Severe Drug Eruption in Guinea Conakry

Severe drug reactions are defined as mucocutaneous complications secondary to systemic administration of drugs likely to be life threatening. Our work was designed to determine the evolutionary epidemiological and etiological characteristics of severe drug reactions to the Department of Dermatology Venereology, at Donka Teaching Hospital. A prospective descriptive study of all cases of severe drug reactions received at the Department of Dermatology Venereology of the Donka Teaching Hospital was conducted over a period of two years, from June 2009 to May 31, 2011. We identified 22 Stevens-Johnson syndrome, 13 Toxic Epidermal Necrolysis, 1 Stevens-Johnson syndrome Border Toxic Epidermal Necrolysis, 1 Drug Rash with Eosinophilia and Systemic Symptoms and 2 Acute generalized exanthematous pustulosis among 481 hospitalized patients, of whom 50 had consulted for drug reactions, that is to say, a frequence of 10.40%. The Stevens-Johnson syndrome accounted for 44%, the Stevens-Johnson syndrome Border Toxic Epidermal Necrolysis 2%, Toxic Epidermal Necrolysis 26%, Drug Rash with Eosinophilia and Systemic Symptoms 2% and Acute generalized exanthematous pustulosis 4% of drug reaction. The female sex was predominant (28 women vs. 11 men), that is to say 71.59% vs. 26.21 with a sex ratio of 2.55. The average age of our patients was 29.72 years;the range of ages 21 - 40 years was the most affected (51.28%) followed by 0 - 20 years (33.33%). The lethality rate was 9.09% (2/22) in the Stevens-Johnson syndrome and 53.85% (7/13) in the Toxic Epidermal Necrolysis. HIV infection was found in 17.95% (7/26) of our patients and 71.42% (5/7) of the deceased. The drug accountability was established in 79.48%;the most commonly implicated drugs in the Toxic Epidermal Necrolysis were sulfonamides followed by ARVs (nevirapine) and anti TB (isoniazid);in the SJS sulfonamides followed by salts of quinine and anti TB, the only case of DRESS was due to quinine. No drug was found in 20.52% (8 cases). HIV infection remains a poor prognostic factor. Our study shows the scarcity of Drug Rash with Eosinophilia and Systemic Symptoms and Acute generalized exanthematous pustulosis in our service.

Compound-honeysuckle-induced drug eruption with special manifestations:A case report

BACKGROUND The clinical manifestations of drug eruption are complex and diverse,which can lead to missed diagnosis or misdiagnosis.The clinical manifestations of drug eruption caused by compound honeysuckle have not been reported.CASE SUMMARY A 20-year-old man was admitted to our department of dermatology due to erythema and papules on the chest and abdomen with pruritus for 3 d.The next day after taking compound honeysuckle granules,the patient suddenly developed a rash and intense itching on his chest and abdomen.Physical examination revealed diffuse red needle-cap size macules and papules with welldefined borders on the chest and abdomen,and discoloration after finger pressure.No abnormality was observed in other areas of the skin.Back skin scratch was positive.White blood cells,eosinophil count and eosinophil ratio were higher than normal.Histopathological examination of the skin lesions on the left abdomen revealed intercellular edema,blurred focal basal cell layers,and focal lymphocyte infiltration in the superficial dermis and perivascular areas.Immunohistochemistry showed CD3+,CD4+and CD8+T lymphocytes.The diagnosis was drug eruption with special manifestations induced by compound honeysuckle.The skin lesions completely subsided without pruritus after 2 wk of antihistamine and hormone therapy.Follow-up for>1 mo showed no recurrence.CONCLUSION Chinese patent medicine compound honeysuckle granules can induce allergic reaction and rare skin damage.

Care strategies for patients with severe drug-induced hepatitis

Objective: The aim of this study is to analyse the clinical characteristics of 32 patients with severe drug-induced hepatitis, reinforce the practice of unique nursing and holistic nursing, improve the therapeutic effect, reduce the patients’ mortality, and increase their quality of life. Methods: We give patients individualized dietary guidance, medication nursing, and psychological care according to the characteristics of severe hepatitis and its complications, using com- prehensive medical treatment and combined signs of Traditional Chinese Medicine. Results: Overall, 22 (68.8%) out of 32 cases were improved, 8 (25.0%) cases died, and 2 (6.2%) cases were discharged of free will. In addition, the average hospital stay was 28.75 days. Conclusion: This study indicates that dietary guidance for the patients with severe drug-induced hepatitis varies with the individual. The result embodies the concept of Traditional Chinese Medicine that different treatment for the same disease and different diet for the same disease. Special nursing enriches the connotation of holistic nursing. Both of them are vital for improving the survival rate and promoting rehabilitation of patients with severe drug-induced hepatitis.

