• Clinical and Experimental Pediatrics
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• 제60권6호
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• pp.167-174
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• 2017

Mycoplasma pneumoniae pneumonia (MPP) is one of the most common forms of community-acquired pneumonia in children and adolescents. Outbreaks of MPP occur in 3- to 7-year cycles worldwide; recent epidemics in Korea occurred in 2006-2007, 2011, and 2015-2016. Although MPP is known to be a mild, self-limiting disease with a good response to macrolides, it can also progress into a severe and fulminant disease. Notably, since 2000, the prevalence of macrolide-resistant MPP has rapidly increased, especially in Asian countries, recently reaching up to 80%-90%. Macrolide-resistant Mycoplasma pneumoniae (MRMP) harbors a point mutation in domain V of 23S rRNA with substitutions mainly detected at positions 2063 and 2064 of the sequence. The excessive use of macrolides may contribute to these mutations. MRMP can lead to clinically refractory pneumonia, showing no clinical or radiological response to macrolides, and can progress to severe and complicated pneumonia. Refractory MPP is characterized by an excessive immune response against the pathogen as well as direct injury caused by an increasing bacterial load. A change of antibiotics is recommended to reduce the bacterial load. Tetracyclines or quinolones can be alternatives for treating MRMP. Otherwise, corticosteroid or intravenous immunoglobulin can be added to the treatment regimen as immunomodulators to downregulate an excessive host immune reaction and alleviate immune-mediated pulmonary injury. However, the exact starting time point, dose, or duration of immunomodulators has not been established. This review focuses on the mechanism of resistance acquisition and treatment options for MRMP pneumonia.

• Tuberculosis and Respiratory Diseases
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• 제65권4호
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• pp.328-333
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• 2008

박리성 간질성 폐렴은 흡연가에 호발하는 비교적 드문 미만성 간질성 폐질환이다. 박리성 간질성 폐렴은 치료에 대한 반응과 예후가 좋은 질환이나, 재발하는 경우가 있고 치료기간이 명확히 정해져 있지 않으며, 심한 섬유화가 동반되는 경우는 드문 질환이다. 저자들은 흉부 전산화단층 촬영에서 견인성 기관지확장증과 초기의 벌집모양 폐 소견과 함께 미만성 간유리혼탁화를 보이는 환자에서 흉강경하 폐 조직 검사로 박리성 간질성 폐렴을 진단하였고, 치료 종결 후 재발한 박리성 간질성 폐렴을 경험하였기에 이를 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제41권6호
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• pp.670-675
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• 1994

본 저자들은 스쿠알렌(Shark liver oil)을 반복적으로 사용한 75세 남자 환자에서 방사선 소견과 객담 검사로 진단한 지방성 폐렴 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제40권6호
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• pp.719-724
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• 1993

저자들은 평소 건강하였던 42세 주부에서 원인을 알 수 없는 갑자기 발생된 호흡부전을 주소로 입원하여 임상적, 방사선학적으로 급성 간질성 폐렴의 증상을 보이고 개흉 폐 생검술에서 조직학적으로 급성 간질성 폐렴에 합당한 소견으로 확진된 1예를 보고하는 바이다.

• Journal of Korean Medical Science
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• 제33권43호
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• pp.268.1-268.11
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• 2018

Background: We aimed to compare the therapeutic efficacy of prolonged macrolide (PMC), corticosteroids (CST), doxycycline (DXC), and levofloxacin (LFX) against macrolide-unresponsive Mycoplasma pneumoniae (MP) pneumonia in children and to evaluate the safety of the secondary treatment agents. Methods: We retrospectively analyzed the data of patients with MP pneumonia hospitalized between January 2015 and April 2017. Macrolide-unresponsiveness was clinically defined with a persistent fever of ${\geq}38.0^{\circ}C$ at ${\geq}72$ hours after macrolide treatment. The cases were divided into four groups: PMC, CST, DXC, and LFX. We compared the time to defervescence (TTD) after secondary treatment and the TTD after initial macrolide treatment in each group with adjustment using propensity score-matching analysis. Results: Among 1,165 cases of MP pneumonia, 190 (16.3%) were unresponsive to macrolides. The proportion of patients who achieved defervescence within 48 hours in CST, DXC, and LFX groups were 96.9% (31/33), 85.7% (12/14), and 83.3% (5/6), respectively. The TTD after initial macrolide treatment did not differ between PMC and CST groups (5.1 vs. 4.2 days, P = 0.085), PMC and DXC groups (4.9 vs. 5.7 days, P = 0.453), and PMC and LFX groups (4.4 vs. 5.0 days, P = 0.283). No side effects were observed in the CST, DXC, and LFX groups. Conclusion: The change to secondary treatment did not show better efficacy compared to PMC in children with macrolide-unresponsive MP pneumonia. Further studies are needed to guide appropriate treatment in children with MP pneumonia.

