Comparative Study Of Clinical Characteristics Between Melioidosis Pneumonia And Klebsiella Pneumoniae Pneumonia

Objective:By comparative analysis of the clinical features of melioidosis pneumonia and klebsiella pneumoniae pneumonia,To provide a basis for early differential diagnosis.Thus,it can guide clinical medical workers to identify,diagnose and intervene early,then further improve the prognosis of patients and reduce the case fatality rate.Method:Clinical data of 60 patients with melioidosis pneumonia and 78 patients with klebsiella pneumoniae pneumonia who were first Affiliated Hospital of Hainan Medical College and the Second Affiliated Hospital of Hainan Medical College and who were admitted and diagnosed between January 2012 and September 2022 were retrospectively reviewed.Data included: general information,chronic medical history,clinical manifestations,laboratory parameters(white blood cell count,percentage of neutrophils,hemoglobin,procalcitonin,Hypersensitivity C-Reactive Protein,ferritin,alanine aminotransferase,aspartate aminotransferase).Data on chest CT signs(pulmonary consolidation,cavitary morphology,air bronchogram,lung nodules,nodules with cavitation,presence of pleural involvement,hilar and mediastinal lymphadenopathy,and pleural effusion)were collected.The obtained data were processed and analyzed by SPSS software.Result:1.General data were contrasting between the two groups,The differences were statistically significant for sex,age,and the presence or absence of type 2diabetes mellitus(P < 0.05).The age of disease onset in the melioidosis pneumonia group was 50.23 ± 13.43 years,with a maximum age of 89 years and a minimum of 1year,this disease is more common in males.The K.pneumoniae pneumonia group had an affected age of 64.59 ± 15.86,and the age of onset was 93 years at maximum and24 years at minimum,with a high prevalence in middle and old age.There was no significant difference in the history of alcohol abuse and the presence or absence of other chronic diseases(P > 0.05).2.The clinical characteristics and comorbidities were compared between the two groups in the presence or absence of cough and expectoration,chest pain,fever,liver abscess,peripheral abscess,and combined sepsis(P < 0.05).In the melioidosis pneumonia group,the clinical manifestations were mainly fever,body temperature39.32 ± 0.79(℃),mainly hyperthermia(T > 39.0℃),multiple combined liver abscesses and peripheral abscesses,and early multiple complicated sepsis.Klebsiella pneumoniae pneumonia group was dominated by cough and expectoration,chest pain,and the body temperature of febrile patients was 38.49 ± 0.63(℃).3.The two groups contrast in their etiological origin,The difference was statistically significant(P < 0.05).Melioidosis pneumonia etiology is dominated by blood cultures,and klebsiella pneumoniae pneumonia etiology is dominated by sputum cultures.4.Laboratory parameters were compared between the two groups,There were no significant differences in ferritin,ALT,AST,WBC,NE,Hb,PCT(P > 0.05)and hs CRP(P < 0.05).5.Two groups of chest CT images with contrast,The lobe involved by the lesion,presence or absence of lung consolidation alone,air bronchial sign,cavitation > 2 cm,nodules with cavitation,pleural thickened adhesions,pleural effusion,hilar and mediastinal lymph node enlargement,and leaf space fall were statistically significant(P < 0.05).There was no significant difference in the indicators of the presence or absence of ground glass opacity,cavities < 2cm,and solid nodules(P > 0.05).Binary logistic regression analysis of the above univariate variables showed that the presence or absence of air bronchograms,cavitation > 2 cm,nodules with cavitation,pleural effusion,hilar and mediastinal lymphadenopathy were independent factors for the diagnosis of melioidosis pneumonia.Conclusions:1.Melioidosis pneumonia,the age span of the affected group is large,the population is generally susceptible,and patients are mostly comorbid with type 2 diabetes.This disease is more common in males.The clinical manifestations are mainly hyperthermia(T > 39.0 ℃),with multiple hepatosplenic abscesses and peripheral soft tissue abscesses,which can easily be complicated by sepsis at an early stage.Laboratory inflammation related indicators above the reference range,hs CRP significantly increased when ferritin > 322 ng /ml,hs CRP > 100 mg /L required a high suspicion of melioidosis pneumonia infection with sepsis.To a high rate of positive blood cultures.The lesions involved multiple lobes and were predominantly upper lobes,and chest CT imaging was notable for air bronchogram,pulmonary cavitation > 2 cm,pulmonary nodules with cavitation,pleural effusion,hilar and mediastinal lymphadenopathy.2.Klebsiella pneumoniae pneumonia,the affected groups are mostly middle-aged and elderly,have chronic diseases,and the prevalence of patients with underlying diseases is high.The clinical manifestations are cough and expectoration,and the characteristic clinical manifestations are cough brick red jelly like sputum,but more rarely,accompanied by chest pain.Laboratory inflammation related indicators(WBC,PCT,NE%,hs CPR)were above the reference range,and sputum cultures were taken as positive.The lesions involved multiple lobes but were predominantly lower lobes,and chest CT images were notable for solitary pulmonary consolidation and multiple pulmonary solid nodules,including lobar drops in the lobar spaces,which are highly specific CT signs.