Four FDA-approved drugs exhibited inhibition effect on severe fever with thrombocytopenia syndrome virus in vitro

Objective:To screen the anti-SFTSV drugs from 1430 FDA-approved drugs via mini-genome system,and to investigate which stage of the infection process could be suppressed by the identified drugs.Methods:The SFTSV mini-genome system was used to screen drugs with inhibitory effect on SFTSV replication and transcription,and the 50%inhibitory concentration(IC_(50))of each drug was calculated by drug concentration gradient inhibition experiment.Drugs were used to pre-incubate with virus and then incubate with cells,to incubate with virus and cells simultaneously,to incubate with cells after virus invading into cells,or to incubate during the whole infection process,and then qRT-PCR was used to measure the viral RNA copies in the culture supernatant.These experiments were performed to quantitatively determine the inhibition effects of drugs on SFTSV indifferent stages of the whole process including virion stability,entry and post-entry stages,so as to clarify the inhibition mechanism of these drugs.Results:Four drugs including Mycophenolate mofetil,Mycophenolic acid,Nitazoxanide,and Vidofludimus were identified having efficient inhibitory effects on SFTSV RNA replication via minigenome system,with the IC_(50) of 0.014μmol/L,0.627μmol/L,1.283μmol/L,and 0.059μmol/L,respectively.All four drugs showed effective inhibition when adding during the whole SFTSV infection process as well as the post-entry stage.Conclusion:Mycophenolate mofetil,Mycophenolic acid,Nitazoxanide and Vidofludimus show efficient anti-viral effects on SFTSV infection.

Efficacy and safety of carrimycin in ten patients with severe pneumonia following solid organ transplantation

BACKGROUND The number of patients undergoing solid organ transplantation has increased annually.However,infections in solid organ transplant recipients can have a severe effect on patient survival owing to the continued use of immunosuppressants.Carrimycin is a novel macrolide antibiotic produced by genetically engineered streptomyces spiramyceticus harboring a 4’’-O-isovaleryltransferase gene(ist)from streptomyces thermotoleran.Carrimycin has good antibacterial and antiviral effects.However,no relevant studies have been conducted on the efficacy and safety of carrimycin in patients with severe pneumonia(SP)after solid organ transplantation.AIM To explore the efficacy and safety of carrimycin in patients with SP after solid organ transplantation to provide a medication reference for clinical treatment.METHODS In March 2022,ten patients with SP following solid-organ transplantation were treated at our hospital between January 2021 and March 2022.When the condition was critical and difficult to control with other drugs,carrimycin was administered.These ten patients'clinical features and treatment protocols were retrospectively analyzed,and the efficacy and safety of carrimycin for treating SP following solid organ transplantation were evaluated.RESULTS All ten patients were included in the analysis.Regarding etiological agent detection,there were three cases of fungal pneumonia,two cases of bacterial pneumonia,two cases of Pneumocystis pneumonia,and three cases of mixed infections.After treatment with carrimycin,the disease in seven patients significantly improved,the course of the disease was significantly shortened,fever was quickly controlled,chest computed tomography was significantly improved,and oxygenation was significantly improved.Finally,the patients were discharged after curing.One patient died of acute respiratory distress syndrome,and two patients discontinued treatment.CONCLUSION Carrimycin is a safe and effective treatment modality for SP following solid organ transplantation.Carrimycin may have antibacterial and antiviral effects in patients with SP following solid organ transplantation.

