肺结核并发肺部真菌感染的CT表现特征分析

目的探讨肺结核并发肺部真菌感染的CT表现特征,并进行观察分析。方法回顾性分析112例经病理组织学或细菌学,以及临床确诊的肺结核并发肺部真菌感染患者的CT表现特征,根据并发真菌感染的种类将患者分为曲霉菌组（61例）、念珠菌组（48例）、隐球菌组（3例）,总结比较组间CT表现特征。结果肺结核并发常见真菌感染的发生率分别为曲霉菌组54．4％0（61／112）、念珠菌组42．9％（48／112）、隐球菌组2．7％（3／112）。其中曲霉菌组与念珠菌组比较,各项临床症状（咳嗽、咯痰、发热、咯血丝痰、胸痛）差异均无统计学意义（P值均〉0．05）。肺结核并发真菌感染的CT表现常见斑片影96例（85．7％）、结节影95例（84．8％）、空洞影93例（83．0％）、树芽征改变74例（66．1％）、磨玻璃样密度影60例（53．6％）。念珠菌组与曲霉菌组肺部感染病灶累及肺叶较广,且曲霉菌组累及3个肺叶以上者（98．0％,47／48）明显多于念珠菌组（80．3%,49／61）,差异有统计学意义（X^2=7．91,P=0．005）。曲霉菌组在斑片影（93．4％,57／6i）、空洞影（93．4％,57／61）、磨玻璃样密度影（63．9％,39／61）表现上较念珠菌组（77．1%,37／48;72．9％,35／48;39．6％,19／48）多见,而念珠菌组以树芽征（79．2％,38／48）、段性或大叶性实变影（39．6％,19／48）较曲霉菌组（59．0％,36／61;3．3％,2／61）多见,差异均有统计学意义（X^2=6．06,P=0．014;X^2=8．60,P=0．003;X^2=6．40,P=0．011;X^2=5．00,P=0．025;X^2=22．76,P=0．000）。曲霉菌组中93．4％（57／61）的感染者可见曲菌球表现,其中37例为典型曲菌球。隐球菌组仅3例,均可见结节影,多位于胸膜下,且1例结节内可见内壁光滑的空洞。结论肺结核并发真菌感染有一定CT表现特征,CT扫描显示的图像特征有助于提示真菌感染的可能,具有一定的诊断价值。     

肾移植术后真菌性肺炎的诊断及治疗

报道16例肾移植术后真菌性肺炎患者，感染真菌为白色念球菌10例，克柔念珠菌、平滑念珠菌、光滑念珠菌、曲霉菌、毛霉菌各1例。应用氟康唑治疗7例，伊曲康唑1例，两性霉素B脂质体3例。治愈11例，死亡5例。表明肺部真菌感染是肾移植术后的严重并发症，其病死率高，早期诊断和治疗效果较好。     

艾滋病合并肺部真菌性疾病的影像学表现

艾滋病患者伴发的真菌感染几乎包含了所有已发现的致病真菌及某些对正常宿主来说是非致病真菌的菌种。其中浅部致病真菌主要有皮肤癣菌和酵母菌,深部致病真菌有隐球菌、球孢子菌、副球孢子菌、曲霉菌、马尔尼菲青霉菌、荚膜组织胞浆菌和肺孢子菌等。肺部真菌感染占深部真菌感染的首位,主要侵犯支气管、肺。随着对艾滋病合并肺部真菌感染认识的提高,发病率有逐年上升的趋势。在我国艾滋病最常并发肺部感染的真菌是白色念珠菌、新生隐球菌、曲霉菌等,     

