脊柱真菌感染的诊断:11例病例分析

背景:脊柱真菌感染十分罕见,临床和影像学无特征性表现,容易误诊。目的:分析脊柱真菌感染患者的诊断过程,提高对该疾病的认识和诊断能力。方法:回顾性分析2015年1月至2020年1月确诊的11例脊柱真菌感染患者的临床资料。包括症状及症状持续时间,有无发热以及引起免疫力降低的前置性因素;血常规、红细胞沉降率(ESR)、C反应蛋白(CRP)、降钙素原(PCT)、1,3-β-D葡聚糖抗原(G试验)和半乳糖甘露醇聚糖(GM试验)等实验室检查;脊柱X线片、CT、MRI等影像学检查。通过CT引导下穿刺活检或手术获取组织进行真菌培养或(和)病理学检查明确致病菌。结果:全部患者表现为病变节段的疼痛,病史1~16周。1例合并高热,4例合并根性刺激痛,4例合并前置性因素。所有患者的ESR明显升高;CRP和PCT轻度升高;白细胞计数无升高。1例GM试验阳性、2例G试验阳性;G试验和GM试验可疑阳性各1例。影像学检查显示病灶累及胸椎2例,腰椎9例。致病菌包括曲霉菌6例,念珠菌4例,隐球菌1例。结论:对存在免疫功能受损并表现为慢性脊柱感染的患者,应考虑真菌感染可能。获取病变组织进行培养和病理学检查是明确脊柱真菌感染的金标准,为防止诊断和治疗的延误,应争取尽早进行。     

耳鼻咽喉真菌感染60例诊治体会

目的探讨耳鼻咽喉真菌感染的临床诊断及治疗方法。方法对60例真菌感染患者的临床诊治资料进行回顾性分析。结果本组中耳部真菌感染20例,鼻及鼻窦真菌感染14例,咽部真菌感染14例,喉部真菌感染12例。经治疗后患者临床症状得到明显缓解和有效控制,均痊愈出院。结论对耳鼻咽喉真菌感染患者应依靠真菌培养、病理学检查及时明确诊断,并实施局部清洁用药和手术治疗,可有效提高治愈率。     

念珠菌与曲霉菌脊柱感染预后影响因素的荟萃分析

1932年,Keating等[1]首次报道脊柱真菌感染,脊柱真菌感染属于系统性感染,复发率和死亡率高于一般细菌感染[2]。近年来,随着免疫缺陷人群的增加,脊柱真菌感染的发生率呈上升趋势,美国的院内感染监测系统显示,真菌感染发生率在过去10年增加了1倍,平均每年发生率约为0.272‰,平均每年增加0.0024‰,年增长率为0.9%[3]。脊柱真菌感染与脊柱结核和布鲁杆菌性脊柱炎同属于肉芽肿性炎,很难在早期鉴别,诊断和检测方法的灵敏度、特异度不高,容易导致诊断延误,影响预后[4]。     

阴茎皮肤深部真菌感染2例报道

真菌是一类种类繁多的微生物 ,全世界有记载的真菌在 10万种以上 ,可使人致病的真菌约有 2 78种。致病真菌分为病原性真菌和条件致病性真菌两大类 ,后者平时不致病 ,在机体免疫力降低时则可致病[1] 。近 10多年来 ,随着免疫抑制剂的广泛应用 ,导管、插管的普遍开展 ,广谱抗生素的大量应用 ,烧伤抢救、放射治疗、器官移植广泛进行 ,特别是免疫缺陷病人的不断增加 ,深部真菌感染率逐渐升高[2 ] 。据不完全统计 ,近 30年来 ,深部真菌感染率增加 3～ 5倍。因此 ,需要临床医生高度警惕真菌感染的存在 ,并切实掌握真菌病的诊断和治疗措施。现将 2…     

肝移植后受者真菌感染的易感因素分析

肝移植为治疗终末期肝病的有效手段.肝移植受者术后常继发真菌感染,其发生率为4%～48%,而病死率则高达50%～80%[1].探讨其易感因素,对真菌感染的预防及早期诊断,对提高疗效具有重要意义.     