Epilepsy Properties and Seizure Suppression in a Severe Motor and Intellectual Disabilities

Purpose: In hospitalized patients with severe motor and intellectual disabilities (SMID), we analyzed the association of the SMID class to factors such as the prevalence of epilepsy, frequency of seizures and number of concomitantly used anti-epileptic drugs (AEDs), and evaluated the usefulness of addition of the new AEDs (gabapentin, topiramate, lamotrigine and levetiracetam) to the treatment regimen. Results: The prevalence of epilepsy in the study population was about 60%. There were 39.5% who were free of epileptic seizures during the 6-year survey period and remained well-controlled with medication. As the SMID increased in severity, the frequency of seizures increased, the number of concomitantly used AEDs increased, and the tendency towards addition of new AEDs became more marked. About the use situation of new AED and old AED, this comparison revealed a tendency towards addition of a new AED when the seizures were poorly controlled in response to concomitant use of multiple old AEDs. The frequency of seizures and the number of concomitantly used AEDs were higher in patients with SMID of high severity than in those with SMID of low severity. Analysis of the time-course of the frequency of seizures before and after the addition of new AEDs revealed a significant reduction in the frequency of seizures following the addition of the new AEDs (P > 0.001). Conclusions: These results suggest that the new AEDs are useful in the management of SMID-associated epilepsy, because of their effect of reducing the frequency of SMID-associated seizures and their high tolerability.

Analysis of the Prognostic Factors of Very Severe Aplastic Anemia Treated with Chinese Kidney-Invigorating Drugs in Combination with Anti-lymphocyte Globulin or Anti-thymocyte Globulin

Objective： To explore the prognostic factors for very severe aplastic anemia （VSAA） patients treated mainly with Chinese Kidney （Shen）-invigorating drugs （CKID） combined with anti-lymphocyte globulin （ALG） or anti-thymocyte globulin （ATG）. Methods： Twenty-seven VSAh. patients were treated with CSID＋ALG/ ATG therapy in conjunction with cyclosporine A, androgen, hemopoietic growth factor, etc. The relationship of the effectiveness and some factors （age of patients, course of illness, blood and bone marrow figures, etc.） were analyzed. Results： In the 25 evaluated VSAA patients who had been followed up for over 1 year, 9 patients （36.0%） were basically cured, 5 （20.0%） remitted, 6 （24.0%） were markedly improved, and 5 （20.0%） were treated in vain, with the total effective rate of treatment being 80.0% （20/25）. Better clinical therapeutic effects were shown in patients newly diagnosed with VSAA, of male sex （P=0.037）, 〉20 years old （P=0.045）, with an illness course ≤ 1 month （,P=0.048）, with peripheral neutrophil count 〉0.1 × 10^9/L （P=0.023）, and with reticulocyte count 〉10 × 10^9/L （P=0.002）. Platelet count （P=0.620） and bone marrow lymphocyte percentage （P=0.736） showed no correlation with the therapeutic effectiveness. Multi-factor analysis by the Kaplan-Meier procedure on the factors influencing survival showed that rather longer survival times occurred in patients 〉 20 years old, with peripheral neutrophil count ≤〈0.1 × 10^9/L, reticulocyte count ≤10 × 10^9/L, and platelet count 〉 10 × 10^9/L （allP=0.0001）. Bone marrow lymphocyte percentage and the initiation time of ALG/ATG application （from onset of the illness） showed no significant influence on patients＇ survival time （P=0.085 and P=0.935, respectively）. Conclusions： CSKD＋ALG/ATG therapy for treatment of VSAA could enhance the current clinical therapeutic effects and elevate patients＇ survival rate. Conditions including male sex, age 〉20 years, illness course ≤1 month, neutrophil count 〉0.1× 10^9/L, and reticulocyte count 〉10 × 10^9/L are the likely effective indices for predicting favorable therapeutic effectiveness in newly diagnosed VSAA patients.

Clinical study of distribution and drug resistance of pathogens in patients with severe acute pancreatitis