呼吸机相关肺炎下呼吸道真菌定植的危险因素及预后观察

目的探讨呼吸机相关肺炎下呼吸道真菌定植的危险因素,并观察其对预后的影响。方法118例呼吸机相关肺炎患者根据肺部分泌物培养结果分为真菌感染组（n=62）与非真菌感染组（n=56）,对比分析其相关的危险因素和患者的预后情况。结果高龄、机械通气天数、气管插管／切开〉7d、两种或以上器官功能障碍、联合使用抗生素,抗生素更换次数≥3次、应用糖皮质激素≥7d、免疫抑制剂等均为呼吸机相关肺部真菌感染的独立危险因素;62例真菌感染组死亡率为（71．0％,44／62）,56例非真菌感染组死亡率为（48．2％,27／56）,两组死亡率比较有显著差异性（P〈0．05）。结论呼吸机相关肺部真菌感染常常是同时存在多种危险因素共同作用的结果,尽早发现其危险因素,及时进行抗真菌治疗,有助于改善患者的预后,降低死亡率。     

肺部常见真菌感染诊断方法及评价

引起肺部感染的真菌有多种,而念珠菌、曲霉菌、隐球菌、卡氏肺孢子菌和毛霉菌等5种真菌在临床上较常见,是本文讨论的主要内容。肺部真菌感染的诊断方法大致包括以各种呼吸道标本涂片、培养为主的微生物学检查、胸部影像学检查、以G-试验、GM-试验、隐球菌乳胶凝集试验等为代表的血清学诊断方法和以巢式多聚酶链式反应（polymerase chain reaction,PCR）、实时荧光PCR及基因芯片为代表的基因诊断方法。     

常见继发性肺部真菌感染的特点

最近 10年来 ,真菌感染已成为世界范围问题[1 ] 。有资料显示院内真菌感染的发生率高达 40 % [2 ] ,肺部真菌感染占内脏真菌感染的首位。由于肺部真菌感染的诊断很困难和治疗时机也有分歧 ,病死率高 ,成为日益严重的临床问题。按真菌的致病性可以分为致病真菌和条件致病真菌两类。①致病真菌如组织胞浆菌、球孢子菌、副球孢子菌、皮炎芽生菌和孢子丝菌等 ,常经呼吸道感染 ,使正常人发病 ,预后较好 ,也有危重病例。致病真菌往往有明确的地域分布。②条件致病真菌如念球菌、曲霉菌、毛霉菌和隐球菌等 ,是在机体免疫力低下时感染发病。条件致病…     

74例肺结核继发肺部真菌感染情况分析

目的探讨山东省结核防治医院肺结核继发肺部真菌感染的危险因素、临床特点及诊治方法.方法收集2002年1月-2004年9月间山东省5家结核病防治医院临床细菌培养及鉴定获得的真菌感染病例74例并进行分析.结果74例真菌感染中致病菌以念珠菌居多,其中白色念珠菌52例,占70.3%;光滑念珠菌9例,占12.2%;热带念珠菌5例,占6.8%;克柔念珠菌3例,占4.1%.另外还有少数近平滑念珠菌、葡萄牙念珠菌及隐球菌、曲霉菌、毛霉菌.采用科玛嘉念珠菌显色培养基,据菌落颜色判定菌种并通过ROSCO纸片扩散法,在规定时间内测定抑菌圈的直径,确定真菌菌株的敏感（S）、中介（Ⅰ）与耐药（R）情况.以两性霉素B、氟胞嘧啶、氟康唑、伊曲康唑及酮康唑为对照药物,白色念珠菌敏感性较好,克柔念珠菌耐药率相对较高.感染的诱发因素多与应用抗生素和激素有关.结论肺结核较易继发真菌感染,应加强抗生素及肾上腺皮质激素的规范应用,以减少真菌感染及其耐药率的发生,有利于结核病控制及减少死亡.     