烧伤后真菌感染研究进展

真菌是引起临床感染的重要病原微生物之一,临床血液培养结果显示,白色念珠菌在常见病原微生物中排位第4[1].近年来真菌感染发生率有进一步增高的趋势,一些条件性致病菌、腐生菌、罕见种属真菌感染越来越多见.虽然新的抗真菌药物不断出现,但深部真菌感染、全身性真菌感染的预后很差,患者病死率极高.因此,真菌感染受到广大临床工作者的高度重视.血液病学、肿瘤学、器官移植学等学科均对临床真菌感染进行了较系统、深入且广泛的研究与讨论,制订了相关的诊断标准与治疗常规[2-3].     

重视肝移植患者真菌感染的早期诊断和治疗

真菌感染仍是肝移植患者发病率和死亡率较高的术后并发症,其特点为发病早,90%的真菌感染发生在肝移植术后2个月内[1-3],发病率为20%～50%,明显高于其他实体器官移植.与感染细菌和病毒比较,肝移植受者感染真菌死亡率明显偏高,为38%～40%[2-3].由于肝移植真菌感染诊断困难,治疗机会不易把握,病死率高.我们就肝移植患者真菌感染的情况作一简介.     

泌尿系统真菌感染的研究近况

近年来,随着广谱抗生素、糖皮质激素、器官移植、导管技术的使用,泌尿系统的真菌感染不断增加.常见的引起泌尿系统真菌感染的致病菌包括念珠菌、曲霉菌、荚膜组织胞浆菌、毛霉菌、乳酒假丝酵母菌.感染途径有上行感染和下行感染,还可以通过器官移植感染.感染部位主要有肾脏、输尿管、膀胱、尿道.其诊断方法主要有尿液真菌培养、超声检查、逆行肾盂造影、排泄性膀胱造影、肾脏X线、CT及MRI等辅助检查.治疗主要是抗真菌感染.免疫力低下以及慢性消耗性疾病的患者避免侵入性操作检查,已经发生的泌尿系统真菌感染应积极应用抗真菌药物,这对于患者预后有重要意义.作者就近5年来泌尿系统真菌感染的情况进行综述.     

肝移植术后肺部真菌感染的诊断和治疗

目的探讨肝移植术后肺部真菌感染的早期诊断及治疗方法。方法回顾分析20例肝移植术后肺部真菌感染患者的临床资料，分析其原发病、免疫状态、感染真菌的种类及抗真菌药物的应用。结果20例患者念珠菌感染17例，死亡2例，曲霉菌感染3例，死亡2例。氟康唑、伊曲康唑、两性霉素B治疗有效率70％，伏立康唑、卡泊芬净治疗有效率100％。结论肝移植术后真菌感染高发，以危重患者为主要目标人群，发生早，病情重。诊断分三级，达到临床诊断即应及早治疗。治疗以伏立康唑为首选，严重感染者联合应用卡泊芬净效果良好。     

复杂肾结石术后真菌性肾盂肾炎

报告８例复杂肾结石术后发生真菌性肾盂肾炎病例。认为长期应用广谱抗生素及患者肾功能减退是导致该病的重要发病因素。重视真菌感染的发生应做到早期诊断，及时及足够时间的抗真菌治疗可缩短治疗疗程。对抗真菌药物的作用及不同用药途径的治疗效果进行探讨。     

A rare post-coronavirus disease 2019 complication of maxillary mucormycotic osteomyelitis in a Southeast Asian patient

Mucormycosis, a rapidly invasive form of fungal infection caused by Mucorales fungi, has high morbidity and mortality rates. Rhino-orbital-cerebral mucormycosis is the most common form of mucormycosis. With the coronavirus disease 2019 (COVID-19) outbreak, a causal correlation between mucormycosis and COVID-19 has been suspected, contributing to the abrupt increase in opportunistic fungal infection cases. We present a case of a Southeast Asian woman in her 60s with complaints of pus discharge in the palatal region with maxillary teeth mobility for 3 months. Physical examination revealed multiple nonvital upper teeth with severe mobility. Incisional biopsy of the maxilla and multidetector computed tomography of the head and neck confirmed the diagnosis of osteomyelitis of the maxilla secondary to mucormycosis. Surgical treatment was performed, and amphotericin B and posaconazole were administered. No operative complications or further bone destruction were observed at 8 months postoperatively.     

