问一个流感肺炎的问题# Biology - 生物学
a*n
1 楼
禽流感引起的肺炎致死，主要是原发病毒性肺炎引起的，还是由于继发细菌性肺炎引起
的？ 如果是继发细菌性肺炎引起的死亡，是不是即使施用抗生素就可以救活,
的？ 如果是继发细菌性肺炎引起的死亡，是不是即使施用抗生素就可以救活,
a*2
2 楼
No, most of the cases the death is caused by respiratory distress syndrome (
ARDS). Systemic inflammation causes the hyaline changes in the alveolae,
which means there is still ventilation, but oxygen can't pass through the
alveolar to exchange CO2.
Just like SARS, the killer is secondary RDS, not virus itself. Antibiotics
doesn't help for secondary PNA. Patients need mechanical ventilation with
high PEEP to keep alveolae open.
Some immunocompromised patients like kids, elderly, DM, HIV, etc patients
may die of secondary common PNA, but RDS is the main cause of death.
ARDS). Systemic inflammation causes the hyaline changes in the alveolae,
which means there is still ventilation, but oxygen can't pass through the
alveolar to exchange CO2.
Just like SARS, the killer is secondary RDS, not virus itself. Antibiotics
doesn't help for secondary PNA. Patients need mechanical ventilation with
high PEEP to keep alveolae open.
Some immunocompromised patients like kids, elderly, DM, HIV, etc patients
may die of secondary common PNA, but RDS is the main cause of death.
a*n
3 楼
why does not antibiotics help for 2nd PNA?
(
【在 a**********2 的大作中提到】
: No, most of the cases the death is caused by respiratory distress syndrome (
: ARDS). Systemic inflammation causes the hyaline changes in the alveolae,
: which means there is still ventilation, but oxygen can't pass through the
: alveolar to exchange CO2.
: Just like SARS, the killer is secondary RDS, not virus itself. Antibiotics
: doesn't help for secondary PNA. Patients need mechanical ventilation with
: high PEEP to keep alveolae open.
: Some immunocompromised patients like kids, elderly, DM, HIV, etc patients
: may die of secondary common PNA, but RDS is the main cause of death.
(
【在 a**********2 的大作中提到】
: No, most of the cases the death is caused by respiratory distress syndrome (
: ARDS). Systemic inflammation causes the hyaline changes in the alveolae,
: which means there is still ventilation, but oxygen can't pass through the
: alveolar to exchange CO2.
: Just like SARS, the killer is secondary RDS, not virus itself. Antibiotics
: doesn't help for secondary PNA. Patients need mechanical ventilation with
: high PEEP to keep alveolae open.
: Some immunocompromised patients like kids, elderly, DM, HIV, etc patients
: may die of secondary common PNA, but RDS is the main cause of death.
a*n
4 楼
does it mean that some immunocompromised patients may have advantage against
RDS?
(
【在 a**********2 的大作中提到】
: No, most of the cases the death is caused by respiratory distress syndrome (
: ARDS). Systemic inflammation causes the hyaline changes in the alveolae,
: which means there is still ventilation, but oxygen can't pass through the
: alveolar to exchange CO2.
: Just like SARS, the killer is secondary RDS, not virus itself. Antibiotics
: doesn't help for secondary PNA. Patients need mechanical ventilation with
: high PEEP to keep alveolae open.
: Some immunocompromised patients like kids, elderly, DM, HIV, etc patients
: may die of secondary common PNA, but RDS is the main cause of death.
RDS?
(
【在 a**********2 的大作中提到】
: No, most of the cases the death is caused by respiratory distress syndrome (
: ARDS). Systemic inflammation causes the hyaline changes in the alveolae,
: which means there is still ventilation, but oxygen can't pass through the
: alveolar to exchange CO2.
: Just like SARS, the killer is secondary RDS, not virus itself. Antibiotics
: doesn't help for secondary PNA. Patients need mechanical ventilation with
: high PEEP to keep alveolae open.
: Some immunocompromised patients like kids, elderly, DM, HIV, etc patients
: may die of secondary common PNA, but RDS is the main cause of death.
a*2
5 楼
Antibiotics help if it is simple PNA and patients do not progress to ARDS.
This is the most common one that we see clinically. A immunocompetent
patient has bacterial PNA (most commonly from Strep. Pneumococcus), then
will be treated with antibiotics. The inflammation in the lungs will be
cleared within days to weeks by antibiotics and own immune system.
