免疫功能低下患者巨细胞病毒性肺炎的诊断和治疗

目的：探讨免疫功能低下患者巨细胞病毒（CMV）肺炎的诊断和治疗. 方法：对31例免疫功能低下患者CMV肺炎的临床资料进行回顾性分析.结果：均接受免疫抑制剂治疗.接受移植手术者27例,死亡7例,CMV肺炎相关病死率22.2%;患有免疫系统疾病者4例,死亡3例,CMV肺炎相关病死率75%.结论：对器官移植患者和长期接受免疫抑制剂治疗的免疫功能低下患者应加强对CMV的监测,早期诊断,及时应用以更昔洛韦为主的综合治疗.     

呼吸重症监护病房免疫功能低下患者肺炎病原学特点分析

目的 了解呼吸重症监护病房免疫功能低下患者(ICH)肺炎病原体特点及耐药情况,为临床经验性选择抗菌药物提供依据.方法 对2005年1月至2008年4月收住北京朝阳医院呼吸重症监护病房的52例ICH肺炎的痰或肺泡灌洗液培养及药敏试验结果进行回顾性分析.结果 52例ICH肺炎中20例医院获得性肺炎检出42株菌,其中革兰阴性杆菌15株(36.0%),以铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌为主;革兰阳性球菌13株(31.0%),以肠球菌属和金黄色葡萄球菌为主;真菌11株(26.2%),以曲霉菌和白色念珠菌为主;肺孢子菌3株(7.1%).32例社区获得性肺炎检出57株菌,其中革兰阴性杆菌19株(33.3%),以铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌为主;革兰阳性球菌16株(28.1%).以肠球菌和金黄色葡萄球菌为主;真菌16株(28.1%),以曲霉菌和白色念珠菌为主;肺孢子菌6株(10.5%).药敏试验显示铜绿假单胞菌对抗生素多重耐药率较高,鲍曼不动杆菌和肺炎克雷伯菌仍对碳青霉烯类较敏感.肠球菌属对万古霉素的耐药率为20.0%,未发现耐万古霉素的葡萄球菌.结论 ICH肺炎中的医院获得性肺炎和社区获得性肺炎病原学特点无差异,感染真菌和革兰阳性球菌比例较高,肺孢子菌肺炎应引起重视,多重耐药菌株高发,耐药率一致.     

Salmonella septic arthritis in systemic lupus erythematosus and other systemic diseases

Salmonella infection is an important problem in immunocompromised patients. The synovium is a particular metastatic focus ofSalmonella infection and can result in many disabilities of life. Systemic lupus erythematosus (SLE) patients were highly susceptible toSalmonella infection. In the past 6 years, 41 patients withSalmonella septic arthritis have been treated in our hospital. Eleven patients had an underlying systemic disease of SLE which presented with a distinctive clinical course. Alcoholic liver disease (six cases) was another common underlying systemic disease. The most frequent predisposing articular factor was avascular necrosis (16 cases). The hip joint was the most commonly involved site.Salmonella group B was the most common serotype (30/41). Seventy-three per cent (8/11) of the SLE group had involvement of two or more joints compared with only three out of 30 patients in the non-SLE group. The sex differentiation shows a predominance of young females (10/11) in the SLE group and middle-aged males in the non-SLE group. Moreover, in the SLE group, all 11 patients shared the risk of lupus nephritis and steroid use. Ten patients hadSalmonella group B bacteraemia and five had urinary tract infections simultaneously. In the non-SLE group, there were 10 patients with a history of steroid use, three with antecedent enteritis, 12 with bacteraemia, and three with necrotising fasciitis. Seven patients in each of the groups had a recurrent course. However, three patients in the non-SLE group had died during the episode of septic arthritis.     

<Emphasis Type="Italic">Aspergillus</Emphasis> in the lung: diverse and coincident forms

Pulmonary disease caused by the fungus Aspergillus has traditionally been regarded as belonging to one of the following, apparently distinct, entities: saprophytic aspergilloma; allergic bronchopulmonary aspergillosis (ABPA); and invasive aspergillosis (IPA); which may be further categorised as angioinvasive, acute or chronic airway invasive) [1]. It is not always obvious that there is overlap between these entities, and that in any given patient more than one Aspergillus-related pathological process can co-exist [2]. The aim of this article is to review the clinical and imaging features of the main categories of Aspergillus-related pulmonary disease and, in particular, to highlight the overlap between them.     

Clostridium difficile in paediatric populations

An increase in Clostridium difficile infection incidence has been observed among hospitalized children in the United States. The present statement, targeted at clinicians caring for infants and children in community and institutional settings, summarizes the relevant information relating to the role of C difficile in childhood diarrhea and provides recommendations for diagnosis, prevention and treatment. Significant differences between adult and paediatric risk factors and disease are discussed, along with emerging therapies. The relationship between age and disease severity in children with a newly emergent and more fluoroqinolone-resistant strain of C difficile (North American Pulse-field type-1 [NAP1]) remains unknown. The importance of antimicrobial stewardship as a preventive strategy is highlighted. This statement replaces a previous Canadian Paediatric Society position statement on C difficile published in 2000.     

曲霉菌性脑脓肿两例报告

本文报道2例少见的孤立性曲霉菌性脑脓肿,术前均行CT检查,术后经病理确诊。1例发病与免疫抑制有关,另1例为耳源性传播。术后1例存活,1例死亡。作者强调了在免疫抑制病人中曲霉菌性脑脓肿的可能性。     

Comparative imaging in the evaluation of hepatic abscesses in immunocompromised children

Three children, two with aplastic anemia and one with chronic granulomatous disease of childhood, were evaluated for hepatic abscess with hepatic scintigraphy (HS), gray-scale sonography (GSS), 67Ga imaging (GA), and computed tomography (CT). Each of the children was found to harbor two abscesses. All were detected with GSS and CT. In the two children imaged with GA, all four abscesses were seen. In two patients imaged twice with HS, 50% of the lesions were missed.     

支气管肺泡灌洗在免疫抑制患者肺部感染中的诊断价值

肺部感染是导致免疫抑制患者死亡的重要原因之一。支气管肺泡灌洗是研究肺泡表面液细胞成分和可溶性物质的一种方法,被广泛用于免疫抑制宿主肺部病变的诊断中,是下呼吸道微生物取样的标准方法。现将支气管肺泡灌洗在免疫抑制患者肺部感染中的诊断价值作一综述。