老年肺结核合并肺及皮肤隐球菌感染1例及文献复习

目的:探讨老年肺结核病人并发肺部及皮肤隐球菌感染时的诊断、治疗方法。方法:结合本院1例肺结核合并肺部及皮肤隐球菌感染病例,总结该病的临床特点、诊断方法和治疗方案。结果:病理学检查可见真菌,PAS(+),粘卡(-),六胺银(+)。通过对患者的抗痨及全身、局部抗真菌治疗,取得了满意疗效。结论:老年肺结核合并肺部及皮肤隐群菌感染患者临床表现不典型,确诊需病理组织检查,及时的诊断是关键,抗痨及抗真菌治疗效果好。     

肺隐球菌病免疫缺陷相关性临床研究

[目的]研究肺隐球菌病免疫缺陷相关性及临床特征,以提高对该病的认识.[方法]将60例患者随机分为外科治疗组35例,内科治疗组25例;分别给予外科及内科治疗,对两组患者的预后进行评价并统计学分析.同时还对免疫缺陷及非免疫缺陷患者预后进行评价并统计学分析.[结果160例肺隐球菌病患者中：内科治疗组有效率为76.0％、治愈率为32.0％、死亡率为16.0％;外科治疗组有效率97.1％、治愈率60.0％、死亡率0％与内科治疗组差异有显著性（P＜0.05）.非免疫缺陷与免疫缺陷组比较：非免疫缺陷组有效率为97.1％、治愈率为75.0％,死亡率为0％,免疫缺陷组有效率75.0％、治愈率17.9％、死亡率14.3％与非免疫缺陷组比较差异有显著性（P＜0.05）.[结论]本研究显示肺隐球菌病治疗外科手术治疗效果优于内科治疗,非免疫缺陷人群预后优于免疫缺陷人群.     

肺隐球菌病的临床特点及诊治分析

目的分析肺隐球菌病的临床特点、诊断、治疗及预后。方法回顾分析23例确诊肺隐球菌病患者的高危因素、临床表现、影像学特点、确诊方法及治疗转归。结果原发性肺隐球菌病21例（91．3％）,继发性2例（8．7％）,合并基础疾病5例（21．7％）。主要症状为咳嗽13例（56．5％）和胸痛9例（39．1％）。影像学主要表现为单发或多发结节／肿块18例（78．3％）,主要分布在肺下叶（12例）。10例经皮穿刺肺活检确诊,12例经外科手术组织病理学确诊。行氟康唑治疗20例中（外科切除病灶10例）,18例痊愈。结论原发性肺隐球菌病较为常见,影像学特点对诊断有一定的提示意义。经皮穿刺肺活检是经济、安全、有效的确诊措施,氟康唑治疗疗效较好。     

原发性肺隐球菌病10例临床分析

目的总结分析10例原发性肺隐球菌病患者的临床特点。方法分析我院10例原发性肺隐球菌病患者的临床、影像学表现、实验室检查、病理及确诊方法、疗效等。结果①10例原发性肺隐球菌病,男6例,女4例,有基础疾病者2例,有临床症状者8例,主要表现为胸痛、咳嗽、咳痰、痰中带血、发热,影像学表现为结节肿块型1例,肺炎型4例,混合病变型5例,全部病例均经病理确诊。②治疗采用手术切除病灶和(或)氟康唑治疗。1例行手术切除后口服氟康唑,另9例均行氟康唑治疗,治愈6例,好转4例,有效率100%,疗程1～12月不等。结论原发性肺隐球菌病临床和影像学表现不典型,呈多样性,应积极行肺活检以协助诊断,肺隐球菌病单用氟康唑抗真菌治疗效果良好。     

Localized cutaneous cryptococcosis successfully treated with itraconazole. Review of medication in 18 cases reported in Japan

A case of localized cutaneous cryptococcosis successfully treated with oral itraconazole is reported. The patient, a 63-year-old Japanese housewife, had had an erythematous and partly eroded lesion in the area of her right earlobe for about 10 months. No findings suggesting a primary focus of Cryptococcus infection were found in the lung, central nervous system or other internal organs. The isolate obtained from the lesion was identified as Cryptococcus neoformans based on the demonstration of encapsulated blastospores and its biological characteristics. The clinical course shifted toward healing in parallel with a decreased serum level of anticryptococcal antibody after initiation of treatment with oral itraconazole in a dose of 100 mg once daily. The treatment was discontinued after 13 weeks. There were neither subjective nor objective side effects. Furthermore, this paper reviews the medications employed in 18 cases with cutaneous cryptococcosis reported in Japan during the nearly 40-year period between 1952 and 1989.     