Diagnostic pitfalls in osteomyelitis of the odontoid process: case report

BACKGROUND

Pyogenic osteomyelitis of the odontoid process is a very rare disease associated with a variety of clinical symptoms, and previous reports have stressed the difficulties inherent in making the diagnosis. The authors present a case of osteomyelitis of the odontoid process with epidural abscess in which magnetic resonance imaging (MRI) was used in the diagnosis, assessment of the extent of concomitant epidural abscess, treatment effect, and long-term follow-up.

CASE DESCRIPTION

A 68-year-old male was admitted to our hospital with cervical pain, neck stiffness, and fever. Although the diagnosis was missed at the beginning, the patient was diagnosed with osteomyelitis of the odontoid process with a paravertebral epidural abscess by MRI. The patient became asymptomatic after 3 months of antibiotic therapy.

CONCLUSION

Pyogenic osteomyelitis of the odontoid process is a rare condition requiring a high index of suspicion for diagnosis. MRI examination should be considered in the diagnosis in patients with neck pain combined with fever. Serial MRI during and after antibiotic therapy provided an objective assessment of the healing rate of the lesions.     

Salmonella osteomyelitis. An important differential diagnosis of granulomatous osteomyelitis

A case of septicemia owing to Salmonella choleraesuis with localization in the lumbar spine and left knee is described. The spinal lesion is dominated by tuberculoid granulomas with or without central necrosis. The necrotic foci within some granulomas show heavy polymorph infiltration, whereas in others they simulate caseous necrosis and are indistinguishable histologically from tuberculosis, brucellosis, and fungal infections. As Salmonella osteomyelitis has a strong tendency to chronicity if antimicrobial treatment is delayed, inappropriate, or inadequate, this diagnosis should be considered in all cases of granulomatous osteomyelitis, especially when the patient is immunosuppressed or has hemoglobinopathy.     

Pyogenic vertebral osteomyelitis: report of a series of 23 patients

Vertebral osteomyelitis, an infectious disease with vague manifestations, can be difficult to diagnose. Although vertebral osteomyelitis represents only 2-4% of bone infections, the consequences are often grave and disabling, even fatal, when untreated. A series of 23 cases is reported in which patient records were reviewed to determine the etiology and appropriateness of diagnosis and management. Information on treatment and follow-up after discharge was obtained from outpatient progress notes, records from subsequent hospital admissions, and telephone interviews of patients. Pyogenic vertebral osteomyelitis was diagnosed by positive needle or open biopsy tissue cultures, positive blood cultures in the appropriate clinical setting, or diagnostic histopathology. Staphylococcus aureus was grown from 75% (15/20) of patient cultures, Escherichia coli from 15%, and Staphylococcus epidermidis from 10%. Overall, 87% (20/23) of these patients were disease-free at follow-up. The experience with this series of patients demonstrates that early diagnosis aided by MRI ensures a high cure rate and low complication rate.     

非典型骨髓炎的影像学表现及治疗

目的 分析非典型骨髓炎的影像学表现探讨诊疗方法.方法观察24例非典型骨髓炎患者影像学表现,并与手术病理结果进行对照.结果 24例患者术后病理均证实为骨髓炎.显示软组织肿胀:X线平片10例,CT 18例,MRI 21例;显示骨膜反应:X线平片15例,CT 18例,MRI未见;显示骨髓腔密度增高:X线平片11例,CT 16例,MRI 24例;显示骨皮质增厚:X线平片10例,CT 14例,MRI 18例.结论 MRI对非典型骨髓炎的早期诊断、鉴别诊断帮助较大,X 线平片仍是基础.X线平片、CT结合MR检查是非典型骨髓炎的早期诊断和鉴别诊断的重要手段.非典型慢性骨髓炎影像学表现不典型,误诊、漏诊率较高,认识其临床及影像学表现可以提高诊疗水平.     

