the clinical and radiological features of severe acute respiratory syndrome (SARS).Methods Analysis of the clinical presentation, chest radiographs, course of disease and features of severe pneumonia in 45 SARS patients diagnosed at our hospital in Beijing between April 5 - 20, 2003. Also included is a summation of the clinical features of SARS.Results (1) SARS appears to have high infectivity; (2) the most common symptom is fever; (3) the count of leukocyte is normal or decreased; (4) most patients (35/45, 77.8%) had experienced a 24-hour fever prior to the abnormal chest X-ray changes which showed progression of pulmonary infiltrates within 48 hours in 71.1% (32/45) of the patients and, (5) the percentage of patients who developed severe pneumonia (24. 4%) is higher than those who developed typical pneumonia.Conclusion SARS is a disease with high infectivity and has its own clinical and radiological features. Early recognition, prompt isolation, and appropriate therapy are the key to combate this infection.