• 대한약침학회지
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• 제24권3호
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• pp.107-121
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• 2021

Objectives: The purpose of this study is to analyze the efficacy of traditional Chinese medicine (TCM) injections specified in the clinical guideline for COVID-19 by conducting a meta-analysis of viral pneumonia data. Methods: TCM injections data on viral pneumonia were collected until July 31, 2021. CNKI, PubMed, EMBASE, and the Cochrane electronic database were used to collect the clinical data. "COVID-19," "Viral pneumonia," "Tanreqing," "Xiyanping," "Reduning," "Xingnaojing," "Xuebijing," "Shenmai," "Shengmai," and "Shenfu" were used as keywords. All data collected were mainly about TCM injections and viral pneumonia. Furthermore, studies that included results such as the total effective rate, cough disappearance time, antipyretic time, lung rhomboid disappearance time, and adverse drug reaction were collected for the meta-analysis to identify the efficacy of TCM injections. However, data unrelated to TCM injections specified in the clinical guidelines for COVID-19 or viral pneumonia were excluded. The quality of included RCTs was assessed by the Cochrane Risk of Bias Tool, and Review Manager 5.3 software was used to conduct the meta-analysis. Results: A total of 18 studies with 1540 patients were included in this study. The results of the meta-analysis showed that the total effective rate OR = 4.61 (95% CI 2.92, 7.25, p = 1.00/ I² = 0%); the cough disappearance time: SMD -1.23 (-1.37, -1.09, p < 0.00001/ I² = 94%); the antipyretic time: SMD -1.26 (-1.40, -1.11, p < 0.00001/ I²=94%); lung rhomboid disappearance time: SMD -1.17 (-1.33, -1.02, p < 0.00001/ I² = 89%); and adverse drug reaction was OR 0.36 (95% CI 0.20, 0.64, p = 0.21/ I² = 30%). From the results, the treatment group (TCM injection) showed better efficacy than the control group (Western medication). Conclusion: Xiyanping, Reduning, and Tanreqing injections may yield benefits as COVID-19 treatments. However, clinical trials on TCM injections for the treatment of COVID-19 are still lacking. More high-quality clinical trials are still required.

• Tuberculosis and Respiratory Diseases
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• 제84권2호
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• pp.115-124
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• 2021

Background: This study aimed to determine the parameters for worsening oxygenation in non-severe coronavirus disease 2019 (COVID-19) pneumonia. Methods: This retrospective cohort study included cases of confirmed COVID-19 pneumonia in a public hospital in South Korea. The worsening oxygenation group was defined as that with SpO₂ ≤94% or received oxygen or mechanical ventilation (MV) throughout the clinical course versus the non-worsening oxygenation group that did not experience any respiratory event. Parameters were compared, and the extent of viral pneumonia from an initial chest computed tomography (CT) was calculated using artificial intelligence (AI) and measured visually by a radiologist. Results: We included 136 patients, with 32 (23.5%) patients in the worsening oxygenation group; of whom, two needed MV and one died. Initial vital signs and duration of symptoms showed no difference between the two groups; however, univariate logistic regression analysis revealed that a variety of parameters on admission were associated with an increased risk of a desaturation event. A subset of patients was studied to eliminate potential bias, that ferritin ≥280 ㎍/L (p=0.029), lactate dehydrogenase ≥240 U/L (p=0.029), pneumonia volume (p=0.021), and extent (p=0.030) by AI, and visual severity scores (p=0.042) were the predictive parameters for worsening oxygenation in a sex-, age-, and comorbid illness-matched case-control study using propensity score (n=52). Conclusion: Our study suggests that initial CT evaluated by AI or visual severity scoring as well as serum markers of inflammation on admission are significantly associated with worsening oxygenation in this COVID-19 pneumonia cohort.