However, things are different in SARS and H7N9 flu. What happended is right
after viral infection, some patients rapidly progress to ARDS, whether or
not there is a secondary bacterial PNA component. The underlying mechanism
is the infection due to some reason induces rapid systemic inflammatory
reaction, such as the release of proinflammatory cytokines like IL-6, TNF-
alpha, together with other mechanisms, lungs will have some typical
pathological changes like groundglass/hyaline changes, which is believed to
be caused by cytokine or other factors attacking lung tissues, which cause
leakage of fluid and its accumulation, then further causes oxygenation
dysfunction. At this time, the only hope is to decrease the inflammatory
reaction by giving high-dose steroids (which was used by Zhong Nanshan in
SARS) and mechanical ventilation. Unfortunately, some patients will die.
Antibiotics are usually used in those patients regardless whether they
really have a secondary PNA because they are clinically seriously ill (high
fever, high WBC, possible positive blood culture, multiple co-morbidities,
multiple organ dysfunction, etc). However, antibiotics will not help much
because the killer is the severe systemic inflammatory reaction, which is
not closely related to bacterial infection.
Hope this helps.
【在 a*********n 的大作中提到】
: why does not antibiotics help for 2nd PNA?
:
: (
This is the most common one that we see clinically. A immunocompetent
patient has bacterial PNA (most commonly from Strep. Pneumococcus), then
will be treated with antibiotics. The inflammation in the lungs will be
cleared within days to weeks by antibiotics and own immune system.
However, things are different in SARS and H7N9 flu. What happended is right
after viral infection, some patients rapidly progress to ARDS, whether or
not there is a secondary bacterial PNA component. The underlying mechanism
is the infection due to some reason induces rapid systemic inflammatory
reaction, such as the release of proinflammatory cytokines like IL-6, TNF-
alpha, together with other mechanisms, lungs will have some typical
pathological changes like groundglass/hyaline changes, which is believed to
be caused by cytokine or other factors attacking lung tissues, which cause
leakage of fluid and its accumulation, then further causes oxygenation
dysfunction. At this time, the only hope is to decrease the inflammatory
reaction by giving high-dose steroids (which was used by Zhong Nanshan in
SARS) and mechanical ventilation. Unfortunately, some patients will die.
Antibiotics are usually used in those patients regardless whether they
really have a secondary PNA because they are clinically seriously ill (high
fever, high WBC, possible positive blood culture, multiple co-morbidities,
multiple organ dysfunction, etc). However, antibiotics will not help much
because the killer is the severe systemic inflammatory reaction, which is
not closely related to bacterial infection.
Hope this helps.
【在 a*********n 的大作中提到】
: why does not antibiotics help for 2nd PNA?
:
: (
a*2
6 楼
That is an interesting thought. I am not sure the statistic data about the
mortality of SARS or H7N9 flu in immunocompetent vs. immunocompromised
patients. But I would doubt it.
1. Immunocompromised patients might not be able to mount a significant
inflammatory reaction like an immunocompetent patient, probably that is part
of the reason why young adults are more fragile to the attack.
2. However, for immunocompromised patients, due to their co-morbidities,
they might not be survivors for this kind of attack either simply because
the co-mobidities will make them more susceptible for other issues which
will kill them.
against
【在 a*********n 的大作中提到】
: does it mean that some immunocompromised patients may have advantage against
: RDS?
:
: (
mortality of SARS or H7N9 flu in immunocompetent vs. immunocompromised
patients. But I would doubt it.
1. Immunocompromised patients might not be able to mount a significant
inflammatory reaction like an immunocompetent patient, probably that is part
of the reason why young adults are more fragile to the attack.
2. However, for immunocompromised patients, due to their co-morbidities,
they might not be survivors for this kind of attack either simply because
the co-mobidities will make them more susceptible for other issues which
will kill them.
against
【在 a*********n 的大作中提到】
: does it mean that some immunocompromised patients may have advantage against
: RDS?
:
: (
a*n
7 楼
very clear explanation. thanks a lot
part
【在 a**********2 的大作中提到】
: That is an interesting thought. I am not sure the statistic data about the
: mortality of SARS or H7N9 flu in immunocompetent vs. immunocompromised
: patients. But I would doubt it.