全身播散性真菌感染41例尸检临床病理分析

分析１１例全身播散性真菌感染尸检临床病理资料。原发病构成：恶性肿瘤２０例，白血病１１例，其它为创伤、免疫性疾病等。真菌感染类型：曲霉菌１４例，念珠菌１２例，隐球菌５例，毛霉菌１例，两种霉菌同时感染９例。侵犯主要器官：肺３９例次，肾２６例次，脑１６例次，肝、心、消化道各１５例次，共计２２个部位。生前用抗真菌药治疗１４例。分析了真菌感染的条件及有关误诊误治的几个问题。     

肺隐球菌病3例

肺隐球菌病是由隐球菌感染引起的一种急性、亚急性或慢性呼吸系统真菌病[1].我国肺真菌病前5位致病原依次为曲霉菌、念珠菌、隐球菌、孢子菌及毛霉菌[2].相对于其他肺真菌病而寿,肺隐球菌病患者发病年龄较轻,社区发病多,预后较好.但是隐球菌肺炎在临床中诊断并不多见,王丽芳等[3]对3所医院13年间诊断的65例隐球菌肺炎进行回顾性分析,表明隐球菌肺炎在影像学上表现多样,临床症状相比其他真菌感染症状较轻微,难与肺癌、肺结核、肺曲霉病等疾病相鉴别.我科近期诊断肺隐球菌病3例,现对其临床症状、检验检查、治疗等方面加以分析,旨在为诊治肺隐球菌病提供帮助.     

肺毛霉菌病2例诊治分析

正肺毛霉菌病(Plumonary mucormycosis)是由毛霉菌目真菌类的接合菌引起的一种严重的肺部机会性真菌感染。有文献报道肺毛霉菌的发病率在所有毛霉菌病例中高达24%;在真菌感染中,毛霉菌发病率占8. 3%～13%,仅次于假丝酵母菌和曲霉菌,位居第3位。我国一项474例肺真菌病患者的调查     

Opportunistic fungal infections in patients with neoplastic disease

Opportunistic infections with yeast and molds are increasingly common in patients with neoplastic diseases. Candida species, Aspergillus species, Phycomyctes, and Cryptococcus neoformans remain most common, but other organisms are being encountered as pathogens. With the exception of Cryptococcus, most opportunistic fungal infections are difficult to diagnose. New diagnostic tests for these diseases are being evaluated. Amphotericin B remains the antifungal agent of choice. In certain patients, the addition of 5-flurocytosine may improve the outcome. Experience with cryptococcosis in severely immunocompromised cancer patients at Memorial Sloan-Kettering Cancer Center suggests that those who are treated with amphotericin B intravenously and intraventricularly via an Ommaya reservoir along with 5-flurocytosine do better than those treated with amphotericin B alone.     

Therapy of Deep-Seated Fungal Infections with 5-Fluorocytosine

Summary: Administration of 5-fluorocytosine in fourteen cases of invasive or systemic fungal infection was accompanied in ten by elimination of the infection. Results which particularly indicated the usefulness of the drug consisted of instances where fungal infections were eliminated following the failure of amphotericin B treatment, and in some patients whose antimicrobial defences had been compromised by immunosuppressive therapy. Success was frequently obtained in infections with Candida and Aspergillus species, as well as in penetrating ocular infections where laboratory identification of the fungus had not been made. The outcome in two cases of Cryptococcus neoformans meningitis was unsatisfactory, and this was shown in one to be due to the emergence of a resistant strain. Toxicity of a minor and reversible nature was encountered in four patients, and consisted of diarrhoea, anaemia or hepatocellular damage.     

Pulmonary fungal infection: emphasis on microbiological spectra, patient outcome, and prognostic factors.

STUDY OBJECTIVES: To investigate the microbiological spectra, patient outcome, and prognostic factors of pulmonary fungal infection. DESIGN: The medical and microbiological records of patients with pulmonary fungal infection were retrospectively analyzed. SETTING: A university-affiliated tertiary medical center. Patients and methods: From January 1988 to December 1997, all cases of pulmonary fungal infection were reviewed. The criteria for inclusion were obvious lung lesion shown on chest radiographs and one of the following: (1) the presence of fungi in or isolation of fungi from the biopsy specimen of open thoracotomy, thoracoscopy, transbronchial lung biopsy, or ultrasound-guided percutaneous needle aspiration/biopsy; or (2) isolation of fungi from pleural effusion or blood, with no evidence of extrapulmonary infection. RESULTS: A total of 140 patients were included. Ninety-four cases of pulmonary fungal infection (67%) were community acquired. The most frequently encountered fungi were Aspergillus species (57%), followed by Cryptococcus species (21%) and Candida species (14%). There were 72 patients with acute invasive fungal infection, with a mortality rate of 67%. Multivariate logistic regression analysis showed that nosocomial infection (p = 0.014) and respiratory failure (p = 0.001) were significantly and independently associated with death of acute invasive fungal infection. CONCLUSIONS: Pulmonary fungal infection of community-acquired origins is becoming a serious problem. It should be taken into consideration for differential diagnosis of community-acquired pneumonia. Furthermore, acute invasive fungal infection is associated with a much higher mortality rate for patients with nosocomial infection or complicating respiratory failure. Early diagnosis with prompt antifungal therapy, or even with surgical intervention, might be warranted to save patients' lives.     

