A 41-year-old man from the emergency department presented with fever for 2 weeks, sore throat, dry cough and generalized umbilicated skin lesions (face (Fig. 1), and chest (Fig. 2)). HIV antibody was positive, CD4+ count was 2/μL. His skin swab, sputum and blood culture all yielded Talaromyces (Penicillium) marneffei (Fig. 3).Talaromyces marneffei is an important cause of morbidity and mortality in HIV-infected and other immunosuppressed patients who live in or are from endemic areas especially Southeast Asia. Amphotericin B or Itraconazole should be initiated as soon as possible for patients with talaromycosis.
Background
In early 2022, there was a sudden surge of patients infected by the Omicron variant of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Hong Kong (HK), resulting in 9,163 deaths as of 29 May 2022. Many of the local population had not been vaccinated before this wave. The number of patients who developed coronavirus disease 2019 (COVID-19) related respiratory failure outnumbered the capacity of intensive care unit (ICU) beds. Some of these patients had to be supported with high flow nasal cannula (HFNC) therapy outside ICU setting. HK was in crisis situation. The primary objective of this study is to assess the 28-day mortality of this group of patients. The secondary objective is to explore any predictors of non-survivors to help clinical decision-making in future crisis.
Methods
This is a retrospective observational study of patients suffering from COVID-19 related respiratory failure who received HFNC therapy in general medical wards of two hospitals during the period of 17 Mar to 30 Apr 2022. Survival and risk factors were reviewed.
Results
Forty-nine patients were recruited. Twenty-six patients (53%) survived at 28-day after initiation of HFNC support. Three clinical parameters were found to be significantly associated with mortality at 28-day: (I) SpO
2
/FiO
2
(SF) ratio <160 at 48 hours; (II) SF ratio <191 at 72 hours; (III) serial SF ratio at 48 or 72 hours showing no improvement over that at the time of initiation of HFNC therapy.
Conclusions
Use of HFNC outside ICU setting showed benefit to patients suffering from COVID-19 related acute hypoxemic respiratory failure (AHRF). Serial SF ratio monitoring at 48 and 72 hours after therapy initiation might serve as predictors of outcome and thus guide clinical decision-making for medical resource allocation in outbreak situation.
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