• Tuberculosis and Respiratory Diseases
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• 제45권3호
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• pp.491-494
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• 1998

• Tuberculosis and Respiratory Diseases
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• 제79권2호
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• pp.91-97
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• 2016

Background: Chronic obstructive pulmonary disease (COPD) is sometimes complicated with pneumonia, but little is known about the risk factors that promote the development of pneumonia in COPD. These risk factors were evaluated in the present study. Methods: The data of 324 patients with COPD from a prospective multi-center observational cohort with obstructive lung disease were evaluated retrospectively. To identify risk factors for the development of pneumonia in COPD, the clinical and radiological data at enrollment and the time to the first episode of pneumonia were analyzed by Cox proportional hazard analysis. Results: The median follow-up time was 1,099 days and 28 patients (8.6%) developed pneumonia. The Cox analysis showed that post-bronchodilator forced expiratory volume in one second ($FEV_1$, % of predicted) and the computed tomography (CT) emphysema extent (inspiratory V950) were independent risk factors for the development of pneumonia (post-bronchodilator $FEV_1$: hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.94-1.00; p=0.048 and inspiratory V950: HR, 1.04; 95% CI, 1.01-1.07; p=0.01). Conclusion: Emphysema severity measured by CT and post-bronchodilator $FEV_1$ are important risk factors for the development of pneumonia in COPD.

• Journal of Animal Science and Technology
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• 제50권4호
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• pp.437-444
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• 2008

임상적, 경제적으로 매우 중요한 돼지의 질병중 하나인 폐렴이 주요 경제형질과 어떠한 상관관계를 가지는지 조사하기 위하여 충남 홍성에서 도축된 돼지 총 6,362개체를 본 연구에 이용하였다. 폐렴은 진행정도에 따라 4단계로 분류하였으며 생산된 비육돈의 도체중, 등지방 두께, 육질, 규격, 삼겹살 두께를 측정하여 폐렴질병과 형질과의 연관성을 비교 분석하였다. 그 결과 폐렴의 정도가 증가함에 따라 도체중이 유의적으로 감소함을 알 수 있다(P<0.01). 등지방두께와 각 폐렴 단계별 증상간의 상관관계를 보면 등지방 두께는 폐렴 중증과 폐 농양간의 유의적인 차이는 보이지 않으나 폐렴 경증 단계와는 매우 높은 유의성이 있는 것으로 나타났다(P<0.01). 삼겹살두께와 각 폐렴 증상간의 상관관계를 보면 삼겹살 두께에서 정상과 경증, 중증, 농양 간에 유의적인 차이가 존재하나(P<0.01) 경증, 중증, 농양 간에는 차이를 보이지 않음을 확인할 수 있었다. 육질등급 출현율과 각 폐렴 증상간의 상관관계를 보면 정상과 경증, 중증 간에 유의적인 차이가 존재함을 확인할 수 있었다(P<0.01). 이는 폐렴의 정도가 심해짐에 따라 육질이 나빠지는 것을 알 수 있으며 폐렴이 규격 육질등급 출현율에 큰 영향을 미친다는 것을 알 수 있다. 규격등급 출현율과 각 폐렴 증상간의 상관관계를 보면 정상과 폐 농양 간에는 유의적인 차이를 발견할 수 없었으나 정상과 경증 및 중증 간에는 규격등급 출현율에서 유의적인 차이가 있음을 알 수 있었다(P<0.01). 이는 폐렴의 단계에 따라 도체의 규격등급 출현율에도 크게 영향을 미치고 있다는 것을 알 수 있다. 본 연구를 통하여 폐렴증상이 심해질수록 돼지의 주요 경제적 형질이 저하된다는 것을 확인하였으며 경제적 손실을 방지하기 위해서는 농가에서 폐렴이 발생하지 않도록 지속적인 관찰과 예방이 필요함을 알 수 있다.