Table 1.
Clinical characteristics of the two cases.
| Case 1 | Case 2 | |
|---|---|---|
| Sex | Male | Male |
| Age | 49 years old | 50 years old |
| Underlying disease | None | Silicosis |
| Personal History | History of contact with poultry | History of contact with poultry |
| Alcohol History | Smoking history | |
| Clinical manifestation | Fever (39.8 °C) Progressive dyspnea One bloody stools |
Fever (38.5 °C) Progressive dyspnea Cough with a small amount of white sticky sputum Transient disturbance of consciousness |
| Physical examination | Plenty moist rale in auscultation | Moist rale in auscultation |
| Arterial blood gas analysis | PH 7.55, PaCO2 29.1 mmHg, PaO2 60 mmHg, oxygenation index 171 mmHg | PH 7.5, PaCO2 31.4 mmHg, PaO2 73 mmHg, oxygenation index 209 mmHg; |
| Routine blood tests | WBC 13.3 × 10^9/L, NE％95.7％, LY％ 2.2％ | WBC 8.18 × 10^9/L, NE% 84.9%, LY％ 10.7％ |
| CRP | 94.77mg/L | 121.6mg/L |
| PCT | 8.628ng/ml | 1.876ng/ml |
| Biochemical indicators | Elevated liver enzymes Hypoproteinemia Hypokalemia and hyponatremia. |
Hypoproteinemia Hypokalemia and hyponatremia. |
| Sputum culture | Achromobacter xylosoxidans | no pathogen detected |
| Blood culture | no pathogen detected | no pathogen detected |
| Other serological test for pathogensa | Negative | Negative |
| CT | Bilateral diffuse infiltrates and a small amount of pleural effusion | Multiple patchy-like shadows and a small amount of pleural effusion |
| Respiratory support | Invasive mechanical ventilation | Mechanical ventilation |
| Main diagnosis | 1. Severe pneumonia 2. ARDS 3. Hepatic insufficiency |
1. Severe pneumonia 2. Silicosis |
WBC white blood cell, NE Neutrophil, LN Lymphocyte, CRP C-reactive protein, PCT Procalcitonin, CT computed tomography.
a
Other serological test for pathogens include serum-specific IgM antibodies to nine respiratory pathogens (include legionella pneumophila, mycoplasma pneumoniae, coxiella burnetii, chlamydia pneumoniae, adenovirus, respiratory syncytial virus, type A and type B influenza virus, parainfluenza virus), and RNA real-time fluorescent constant temperature amplification detection (include mycoplasma pneumoniae, enterovirus, enterovirus 71, coxsackievirus A16, and universal influenza A virus).