PDF(Pubmed)
Abstract：
Rare cases of Pseudomonas aeruginosa community-acquired pneumonia (PA-CAP) were reported in non-immunocompromised patients. We describe a case of Pseudomonas aeruginosa (PA) necrotizing cavitary CAP with a fatal outcome in a 53-year-old man previously infected with SARS-CoV-2, who was admitted for dyspnea, fever, cough, hemoptysis, acute respiratory failure and a right upper lobe opacification. Six hours after admission, despite effective antibiotic therapy, he experienced multi-organ failure and died. Autopsy confirmed necrotizing pneumonia with alveolar hemorrhage. Blood and bronchoalveolar lavage cultures were positive for PA serotype O:9 belonging to ST1184. The strain shares the same virulence factor profile with reference genome PA01. With the aim to better investigate the clinical and molecular characteristics of PA-CAP, we considered the literature of the last 13 years concerning this topic. The prevalence of hospitalized PA-CAP is about 4% and has a mortality rate of 33-66%. Smoking, alcohol abuse and contaminated fluid exposure were the recognized risk factors; most cases presented the same symptoms described above and needed intensive care. Co-infection of PA-influenza A is described, which is possibly caused by influenza-inducing respiratory epithelial cell dysfunction: the same pathophysiological mechanism could be assumed with SARS-CoV-2 infection. Considering the high rate of fatal outcomes, additional studies are needed to identify sources of infections and new risk factors, along with genetic and immunological features. Current CAP guidelines should be revised in light of these results.
摘要：
在非免疫功能低下的患者中报告了罕见的铜绿假单胞菌社区获得性肺炎（PA-CAP）病例。我们描述了一例铜绿假单胞菌（PA）坏死性空洞性CAP的病例，该病例先前感染了SARS-CoV-2的53岁男子因呼吸困难而入院，发烧,咳嗽,咯血,急性呼吸衰竭和右上叶混浊。入院6小时后,尽管有效的抗生素治疗，他经历了多器官衰竭并死亡。尸检证实坏死性肺炎伴肺泡出血。血液和支气管肺泡灌洗培养物对属于ST1184的PA血清型O：9呈阳性。该菌株与参考基因组PA01共享相同的毒力因子谱。为了更好地研究PA-CAP的临床和分子特征，我们考虑了过去13年关于这个主题的文献。住院PA-CAP的患病率约为4％，死亡率为33-66％。吸烟,酒精滥用和液体污染暴露是公认的危险因素;大多数病例表现出上述相同的症状,需要重症监护.描述了PA甲型流感的共感染，这可能是由流感引起的呼吸道上皮细胞功能障碍引起的：SARS-CoV-2感染可以假定相同的病理生理机制。考虑到致命结局的高发生率，需要更多的研究来确定感染源和新的危险因素，以及遗传和免疫学特征。当前的CAP指南应根据这些结果进行修订。