Background Previous researches about necrotic pancreatic tissue infections are numerous, but the study on systemic infection related to the severe acute pancreatitis （SAP） treatment period is limited. This study aimed to investigate the distribution and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP during the past three years. Methods A retrospective study was conducted on the distribution, category and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP from 2008 to 2011. Results A total of 594 pathogenic bacteria samples were isolated. Among them 418 isolates （70.4%） were Gram bacteria negative, 142 isolates （23.9%） were Gram bacteria positive, and 34 isolates （5.7%） were found fungi. The most common Gram negative bacteria were Escherichia coli （19.8%）, and the dominant Gram positive pathogenic bacteria were Enterococcus faecium. The distribution of SAP-related infectious pathogens was mainly in peritoneal drainage fluid, sputum, bile, and wound secretions. Almost all the Gram negative pathogenic bacteria were sensitive to carbapenum. Extended-spectrum I]-Iactamases （ESBLs） producing strains were more resistant to penicillins and cephalosprins than the ESBLs non-producing strains. Staphylococcus was sensitive to vancomycin and linezolid. The drug resistance of meticillin-resistant staphylococcus （MRS） to commonly used antibiotics was higher than meticillin-sensitive streptococcus （MSS）. Enterococcus sp. exhibited lower drug-resistance rates to vancomycin and linezolid. Conclusions Gram negative bacteria were the dominant SAP-related infection after hepatobiliary surgery. A high number of fungal infections were reported. Drug resistant rates were high. Rational use of antibiotics according to the site of infection, bacterial species and drug sensitivity, correctly executing the course of treatment and enhancing hand washing will contribute to therapy and prevention of SAP-related infection and decrease its mortality.

Two cases of childhood absence epilepsy who showed seizure disappearance after ethosuximide drug eruption

Background Recent studies suggest potential roles of immune response in the pathophysiology of epilepsy.Anti-seizure medications(ASMs)are known to have side effects of drug eruption caused by immune responses.A few reports in adults have demonstrated disappearance of seizures after an ASM drug eruption episode.In this paper,we described 2 cases of childhood absence epilepsy(CAE)who showed seizure disappearance after ethosuximide(ESM)drug eruption,suggesting the possibility that the epilepsy disappears due to immune responses to ASM.Case presentation Case 1 was an 8-year-old girl diagnosed with CAE.She was treated with valproate acid(VPA)initially,and then ESM was administered as an additional treatment.Her epileptic seizure disappeared 4 days after initiation of ESM.However,drug eruption appeared 1 week after the administration of ESM.Even after discontinuation of ESM administration,she maintains no seizure after the drug eruption.Case 2 was a 5-year-old boy diagnosed as CAE.He was treated with VPA initially,and ESM was administered additionally.Drug eruption appeared 1 month after the administration of ESM.Even after ESM was terminated,he maintained seizure freedom after the appearance of eruption.Conclusions Epileptic seizures may have been suppressed due to the immune responses caused by ASM eruption.Further studies are needed to elucidate the pathophysiologic effects of drug eruption on epilepsy through immune responses.

Antiviral activity of vitamin D derivatives against severe fever with thrombocytopenia syndrome virus in vitro and in vivo

Severe fever with thrombocytopenia syndrome virus(SFTSV)is a tick-borne virus that causes the severe fever thrombocytopenia syndrome,which manifests as fever and haemorrhage,accompanied by severe neurological complications.To date,no specific antiviral drugs have been approved for this indication.Herein,we investigated whether vitamin D derivatives inhibit SFTSV both in vitro and in vivo.An in vitro study demonstrated that vitamin D derivatives significantly suppressed viral RNA replication,plaque formation,and protein expression in a dosedependent manner.Subsequently,in vivo studies revealed that doxercalciferol and alfacalcidol were associated with increased survival and reduced viral RNA load in the blood.Time-of-addition assay suggested that vitamin D derivatives primarily acted during the post-entry phase of SFTSV infection.However,cytopathic effect protective activity was not observed in RIG-I immunodeficient cell line Huh7.5,and the administration of vitamin D derivatives did not improve the survival rates or reduce the blood viral loads in adult A129 mice.Further transcriptome exploration into the antiviral mechanism revealed that alfacalcidol stimulates host innate immunity to exert antiviral effects.To expand the application of vitamin D derivatives,in vitro and in vivo drug combination assays were performed,which highlighted the synergistic effects of vitamin D derivatives and T-705 on SFTSV.The combination of alfacalcidol and T-705 significantly enhanced the therapeutic effects in mice.This study highlights the potential of vitamin D derivatives against SFTSV and suggests that they may have synergistic effects with other compounds used in the treatment of SFTSV infection.