Endobronchial cryptococcosis in AIDS

Although cryptococcosis is a common thoracic complication among patients with AIDS, endobronchial abnormalities have rarely been reported. A 45-year-old man presented with a productive cough, fever, and headache. His CD4+ cell count was 7/mm3 and testing for antibodies to HIV-1 was positive. Radiological examination revealed consolidation in the left lung, including cavitation. Bronchoscopic examination demonstrated white, slightly raised, plaque-like lesions in the trachea and left bronchi. Histopathological examination of endobronchial biopsy specimens revealed granulation tissue with abundant encapsulated yeast in the tissue. Cryptococcus neoformans was cultured from the bronchial lavage specimen. Cryptococcal infection should be included in the differential diagnosis of endobronchial abnormalities in patients with AIDS.     

Disseminated Cutaneous Cryptococcosis

Summary: A case of primary cutaneous cryptococcosis in a Thai woman with impairment of cellular immunity is reported. The infection later metastasized to different parts of the body resulting in various cutaneous lesions. With the presence of cryptococcus cells in the spinal fluid, there were no neurological manifestations. The infection was successfully treated with the combination of amphotericin B and 5-fluorocytosine.
Zusammenfassung: Bericht über einen Fall einer primären cutanen Cryptococcose bei einer thailändischen Frau mit einer gestörten zellulären Immunität. Später metastasierte die Infektion in verschiedene Körperregionen, wodurch zahlreiche cutane Herde entstanden. Trotz Gegenwart von Cryptococcus-Zellen im Liquor cerebrospinalis bestanden keine neurologischen Symptome. Die Infektion wurde erfolgreich mit einer Kombination von Amphotericin B und 5-Fluorocytosin behandelt.     

Pulmonary Cryptococcosis in a Rhesus Monkey (Macaca Mulatta)

Summary: Pulmonary cryptococcosis was diagnosed in a 5-year-old-male rhesus monkey from Delhi during 1979. The animal undergoing treatment for bacterial pneumonia was admitted to the indoor ward of Veterinary Hospital with a history of low grade fever, dyspnea and cough. Despite treatment with broad-spectrum antibiotics, hydrocostisones and other supportive drugs, the monkey died. Cryptococcus neoformans was cultured from the lungs of the autopsied animal on sunflower agar medium at 28°C. Histological section of the lung tissue showed large monuclear cells proliferation along with cryptococcal cells. Epidemiological investigation established the source of infection in the environment of the monkey.
Zusammenfassung: Eine pulmonale Crytococcose wurde bei einem 5jährigen männlichen Rhesusaffen 1979 in Delhi diagnostiziert Das Tier wurde während einer Behandlung wegen bakterieller Pneumonie in des Veterinärkrankenhaus mit niedrigem Fieber, Dyspnoe und Husten aufgenommen. Der Affe verstarb trotz Behandlung mit Breitspektrumantibiotika, Hydrocortison und anderen Medikamenten. Aus dem Autopsiematerial konnte Cryptococcus neoformans von den Lungen auf Sonnenblumen-Agar bei 28°C isoliert werden. Histologische Lungenschnitte zeigten Proliferation großer mononukleärer Zellen zusammen mit Cryptococ-cus-Zellen. Bei epidemiologischen Untersuchungen konnte die Infektionsquelle in der Umgebung des Affen nachgewiesen werden.     

Efficacy Evaluation of a Novel Submicron Miconazole Emulsion in a Murine Cryptococcosis Model

Submicron emulsions of miconazole were stabilized by using a combination of three emulsifiers comprising phospholipids, poloxamer, and deoxycholic acid (DCA). The presence of DCA was vital for prolonged emulsion stability owing to its contribution to the elevated zeta potential of the emulsion. Further, the results by the phospholipid surface labelling colorimetric technique clearly suggested that poloxamer molecules interacted with phospholipid polar-head groups of the mixed DCA-phospholipid interfacial film, resulting in the stabilization of the emulsion by a steric enthalpic entropic mechanism. The plain emulsion vehicle was well tolerated up to a dose of 0.6 ml injected i.v. to BALB/c mice. The maximum tolerated dose of miconazole was 80 and 250 mg/kg in Daktarin^® i.v. (a marketed product) and emulsion, respectively, showing an improved safety ratio of 1 to 3 in favor of the emulsion. These results tended to confirm that the adverse effects associated with Daktarin^® i.v. injection should be associated with the vehicle rather than with the miconazole itself. In a murine cryptococcosis model, only one mouse out of ten remained alive by day 15 in the infected group treated with Daktarin^® i.v., while in the miconazole emulsion treated group, mice began to die from day 16 up to day 25 post inoculation. Thus, the multiple-dose treatment with the miconazole emulsions improved the protection offered to the infected mice. However, the therapeutic levels of miconazole that were reached in the target organ (brain) were lower than those required for complete eradication of Cryptococcus neoformans, which is known to multiply preferentially in the brain.