Autopsy cases of terminal pulmonary infections

In order to clarify the present state of terminal pulmonary infections, all autopsy cases from 1976 to 1985 reported in the annual records of autopsy cases in Kyushu University Hospital were reviewed. Of the total of 2,238 autopsy cases, pulmonary infections were present in 1,042 (46.6%) and in 595 (26.6%) pulmonary infections were fatal. Among the primary diseases associated with pulmonary infections, hematologic diseases such as leukemia and malignant lymphoma, lung cancer, esophageal cancer and cerebrovascular disease were most frequent. The pathogens of fatal pulmonary infections occurring in autopsy cases were bacteria (26.6%), Aspergillus (3.2%), Candida (1.8%), cytomegalovirus (1.7%), Pneumocystis carinii (1.1%), Mycobacterium (0.9%), Cryptococcus (0.6%) and phycomycetes (0.1%). The incidence of non-bacterial, especially fungal, pulmonary infections has increased during the recent five-year period. Among the pulmonary infections associated with lung cancer in autopsy cases, mycobacteriosis occurred more frequently than fungal infection. The incidence of fatal mycobacteriosis was more frequent in cases receiving steroids than in those not receiving steroids. Antemortem diagnosis of pulmonary infections was made in only 4.6% and 26.3% of cases of non-bacterial infection and mycobacteriosis, respectively. There was no autopsy case diagnosed before death as aspergillosis, which most frequently occurred among the fungal pulmonary infections in autopsy cases.     

Systemic fungal infections after renal transplantation

In a retrospective evaluation, the incidence of systemic fungal infections (SFIs) in 296 kidney graft recipients admitted to our center between 1986 and 1999 was found to be 4%. Eighteen percent of 28 recipients transplanted in India and 8% of 12 recipients transplanted in Russia developed SFI. In contrast, SFI was encountered in only 2% of recipients transplanted at our center. The median time of diagnosis of SFI was 5 months after transplantation. The lungs and central nervous system were the most frequently affected sites. The most common etiologic agent was Aspergillus fumigatus (n = 7) but Candida spp. (n = 1), Rhizopus spp. (n = 1) and Cryptococcus neoformans (n = 1) were also encountered. In 2 patients, 2 different pathogens were isolated at the same time: A. fumigatus and Rhizopus spp. in 1 patient and Candida spp. and A. fumigatus in another. In order to determine predisposing factors for SFI, patients admitted immediately before and after those with SFI were used as controls: long-term hospitalization, long-term antibiotic use and post-transplant diabetes mellitus were found to be predisposing factors. Eight patients were treated with antifungal drugs and a good response to liposomal amphotericin B therapy was obtained in 3/5. Nine patients (75%) with SFI died. As SFIs are associated with a high mortality rate in renal transplant recipients, antifungal therapy, especially with liposomal amphotericin B, should be started whenever fungal infection is suspected, even before the results of microbiologic and/or histologic examinations are known.     

