疑诊肺部真菌感染的10例经验性用药分析

目的 探讨疑诊肺部真菌感染的经验性抗真菌用药方案.方法 对疑诊肺部真菌感染并以经验性广谱抗真菌治疗好转10例患者的临床资料进行回顾分析.结果 10例患者主要临床表现为发热（10/10）、咳嗽、咳痰（8/10）.胸部CT检查均表现为密度较高的感染性病灶（5例伴空洞,8例伴光晕征）.4例痰培养见真菌孢子和菌丝.8例有真菌感染危险因素,3例初用氟康唑治疗无效,改用伊曲康唑好转;6例用伊曲康唑好转;1例用两性霉素B好转.结论 肺部真菌感染确诊困难,流行病学调查显示非白念真菌发病率有增高趋势,疑诊肺部真菌感染应及时将广谱抗真菌治疗作为一线药物.

The analysis of empirical antifungal medication to possible pulmonary mycotic infection:ten case report and literature review

Objective To explore the empirical antifungal medication on possible pulmonary mycotic infection.Methods The clinical data of 10 patients with preliminary diagnosis of possible pulmonary mycotic infection admitted to respiratory department of Union hospital,Huazhong university of science and technology and successfully treated by empirical broad-spectrum of antifungal therapy from January 2006 to July 2006,were analyzed retrospectively and review the literature.Results The main clinical symptoms were fever(10/10),cough and expectoration(8/10).The chest CT findings:multiple nodular and patchy consolidations in the bilateral lungs in all cases,of which 5 cases had cavity and 8 cases had halo site.Sputum culture revealed fungal spore and hypha in 4 cases.8 cases had risk factors of fungal infection.There cases failed to improve by fluconazol therapy at first until treated by itraconazole,6 cases were improved by itraconazole and one by amphotericin B.Conclusion Since the confirmation of pulmonary mycotic infection is difficult and the incidence of non-Blastomyces albicans infection has a heightened tendency by the epidemiologic survey,it is of significance to use broad-spectrum antifungal agents as the first chosen medication for possible pulmonary mycotic infection in time.