: 1. Immunocompromised patients might not be able to mount a significant
: inflammatory reaction like an immunocompetent patient, probably that is part
: of the reason why young adults are more fragile to the attack.
: 2. However, for immunocompromised patients, due to their co-morbidities,
: they might not be survivors for this kind of attack either simply because
: the co-mobidities will make them more susceptible for other issues which
: will kill them.
part
【在 a**********2 的大作中提到】
: That is an interesting thought. I am not sure the statistic data about the
: mortality of SARS or H7N9 flu in immunocompetent vs. immunocompromised
: patients. But I would doubt it.
: 1. Immunocompromised patients might not be able to mount a significant
: inflammatory reaction like an immunocompetent patient, probably that is part
: of the reason why young adults are more fragile to the attack.
: 2. However, for immunocompromised patients, due to their co-morbidities,
: they might not be survivors for this kind of attack either simply because
: the co-mobidities will make them more susceptible for other issues which
: will kill them.
a*2
8 楼
No problem.
s*y
9 楼
谢谢科普！
(
【在 a**********2 的大作中提到】
: No, most of the cases the death is caused by respiratory distress syndrome (
: ARDS). Systemic inflammation causes the hyaline changes in the alveolae,
: which means there is still ventilation, but oxygen can't pass through the
: alveolar to exchange CO2.
: Just like SARS, the killer is secondary RDS, not virus itself. Antibiotics
: doesn't help for secondary PNA. Patients need mechanical ventilation with
: high PEEP to keep alveolae open.
: Some immunocompromised patients like kids, elderly, DM, HIV, etc patients
: may die of secondary common PNA, but RDS is the main cause of death.
(
【在 a**********2 的大作中提到】
: No, most of the cases the death is caused by respiratory distress syndrome (
: ARDS). Systemic inflammation causes the hyaline changes in the alveolae,
: which means there is still ventilation, but oxygen can't pass through the
: alveolar to exchange CO2.
: Just like SARS, the killer is secondary RDS, not virus itself. Antibiotics
: doesn't help for secondary PNA. Patients need mechanical ventilation with
: high PEEP to keep alveolae open.
: Some immunocompromised patients like kids, elderly, DM, HIV, etc patients
: may die of secondary common PNA, but RDS is the main cause of death.
a*2
10 楼
Np
【在 s******y 的大作中提到】
: 谢谢科普！
:
: (
【在 s******y 的大作中提到】
: 谢谢科普！
:
: (
s*y
11 楼
那么对于这个流感病毒，看起来是肺部感染引起的功能衰竭而直
接导致死亡？ 我好奇的再追问一下，流感病毒会不会同时引起心肌炎以及肾衰？如果
引起了的话，如何救治？
【在 a**********2 的大作中提到】
: Np
接导致死亡？ 我好奇的再追问一下，流感病毒会不会同时引起心肌炎以及肾衰？如果
引起了的话，如何救治？
【在 a**********2 的大作中提到】
: Np
a*2
12 楼
Strictly speaking, it is a systemic inflammatory reaction, not only lungs.
It can definitely cause cardiomyositis and acute kidney injury/failure, as
well as other organ dysfunction (multiple organ dysfunction). Treatment is
supportive management, like vasopressors if hypotension, antibiotics for
bacteremia, IV fluid for acute kidney injury with caution because it may
worsen pulmonary condition, most importantly, ventilation support. Steroids
as well.
【在 s******y 的大作中提到】
: 那么对于这个流感病毒，看起来是肺部感染引起的功能衰竭而直
: 接导致死亡？ 我好奇的再追问一下，流感病毒会不会同时引起心肌炎以及肾衰？如果
: 引起了的话，如何救治？
It can definitely cause cardiomyositis and acute kidney injury/failure, as
well as other organ dysfunction (multiple organ dysfunction). Treatment is
supportive management, like vasopressors if hypotension, antibiotics for
bacteremia, IV fluid for acute kidney injury with caution because it may
worsen pulmonary condition, most importantly, ventilation support. Steroids
as well.
【在 s******y 的大作中提到】
: 那么对于这个流感病毒，看起来是肺部感染引起的功能衰竭而直
: 接导致死亡？ 我好奇的再追问一下，流感病毒会不会同时引起心肌炎以及肾衰？如果
: 引起了的话，如何救治？
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