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Objective: To evaluate the value of chest CT findings and dynamic changes of viral load in patients with novel influenza A (H1N1) infection in clinical diagnosis, differential diagnosis and treatment., Methods: Fifty-one patients with confirmed novel influenza A (H1N1) according to the diagnostic criteria of the Ministry of Health, received chest X-ray, CT scans (HRCT) and viral load tests in our hospital from May to December of 2009. Based on whether there were signs of pneumonia in CT imaging, the patients were divided into a pneumonia group (n = 31) and a non-pneumonia group (n = 20). The relationship between chest CT changes and viral load was observed and analyzed statistically using SPSS 10.5 software., Results: Patchy consolidations of lungs were the main findings in pneumonia group with influenza A (H1N1) infection, and ground-glass opacities were the main CT findings at acute and convalescent phases. Lobular and segmental shadows of the lungs were diffusely distributed, mostly found in lower lungs, especially the left lung. In some cases, the lung diseases were accompanied with mediastinal lymphadenopathy. Co-existence of pulmonary parenchymal, interstitial and pleural diseases was observed. Peak viral load occurred at the early phase of illness, with the mean initial viral load being 7.7 copies/ml and 4.2 copies/ml in the pneumonia and the non-pneumonia groups respectively. The viral nucleic acid became negative 4 days after antiviral treatment (course of 6 days). Dynamic observation of 3 patients with novel influenza A (H1N1) pneumonia showed that, the viral clearance period preceded the absorption of lung lesions in 2 cases, but viral clearance period of a young patient was significantly prolonged., Conclusion: In patients with the novel influenza A (H1N1) infection, the viral load in the pneumonia group was significantly higher than that in the group with normal chest imaging. Dynamic observation on chest imaging and viral load may be beneficial for clinicians to start prompt and effective treatment.

Objective: To study the clinical features of acquired immune deficiency syndrome (AIDS) complicated with tuberculosis of mesenteric lymph nodes., Methods: Cases (n = 153) with AIDS complicated with tuberculosis hospitalized in this hospital from September 1999 to December 2008 were retrospectively analyzed. Mesenteric lymph node tuberculosis was found in 11 cases, including 7 males and 4 females. One patient was 8 years old, and the other 10 were over 22 years (ranging from 8 to 55 years)., Results: In patients with AIDS complicated with tuberculosis, 7% (11/158) had tuberculosis of the mesenteric lymph nodes. The CD(4)(+) cell count was less than 50 x 10(6) cells/L in 8 cases, and (50 - 100) x 10(6) cells/L in 3 cases. The symptoms included fever (11/11), abdominal pain (11/11), abdominal distension (11/11), night sweat (7/11), weight loss (10/11), diarrhea (7/11), anemia (5/11), abdominal mass (3/11), and ascites (1/11). Abdominal ultrasound showed multiple enlarged mesenteric lymph nodes in all of the 11 cases, and abdominal CT scanning presented typical enhanced ring shadows. Biopsy of mesenteric lymph nodes was obtained from 2 cases, and both revealed tuberculoma, caseous necrosis. Longerhan cell infiltration, and positive stain for fast anti-acid bacilli. Enlarged mesenteric lymph nodes became smaller and disappeared after treatment with antituberculous drugs for 6 months and highly active antiretroviral therapy (HAART) for 5 months in all the 11 patients., Conclusions: There were no specific clinical manifestations in AIDS patients with tuberculosis of mesenteric lymph nodes. However, AIDS patients with CD(4)(+) cell count less than 50 x 10(6) cells/L might be more prone to developing tuberculosis of the mesenteric lymph nodes. Abdominal CT scanning with typical strengthened ring shadow is suggestive of the diagnosis. Anti-tuberculous therapy combined with HAART is recommended for the treatment of patients with suspected tuberculosis.

Objective: To investigate the clinical manifestations and the chest imaging characteristics of an epidemic outbreak of respiratory infection caused by Chlamydia pneumoniae (CP)., Methods: A prospective study for CP infection in 15 patients from September 2003 was carried out. Sputum and throat swab specimen were obtained and CP DNA was detected by polymerase chain reaction (PCR). Serum samples were obtained and immunoglobulin G and M (IgG and IgM) of antibodies to CP. pneumoniae were studied by microimmunofluorescence test. Chest X-ray and computed tomography were retrospectively analyzed., Results: All patients presented fever, headache, sore throat, hoarseness, muscular ache, and dry cough. Acute cough was often associated with chest pain. The sputum blood was present in 3 patients (20%). Moist rales were heard in 4 patients. Chest imaging abnormalities were present in 67% (10 patients). The organism was demonstrated in 87% (13 patients) by PCR. The most common imaging abnormalities were unilateral and (or) bilateral multi-focal or solitary alveolar nodular opacities (9 patients). The patchy shadows were found in 2 patients, and pulmonary consolidation associated with the local pulmonary edema in 1 patient. Hilar or mediastinal lymphadenopathy and pleural effusion was not found., Conclusions: The colony occurrences and similar clinical and chest imaging manifestations are characteristics of an outbreak of respiratory infection caused by CP in medical workers. An outbreak of respiratory infection caused by CP should be differentiated from severe acute respiratory syndrome (SARS).

Objective: To explore the imaging features in cases with AIDS complicated by pulmonary tuberculosis and the association with CD(4)(+) T lymphocytes., Methods: A retrospective analysis was carried out of the manifestations of chest X-rays in patients with late stage AIDS complicate by pulmonary tuberculosis (n = 26 cases) and patients with pulmonary tuberculosis only (n = 60 cases). The results of measurements of CD(4)(+) T lymphocytes were compared., Results: (1) The chest X-ray features in patients with AIDS complicated by pulmonary tuberculosis showed more patchy and blurring shadows (53.8% vs 8.3%; P < 0.01), more military changes (23.1% vs 5.0%; P < 0.05), more enlarged intrathoracic lymph nodes (34.6% vs 8.3%; P < 0.01) as well as more extra-pulmonary tuberculous processes (23.1% vs 3.3%; P < 0.05) as compared to patients with pulmonary tuberculosis alone. Fewer upper lung or apical lesions (23.1% vs 76.7%; P < 0.01), as well as less consolidation (11.5% vs 71.7%; P < 0.01) and cavity formation (7.7% vs 30.0%; P < 0.05) were found in AIDS patients. No significant difference was found in the occurrence of hydrothorax (11.5% vs 20.0%; P > 0.05). (2) The relative numbers of CD(4)(+) T lymphocytes in patients with AIDS complicated by pulmonary tuberculosis and in patients with pulmonary tuberculosis alone were (5.0 +/- 6.4)% and (65.3 +/- 1.5)% respectively. Atypical manifestations of tuberculosis were found in 15 out of the 26 cases of AIDS patients showing a CD(4)(+) T lymphocytic count < 50/microl, in 3 of the 4 cases with the count between 50/microl - 100/microl, while in cases with CD(4)(+)T lymphocytic count between 100/microl -200/microl (n = 4) and > 200/microl (n = 2), numbers of atypical tuberculosis were 2 and 0 respectively., Conclusions: The chest X-ray changes of tuberculosis in cases with late stage AIDS were mostly of the atypical pattern, and were related to a significant decrease in CD(4)(+)T lymphocyte count.