Delayed hypersensitivity reaction resulting in maculopapular-type eruption due to entecavir in the treatment of chronic hepatitis B

Several clinical trials have demonstrated the potent antiviral efficacy of entecavir (ETV), and this relatively new nucleoside analogue drug has rapidly become a frequently prescribed therapy for chronic hepatitis B (CHB) worldwide. While the studies have also shown a good overall safety profile for ETV, adverse drug reactions (ADRs) in patients with advanced cirrhosis have been reported and represent a broad spectrum of drug-induced injuries, including lactic acidosis, myalgia, neuropathy, azotemia, hypophosphatemia, muscular weakness, and pancreatitis, as well as immune-mediated responses (i.e., allergic reactions). Cutaneous ADRs associated with ETV are very rare, with only two case reports in the publicly available literature; both of these cases were classified as unspecified hypersensitivity allergic (type I) ADR, but neither were reported as pathologically proven or as evaluated by cytokine release analysis. Here, we report the case of a 45-year-old woman who presented with a generalized maculopapular rash after one week of ETV treatment for lamivudine-resistant CHB. The patient reported having experienced a similar skin eruption during a previous three-month regimen of ETV, for which she had self-discontinued the medication. Histopathological analysis of a skin biopsy showed acanthotic epidermis with focal parakeratosis and a perivascular lymphocytic infiltrate admixed with interstitial eosinophils in the papillary and reticular dermis, consistent with a diagnosis of drug sensitivity. A lymphocyte stimulation test showed significantly enhanced IL-4, indicating a classification of type IVb delayed hypersensitivity. The patient was switched to an adefovir-lamivudine combination regimen and the skin eruption resolved two weeks after the ETV withdrawal. This case represents the first pathologically and immunologically evidenced ETV-induced delayed type hypersensitivity skin reaction reported to date. Physicians should be aware of the potential, although rare, for cutaneous ADRs associated with ETV treatment.

Drug-induced erythroderma in patients with acquired immunodeficiency syndrome

BACKGROUND: To explore the clinical manifestations, diagnosis, and treatment of patients with acquired immunodeficiency syndrome(AIDS) complicated with drug-induced erythroderma.METHODS: The clinical data of 12 AIDS patients with drug-induced erythroderma in our hospital were retrospectively analyzed. The general information, offending medications, complications, modified severity-of-illness score for toxic epidermal necrolysis(SCORTEN) scores, and disease outcome spectrums were analyzed.RESULTS: Drug-induced erythroderma was mostly caused by antiviral drugs, antituberculosis drugs, antibiotics, traditional Chinese medicine, and immune checkpoint inhibitors. The spectrum of sensitizing drugs was broad, the clinical situation was complex, and infections were common. The affected areas were greater than 40% body surface area in all patients. The modified SCOTERN score averaged 3.01±0.99. All patients were treated with glucocorticoids, and nine patients were treated with intravenous immunoglobulin(IVIG) pulse therapy at the same time. The average time to effectiveness was 7.08±2.23 days, and the average hospital stay was 17.92±8.46 days. Eleven patients were cured, and one patient died of secondary multiple infections, who had a modified SCORTEN score of 5 points. The mortality rate in this study was 8.3%.CONCLUSIONS: The clinical situation of AIDS patients with drug-induced erythroderma in hospitalized patients is complex and the co-infection rate is high. The use of modified SCORTEN score may objectively and accurately assess the conditions, and the use of glucocorticoid combined with IVIG therapy may improve the prognosis.

Reliability and Validity of Addiction Severity Index in Drug Users with Methadone Maintenance Treatment in Guizhou Province, China

Objective To evaluate the reliability and validity of the Chinese version of addiction severity index （ASI）-5th version （ASI-C-5）, in illegal drug users receiving methadone maintenance treatment （MMT） in China. Methods One hundred and eighty-six heroin addicts （144 men and 42 women） receivihg MMT at three clinics in Guizhou province, southwest China, were recmited. They were all interviewed with a questionnaire of ASI-C-5 and 35 were re-interviewed at an interval of seven days to assess its test-retest reliability. Results Cronbach＇s alpha for internal consistency of CSs varied from 0.60 to 0.81 in all domains. Test-retest reliability of composite scores （CSs） of ASI-C-5 were satisfactory （r=0.38-0.97）. Based on item analysis and expert＇s suggestions, five items were deleted and one item was modified in ASI-C-5. Criterion validity of ASI-C-5 was found acceptable, as compared to addicts＇ self-rating anxiety scale （SAS） and self-rating depression scale （SDS） （r=0.59 and 0.45） except for social support rating scale （SSRS）. Conclusions ASI-C-5 can be used for heroin addicts receiving MMT with acceptable reliability and validity.