Effect of fluconazole prophylaxis on fungal blood cultures: an autopsy-based study involving 720 patients with haematological malignancy

To investigate the utility of blood culture of invasive fungal infections in patients with haematological malignancies, an autopsy survey was conducted in 720 patients who were treated between 1980 and 1999. We identified 252 patients with invasive mycosis. These included Candida (n = 94), Aspergillus (n = 91), Zygomycetes (n = 34), Cryptococcus (n = 7), Trichosporon (n = 11), Fusarium (n = 1), and unknown fungi (n = 20). Of the 94 patients with invasive candidiasis, 20 had positive blood cultures. Of the 11 patients with invasive trichosporonosis, seven had positive blood cultures. The sensitivities of blood cultures were 1.1%, 0% and 14% for detecting invasive aspergillosis, zygomycosis and cryptococcosis respectively. Multiple regression analysis showed a significant correlation between results of Candida blood cultures and some variables, including prophylactic use of absorbable antifungals (P = 0.0181) and infection by Candida albicans (P = 0.0086). The sensitivity of blood cultures decreased when patients received antifungal chemoprophylaxis. Unless these agents are inactivated in culture bottles, conventional blood cultures might produce false-negative results.     

In situ detection of Aspergillus 18S ribosomal RNA in invasive pulmonary aspergillosis.

OBJECTS: We attempted to evaluate the usefulness of in situ hybridization (ISH) in the specific diagnosis of Aspergillus pulmonary infection. METHODS: We used an ISH technique using a multiple digoxigenin-incorporating probe, which was constructed by means of the polymerase chain reaction (PCR) from the 18S ribosomal RNA of Aspergillus fumigatus. MATERIALS: We studied twelve formalin-fixed, paraffin-embedded lung tissue sections from autopsy-confirmed invasive pulmonary aspergillosis (IPA) (5 acute myelocytic leukemias, 2 acute lymphocytic leukemias, 2 chronic myelocytic leukemias, 1 adult T-cell leukemia, 1 non-Hodgkin's lymphoma and 1 chronic obstructive pulmonary disease.), and 18 sections from other pulmonary infections as control. RESULTS: ISH using the probe and a low-viscosity hybridization buffer solution (LV) positively stained hyphal elements in 12 of 12 autopsy lung tissue specimens from subjects with IPA, while ISH using the probe and a high viscosity hybridization buffer solution (HV) positively stained the hyphal elements in 6 of 12. Specifically, ISH (LV) demonstrates hyphal elements of Aspergillus spp. in the center of Aspergillus abscess. While, ISH (HV) can detect hyphal elements located in the periphery of a suppurative abscess as well as those in the blood vessel. Conversely, ISH did not show positive results for any of the autopsy tissue specimens from subjects with other fungal pneumonia infections (Candida n=5, Mucor n=2, Cryptococcus n=2, and Pseudallescheria n=1), Pneumocystis carinii pneumonia (n=5), and cytomegalovirus pneumonia (n=3). Dual staining by means of ISH and immunohistochemistry (IHC) using anti-neutrophil elastase (NE) and anti-CD68 monoclonal antibodies showed that NE positive cells were localized at the edge of the radial growth of the organism, but CD68 positive cells were located around the center of the abscess. The accumulation of NE positive cells was rarely seen in half of the cases (6/12). In contrast, CD68 positive cells were routinely present in the center of the abscess (12/12). CONCLUSION: ISH in conjunction with IHC is a useful tool for differentiating Aspergillus spp. from other fungal genera in tissue sections from patients with IPA and may have a certain role in the evaluation of the interactions between organisms and recruiting inflammatory cells.     

