A male with relapsig communityacquired pneumonia 课件.ppt

A male with relapsing community-acquired pneumonia (CAP) Case presentation In November 2005, a 20-year-old male from Torino (Turin), Italy presented with fever, dyspnoea and cough Vital signs: axillary temperature 38.5°C, heart rate 125/min, sat O2 98%, respiratory rate 22 breaths/min, blood pressure 120/80 mmHg Physical examination: no cyanosis; no orthopnoea; no signs of respiratory distress Signs of left-sided consolidation Laboratory findings: white blood cell (WBC) count 10.2 x 109/L (10 200/μL) (neutrophils 75%), normal liver and renal function, haemoglobin (Hb) 6.7 mmol/L (10.8 g/dL) Past medical history No chronic heart or lung diseases; no diabetes Non-smoker and never treated with steroids He had neither travelled recently nor had contact with sick children No known exposure to infectious diseases Not known to be an intravenous (IV) drug user He had a tonsillectomy 12 years previously He receives chronic treatment with valproic acid for seizures (last seizure was 4 years ago) Chest X-ray (November 2005) How would you treat this patient? Admission to hospital for parenteral therapy Parenteral therapy on an outpatient basis Oral therapy on an outpatient basis Outpatient treatment The patient was treated empirically with 500 mg qd IV levofloxacin He was switched to oral therapy on Day 4 CAP: treatment options for non-hospitalised patients Azithromycin Clarithromycin Clarithromycin ER Doxycycline Azithromycin or clarithromycin + amoxicillin or AM/CL Gati-, gemi-, levo- or moxifloxacin Azithromycin Clarithromycin Clarithromycin ER Telithromycin Clinical evolution The patient was treated with levofloxacin for 10 days No fever on Day 3; WBC count back to normal on Day 4 Cough persisted after treatment was completed Patient relapses... One month after his first visit, the patient was admitted with fever, cough and dyspnoea The patient is pale and appears unwell Persisting signs of left-sided consolidation Laboratory findings: ESR 64 mm/h, C-reactive