Critically evaluating the role of diagnostic imaging in osteomyelitis

Early diagnosis, essential for timely appropriate treatment and reduction of complications, can be difficult. This article aims to give an overview of the role that different imaging modalities have to play in the diagnosis of osteomyelitis. Osteomyelitis is a heterogeneous disease in its pathophysiology, clinical presentation, and management. It infers inflammation of bone and marrow, whereas osteitis is inflammation of the bone only. Thus, a soft-tissue infection that reaches the bone surface but has not infected the marrow is osteitis and not osteomyelitis. Chronic osteomyelitis is divided into active and inactive forms. Newly appearing periosteal reaction or bone destruction within the chronic involucrum are indicators of activation. Imaging modalities represent different underlying pathophysiological processes that may be represented in differing types and differing phases of osteomyelitis. Sequential selection of appropriate imaging modalities requires a thorough understanding of the disease processes and the process by which each modality visualizes this dynamic disease process.     

婴幼儿急性骨髓炎后遗畸型原因分析

目的:充分认识急性化脓性骨髓炎在婴幼儿中发病的特点及转归,力争早期诊断早期治疗,达到降低残疾程度。方法:总结24例急性骨髓炎发病原因及治疗过程。结果:本组婴幼儿发病部位以股骨居多(66％),临床表现不典型是早期不能确诊的主要因素,后遗畸型是感染致骨与关节病理破坏的必然转归。     

Diagnostic errors in hematogenic osteomyelitis of the pelvic bones

The authors have analysed the caused of frequent diagnostic errors in the primary diagnosis which reach 51.2% in 41 patients with hematogenic osteomyelitis of the pelvis. A high percentage of diagnostic errors is caused by more frequent occurrence of hematogenic osteomyelitis of the pelvis in the adults aged 20 to 60 and older who are "not expected" to have hematogenic osteomyelitis which is considered to be a disease characteristic of children and adolescents, by an inadequacy between the provoking etiologic factor and the subsequent development of the disease and by disguise of hematogenic osteomyelitis of the pelvis with symptoms of other frequently occurring diseases. The character of the diagnostic errors is clearly linked with the localization of the process in the bones of the pelvis.     

Double valve replacement for infective endocarditis following osteomyelitis; report of two cases

Infective endocarditis(IE) is relatively common but it is lethal complication of osteomyelitis. We report the case of 2 patients who had been diagnosed as IE during their conservative therapy of osteomyelitis. Both of the patients had been admitted because of severe back pain. Then IE was revealed from congestive heart failure and/or persistent fever. As several times of echocardiogram showed the progression of valvular lesion despite their antibiotic therapies, they underwent the operation of aortic and mitral valve replacements. On bacteremia-related disease like osteomyelitis, high index of suspicion and early diagnosis of IE are essential to its successful treatment.     

Fungal postoperative spondylodiscitis due to Scedosporium prolificans

Background contextPostoperative fungal spondylodiscitis is a rare infectious disease.PurposeWe report the first case of postoperative spondylodiscitis because of Scedosporium prolificans and review postoperative vertebral infection caused by fungi.Study design/settingMedline search.MethodsCase report and literature review.ResultsOn reviewing the cases of postoperative fungal spondylodiscitis reported so far in the literature, we found eight were caused by mold, and five by yeast. Clinically, the disease presents similar to postoperative vertebral osteomyelitis caused by bacteria, and a high clinical index of suspicion may be required to perform appropriate cultures to establish a diagnosis. Our review revealed a significant number of cases that were cured after surgical debridement and/or antifungal therapy.ConclusionsOn the basis of this limited assessment, it appears that the clinical course and prognosis of postoperative fungal spondylodiscitis is similar to that reported for postoperative pyogenic spondylodiscitis.