Liver involvement in the drug reaction,eosinophilia,and systemic symptoms syndrome

First described in 1996,the drug reaction,eosinophilia,and systemic symptoms syndrome(DReSS) is considered,along with Stevens-Johnson syndrome and toxic epidermal necrolysis,a severe cutaneous drug reaction. It is characterized by the presence of a maculopapular erythematous skin eruption,fever,lymphadenopathy,influenza-like symptoms,eosinophilia,and visceral involvement such as hepatitis,pneumonitis,myocarditis,pericarditis,nephritis,and colitis. The prognosis of patients with DReSS is related to the severity of visceral involvement. The mortality ranges from approximately 5% to 10%,and death is mainly due to liver failure,which is also the organ most commonly involved in this syndrome. Although it was previously hypothesized in 1994,DReSS syndrome can lead to reactivation of one or more human herpesvirus family members. Now being included as diagnostic criteria in a proposed diagnostic score system,this reactivation can be detected up to 2-3 wk after DReSS syndrome onset. Other causes of mortality in DReSS syndrome include myocardial or pulmonary lesions and hemophagocytosis. We reviewed the literature of previously reported case-series of DReSS and liver involvement,highlighting the pattern of liver damage,the treatment used,and the outcome.

A Practical Approach to Demystifying Drug Allergy in the Intensive Care Unit. A Review Article

Drug hypersensitivity reaction (DHR) is defined as an immunologically mediated response to a pharmacology agent. Some reactions require prior sensitization and some do not. The interactions between different drugs and the immune system occur by different mechanisms leading to variable clinical features. Some reactions are simple and do not alter patient quality of life. Some are life threatening and require immediate recognition and appropriate therapy. Confirming the diagnosis of DHR is often challenging. The environment in the Intensive care units (ICU) is considered high risk place for DHR development as it offers most of the risk factors. In this review, we offer a delicate combined approach that allows an accurate diagnosis of most of the DHRs encountered in the ICU.

Molecules against COVID-19:An in Silico Approach for Drug Development

A large number of deaths have been caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)worldwide,turning it into a serious and momentous threat to public health.This study tends to contribute to the development of effective treatment strategies through a computational approach,investigating the mechanisms in relation to the binding and subsequent inhibition of SARS-CoV-2 ribonucleic acid(RNA)-dependent RNA polymerase(RdRp).Molecular docking was performed to screen six naturally occurring molecules with antineoplastic properties(Ellipticine,Ecteinascidin,Homoharringtonine,Dolastatin 10,Halichondrin,and Plicamycin).Absorption,distribution,metabolism,and excretion(ADME)investigation was also conducted to analyze the druglike properties of these compounds.The docked results have clearly shown binding of ligands to the SARS-CoV-2 RdRp protein.Interestingly,all ligands were found to obey Lipinski’s rule of five.These results provide a basis for repurposing and using molecules,derived from plants and animals,as a potential treatment for the coronavirus disease 2019(COVID-19)infection as they could be effective therapeutics for the same.

