Population-Based Analysis of Invasive Fungal Infections,France, 2001–2010

To determine the epidemiology and trends of invasive fungal infections (IFIs) in France, we analyzed incidence, risk factors, and in-hospital death rates related to the most frequent IFIs registered in the national hospital discharge database during 2001–2010. The identified 35,876 IFI cases included candidemia (43.4%), Pneumocystis jirovecii pneumonia (26.1%), invasive aspergillosis (IA, 23.9%), cryptococcosis (5.2%), and mucormycosis (1.5%). The overall incidence was 5.9/100,000 cases/year and the mortality rate was 27.6%; both increased over the period (+1.5%, +2.9%/year, respectively). Incidences substantially increased for candidemia, IA, and mucormycosis. Pneumocystis jirovecii pneumonia incidence decreased among AIDS patients (−14.3%/year) but increased in non-HIV–infected patients (+13.3%/year). Candidemia and IA incidence was increased among patients with hematologic malignancies (>+4%/year) and those with chronic renal failure (>+10%/year). In-hospital deaths substantially increased in some groups, e.g., in those with hematologic malignancies. IFIs occur among a broad spectrum of non–HIV-infected patients and should be a major public health priority.     

非免疫缺陷原发性肺隐球菌病21例临床分析

目的总结肺隐球菌病的临床资料,提高其诊疗水平。方法收集确诊的21例原发性肺隐球菌病患者的临床资料,对临床表现、实验室检查、影像学检查、病理学检查及治疗进行回顾。结果男性15例,女性6例。有基础疾病4例,无基础疾病17例。肺部症状不典型,有咳嗽、咳痰、发热、咯血、胸痛等;其影像学表现常见结节影、块影、片影等,可伴有空洞、毛刺等;孤立结节影6例,病灶累及双肺15例。初期误诊为肺癌行手术切除7例,误诊为结核4例,误诊为普通肺炎7例。17例抗真菌治疗有效,4例抗真菌治疗后行肺叶切除。结论肺隐球菌病临床及影像学表现不特异,无明显免疫缺陷者也可发病,常误诊为肺癌、肺结核、肺炎,确诊多依赖病理活检。多数患者抗真菌治疗有效,少数需手术治疗。     

1 例肺新型隐球菌感染左下肺叶切除术后患者的治疗用药分析与监护

目的：通过临床药师参与1例肺新型隐球菌感染肺叶切除术后患者的治疗过程,探讨药师在临床治疗中发挥的作用.方法：针对具体病例,以药物治疗为介入点,协助医师制定治疗方案,并对患者实施全程的药学监护,包括疗效观察、药品不良反应监测、患者用药指导及出院教育等.结果与结论：临床药师为患者实施药学监护可以提高患者治疗的依从性,提高药物治疗水平,提高患者用药的安全性、有效性和经济性,使用药更合理.     

Case report. Disseminated cutaneous cryptococcosis in an immunocompetent host

A 50-year-old Indian housewife presented with multiple cutaneous lesions over the upper back, thigh and both the extremities, which first appeared 5 months previously. The diagnosis of disseminated cutaneous cryptococcosis was made on the basis of the demonstration and isolation of Cryptococcus neoformans from the aspirated pus and skin biopsy. A serological test for HIV antibodies was negative. The patient responded to itraconazole treatment.     

Disseminated cryptococcosis with extensive subcutaneous nodules in a renal transplant recipient

Patients with disseminated cryptococcosis infrequently present with cutaneous involvement. A 34-year-old woman who had a renal transplant developed disseminated cryptococcosis with an unusual cutaneous presentation. Extensive subcutaneous nodules are rare in disseminated cryptococcosis, but the patient belonged to a high-risk group. Fluconazole 200 mg/d was administered intravenously. After a total dose of 1800 mg of fluconazole was given, the patient ' s situation improved.     

胸腔镜手术治疗肺隐球菌病11例报告

目的探讨肺隐球菌病的临床特点及胸腔镜手术的疗效. 方法回顾分析1996年1月～2002年12月我院11例肺隐球菌病的临床资料,其中胸腔镜肺楔形切除术8例,胸腔镜辅助改良后外侧小切口肺叶切除术2例,肺楔形切除术1例. 结果术前误诊10例.孤立性病变8例,双肺多发性病变3例.完全切除病灶8例,肺活检术3例.术后除2例伤口皮下积液外无其它并发症.术后随访12～72个月,(38.6±10.8)个月,无脓胸、支气管胸膜瘘发生,无肺隐球菌病复发. 结论肺隐球菌病多无基础疾病及症状,以孤立性病变多见.术前难以明确诊断,胸腔镜手术能彻底切除病灶,创伤小,恢复快.     

小儿全身性隐球菌病四例报告

小儿隐球菌病近年发病有上升趋势。为提高对本病的认识，降低误诊率，我们４例小全身性急性球菌进行了总结和分析。发现：发病年龄较以往资料偏小，因累及脏器的异同，起病方式及临床表现呈多样化，鉴别诊断十分重视。提高对本病的警惕性，对可疑病人反复多次墨汁染色找隐球菌，是降低误诊率的有效措施。     

Cutaneous cryptococcosis as the first symptom of a disseminated cryptococcosis in a patient with lymphogranulomatosis X

A 63-year-old patient, known to have suffered from lymphogranulomatosis X for 4 years is reported, in whom a cutaneous cryptococcosis appeared as first sign of a disseminated cryptococcosis. Despite systemic therapy with amphotericin B, the patient died after a period of 2 months. Differential diagnosis of skin tumours of immunosuppressed patients includes rare skin mycoses, and both histological and mycological examinations should be performed.     

肺隐球菌病的螺旋CT诊断

目的探讨肺隐球菌病的螺旋CT表现,以提高其诊断准确率。方法回顾性分析36例经病理证实的肺隐球菌病的临床及CT资料,分析其特征性表现。结果肺隐球菌病临床症状主要表现为咳嗽及胸痛,无症状8例。CT上根据病灶形态分三型为:①结节、团块或片状影27例,其中单发病灶(结节或团块影)6例,多发病灶(包括多发结节、结节并团块或片状影)21例;②浸润实变影6例;③弥漫混合型3例。36例病灶中位于两肺下叶21例(58.3%),位于肺外带及胸膜下区22例(61.1%),伴有空洞11例(30.6%),晕征7例(19.4%)。结论肺隐球菌病CT表现多样,以结节、团块或片状型多见;病灶多分布于肺外周,可伴空洞、晕征,结合临床表现有助于肺隐球菌病的诊断。     

A rare case of pulmonary cryptococcal inflammatory myofibroblastic tumor diagnosed by fine needle aspiration cytology

In a recent outbreak in British Columbia (BC), Canada, Cryptococcus gattii, a rare species of Cryptococcus, was noted to affect primarily immunocompetent hosts and cause limited pulmonary or CNS disease. We herein report a rare case of a pulmonary inflammatory myofibroblastic tumor caused by a Cryptococcus infection, presumed to be of the gattii species, in a 20‐year‐old immunocompetent college student from Vancouver, BC who presented with a large lung mass. The diagnosis was first made on the fine needle aspirate (FNA) material and was confirmed on the concurrent histologic core biopsy. Cryptococcal inflammatory myofibroblastic tumors have been reported, but neither in the lung nor in the setting of an immunocompetent host. Pulmonary cryptococcosis should therefore be considered in the differential diagnosis of a lung mass, even in an immunocompetent host, especially if the clinical history reveals recent travel to British Columbia where Cryptococcus gattii is endemic. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.