Invasive fungal infection in Chinese patients with systemic lupus erythematosus

Invasive fungal infection (IFI) can be a lethal complication in systemic lupus erythematosus (SLE). The aim of this study was to determine the characteristics of hospitalized SLE patients with IFI, and identify the risk factors compared to SLE with other major infections or those with active disease alone. Data from 18 SLE in-patients with IFI at Shanghai Renji Hospital between January 2007 and January 2011 were collected by chart review. SLE patients with either active Mycobacterium tuberculosis (n = 19) or other bacterial infections (n = 17), or active SLE (n = 54) in the same period acted as controls. SLE in-patients with IFI (n = 11) from January 2002 to December 2006 was considered as a historical control group. The most frequent pathogens of SLE-IFI was Cryptococcus neoformans (n = 9, 50.0 %), followed by Aspergillus and Candida (both n = 3, 16.7 %). The infection sites included lung (n = 8, 44.4 %), central nervous system (n = 8, 44.4 %), and disseminated IFI (n = 2, 11.1 %). Three patients (16.7 %) died from IFI. Compared with other major infections, IFI patients were younger, with shorter SLE disease duration, lower C-reactive protein response, higher corticosteroids, and antibiotics exposure. Compared with active SLE, IFI patients had elevated alanine transaminase level, higher corticosteroids and antibiotics exposure. In multivariate analysis, the only significant risk factors for IFI were maximum prednisolone exposure ≥45 mg/day prior to infection or flare within 3 months (OR?=?10.284, 95 %CI (2.877, 36.836)). Compared with the historical SLE-IFI patients, the short-term survival improved over time (63.6 % versus 83.3 %). SLE-IFI is a unique entity that characterized by certain aforementioned parameters compared with other major infections or disease flare in SLE. Familiar with the disease pattern along with appropriate antifungal treatment may lead to a better outcome in SLE-IFI patients.     

Fungal infections in patients with acute leukemia

We reviewed the records of 32 patients with acute leukemia and proved invasive fungal infections to determine the clinical and pathologic characteristics of systemic mycosis in patients undergoing intensive induction chemotherapy. The incidence of invasive fungal infections among our patients was at least 27 percent, and Candida and Aspergillus accounted for the majority of these infections. Patients with systemic candidiasis generally had prolonged severe neutropenia, fever refractory to antibiotics, and evidence of mucosal colonization by fungi. At autopsy, Candida was always widely disseminated. Patients with aspergillosis generally had neutropenia, fever, and pulmonary infiltrates at the time of admission to the hospital and, at autopsy, their infections were primarily confined to the lungs. Patients infected with both Candida and Aspergillus had clinical and pathologic findings that were a combination of the features of each type of infection. A diagnosis of invasive fungal infection was established before death in only nine of the patients, all of whom had systemic candidiasis. Four of these patients were successfully treated and survived their hospitalization. The reasons for frequently misdiagnosing and unsuccessfully treating systemic mycosis in patients with acute leukemia are examined, and suggestions are made for improved management of patients at high risk for these infections. These suggestions are based upon recognition of the clinical settings in which fungal infections occur, the aggressive use of invasive diagnostic procedures, and the early empiric use of amphotericin B.     

Microbiological infections in HIV positive Bahraini patients with low CD4+ T-lymphocyte count

The correlation of CD4+ T-lymphocyte count and the distribution of pathogenic or opportunistic microbial infection most commonly found in HIV positive individuals differ from one area to the other. The present study reports such findings in 67 HIV positive Bahraini patients in the period May 1997 to Nov. 1998. CD4+ T-lymphocyte count was measured using flow cytometry. Bacterial and fungal cultures were performed. Serological diagnosis was performed when indicated. Viral study was done serologically. The distribution of CD4+ T-lymphocyte count in the studied group was: 21 patients (31.3%) less than 100 cells/microl, 5 patients (7.5%) 100-200 cells/microl, 25 patients (37.3%) 201-500 cells/microl and 16 patients (23.9%) with count more than 500 cells/microl. Among patients with low CD4 count (less than 100 cells/microl) (n=21), microbial infections varied from fungal infections 66%, bacterial infections 57% and viral infections 4.8%. Bacterial infections included Salmonellosis (14.3%), Staphylococcus epidermidis (14.3%), Pseudomonas aeruginosa (9.5%), H. influenzae (9.5%), Legionellosis (4.8%) and E. coli (4.8%). Fungal infection included Candida albicans (52.4%), Pneumocystis carinii (9.5%), Cryptococcus neoformans (4.8%). Viral infection included H. simplex to (4.8%). Fungal infections were the highest common infection in thus study. The most common microbial infection was Candida albicans. P. carinii and Cryptococcus neoformans were less common than found in other studies world wide.