儿童重症肺炎支气管肺泡灌洗液的病原菌及药敏试验分析

目的了解儿童重症肺炎支气管肺泡灌洗液(BALF)的病原菌及药敏试验情况。方法选取该院2021年1月至2023年4月收治的100例重症肺炎患儿作为研究对象,对所有患儿进行支气管镜肺泡灌洗,并分析其BALF病原菌及药敏试验情况。结果100例患儿BALF中共培养出病原菌131株,革兰阴性菌98株(74.81%),革兰阳性球菌33株(25.19%),其中流感嗜血杆菌(25.19%)、肺炎链球菌(21.37%)占比较高,卡他布兰汉菌(15.27%)、肺炎克雷伯菌(11.45%)其次。重症肺炎患儿BALF中前4位病原菌主要以<1岁(97.37%)、1~3岁(96.88%)占比较高,>3~7岁(94.12%)、>7~14岁(92.31%)相对较少。各年龄BALF中流感嗜血杆菌、卡他布兰汉菌、肺炎克雷伯菌分布情况比较,差异均无统计学意义(P>0.05);各年龄BALF中肺炎链球菌分布情况比较,差异有统计学意义(P<0.05)。20株流感嗜血杆菌对四环素、阿莫西林-克拉维酸、头孢噻肟、复方磺胺甲噁唑均较敏感,对氯霉素敏感性其次,对氨苄西林、头孢克洛、头孢呋辛耐药性均较高;15株卡他布兰汉菌对头孢噻肟较敏感,对氨苄西林耐药性最高;8株肺炎克雷伯菌对头孢噻肟较敏感,对氨苄西林、头孢呋辛、氯霉素耐药性均较高,对阿莫西林-克拉维酸、四环素耐药性其次;20株肺炎链球菌对万古霉素、氯霉素均较敏感,对青霉素G、泰利霉素敏感性其次,对复方磺胺甲噁唑耐药性较高,对四环素、头孢噻肟、克林霉素耐药性其次。结论儿童重症肺炎BALF中病原菌以流感嗜血杆菌、肺炎链球菌多见,且0~3岁患儿病原菌占比高于>3~14岁,临床应合理用药以预防耐药菌株产生。

抗癫痫药物致住院患者药疹的临床表现及防治策略

目的 初步评价抗癫痫药物的安全性,并探讨抗癫痫药物引发药疹的防治策略。方法 回顾性分析医院神经内科或儿科2016年1月至2022年12月收治的经皮肤科会诊确诊为由抗癫痫药物致药疹的15例住院患者的临床资料,总结常见引发药疹的抗癫痫药物种类、药疹的分型、系统受累情况、药疹治疗方法的选择和预后。结果 15例患者中,最常引发药疹的药物为奥卡西平(6/15);药疹分型中以麻疹型最常见(13/15),2例Stevens-Johnson综合征(SJS)型分别由奥卡西平和苯巴比妥引起;除药疹外,患者常合并肝功能异常(8/15)、发热(7/15)和外周血嗜酸性粒细胞水平升高(6/15)。经停用/更换致敏抗癫痫药物、抗过敏等对症治疗后,药疹完全消退、系统损害恢复正常。结论 多种抗癫痫药物均可引发药疹,抗癫痫药物引发的药疹以麻疹型多见,但应警惕SJS型的出现及肝功能损害。及时停用致敏药物并更换抗癫痫药物的种类,使用糖皮质激素和(或)抗组胺药物对症治疗,对抗癫痫药物引发的药疹疗效较好。

89例药疹患者的致敏药物分析

目的探讨药疹住院患者的临床特征及常见致敏药物、药疹类型,分析药疹的相关诱发因素,为临床合理用药及预防药疹的发生提供参考。方法回顾性分析2019年4月至2023年12月底石河子大学第一附属医院确诊为药疹的患者临床数据,包括药疹类型、使用致敏药物原因、致敏药物、潜伏期、发热情况、住院时间、治疗与转归等。结果药疹患者共89例,占皮肤科同期住院总病例的2.90%。轻症药疹63例(70.79%),以发疹型为主;重症药疹26例(29.21%),以重症多形红斑(SJS)为主。使用致敏药物原因以感染性疾病最多(44例,占49.44%)。63例(70.79%)为单一药物致敏,其中前3位的致敏药物类别为抗生素类(33.33%)、中成药(26.98%)、抗癫痫药(14.29%)。轻症药疹潜伏期平均(4.56±6.14)d,重症药疹潜伏期平均(9.35±11.33)d,差异有统计学意义(t=2.03,P=0.025)。19.05%轻症药疹以及46.15%重症药疹患者初期并发高热。89例药疹平均住院(9.02±3.58)d,轻症药疹与重症药疹患者住院时间无统计学差异(t=3.06,P=0.05)。89例患者中,有46例(51.69%)系统应用糖皮质激素,其中2例重症药疹联用丙种球蛋白治疗,2例重症药疹联用肿瘤坏死因子(TNF)-α拮抗剂。未随访到死亡病例。结论本地区药疹类型以发疹型为主,抗生素类、中成药、抗癫痫药是前3位的致敏药物种类。多数药疹初期并发高热,尤其是重症药疹,但重症药疹与轻症药疹间住院时间无差异。早期足量应用糖皮质激素或联合治疗可缩短重症药疹的住院时间。