艾滋病合并非结核分枝杆菌病患者的临床特征分析

目的了解艾滋病合并非结核分枝杆菌(NTM)病的临床特征。方法回顾性分析复旦大学附属上海市公共卫生临床中心2019年1月1日至2021年12月31日诊断为艾滋病合并NTM病的190例患者的临床资料。根据是否为播散性NTM病分为艾滋病合并播散性NTM病组与艾滋病合并非播散性NTM病组。统计学分析采用独立样本t检验、曼-惠特尼U检验、χ2检验等。结果 190例艾滋病合并NTM病患者中, 男182例, 女8例, 年龄为(42±13)岁;首次住院天数为15(6, 26) d;患者以合并肺孢子菌肺炎最常见, 占12.1%(23/190);艾滋病合并播散性NTM病87例(45.8%)。患者临床症状以发热[55.8%(106/190)]、咳嗽[50.0%(95/190)]、咳痰[28.9%(55/190)]常见, 艾滋病合并播散性NTM病组乏力[31.0%(27/87)比7.8%(8/103)]、纳差[21.8%(19/87)比10.7%(11/103)]比例高于非播散性NTM病组, 差异均有统计学意义(χ2=16.99, P<0.001;χ2=4.42, P=0.036);艾滋病合并播散性NT...     

艾滋病合并分支杆菌病34例尸检材料的临床病理学研究

目的通过对３４例艾滋病（ＡＩＤＳ）合并分支杆菌病尸检材料的病理学观察，研究分支杆菌病的临床病理学特征，并评价其诊断方法。方法所有病例均按常规进行解剖、取材、固定、包埋、苏木素伊红染色，并用抗酸染色来鉴定分支杆菌。用回顾性研究方法，系统地复习分支杆菌病患者的病理切片与档案。结果在１５１例ＡＩＤＳ尸检材料中发现３４例分支杆菌病，包括２０例鸟－胞复合性分支杆菌（ＭＡＩ）感染、１０例结核病及４例混合感染。ＭＡＩ感染主要累及淋巴结（２１例，占８８％），其次为脾、肝、肺等，常为播散性感染，病变表现为组织细胞增生，胞浆呈泡沫状或空泡状，内含分支杆菌，形成肉芽肿性结节。结核病常累及肺（１０例）及淋巴结（８例），其典型表现为干酪样坏死及结核结节形成。２５例合并其它机会性感染或肿瘤。结论分支杆菌病，特别是结核病和ＭＡＩ，在ＡＩＤＳ中比较常见，常为播散性，常累及肺和淋巴结等器官，其特殊病理表现和阳性抗酸染色反应可作为诊断依据。     

弓形虫脑炎研究近况

弓形虫病是人畜共患的自然疫源性疾病 ,通过先天性和获得性两种途径传播给人 ,人感染后多呈隐性感染 ,在免疫功能缺陷宿主 ,可引起中枢神经系统损害和全身播散性感染。艾滋病并发弓形虫脑炎者达3.% 5～ 14.5%。血清流行病学调查发现 ,弓形虫感染高发地区的艾滋病患者发生弓形虫脑炎者高达 30 % ,是艾滋病重要的致死病因。在国内 ,弓形虫脑炎、脑膜脑炎占获得性弓形虫病的 10 .7%～ 11.4 % ,对人类健康造成严重威胁。现将本病的发病机理、临床表现、诊断与治疗研究近况简述如下。　　弓形虫脑炎的病因与发病机理弓形虫是一种专性细胞内寄生原…     

弓形虫病临床误诊现状分析

为了解弓形虫病临床误诊现状,检索并整理2000年1月至2018年8月PubMed和清华同方CNKI数据库收录的国内外弓形虫病的临床误诊病例,对患者误诊的疾病类型、病变部位、确诊方法、是否合并感染艾滋病、器官移植接受情况等信息进行分析,探讨可能的误诊原因。共获得弓形虫病误诊相关文献70篇,累计误诊病例数251例。文献结果显示,弓形虫病患者的误诊疾病类型共61种,误诊病例数居前的2类疾病分别是虹膜睫状体炎(29例,占11.6%)、视网膜炎(22例,占8.8%)。脑、眼、肝等部位发病的病例数较多,分别为84例(占34.2%)、 64例(占26.0%)和31例(占12.6%)。132例患者经血清学方法诊断为弓形虫抗体阳性; 68例患者(含25例死亡病例)经组织病理学检查,可见弓形虫滋养体或包囊; 13例患者经血液、体液、穿刺液涂片镜检方法查见弓形虫。49例患者出现艾滋病合并感染症状。13例患者接受过骨髓移植, 2例患者接受过肾移植。     

艾滋病合并结核病的临床分析

目的 探讨艾滋病合并结核病的临床特点。方法 对1998年至2002年ll例艾滋病合并结核病进行临床分析。结果 (1)艾滋病感染途径：输血感染者8例，其他途径各1例。(2)合并肺结核病6例，其中继发性肺结核3例，原发性肺结核1例，血行播散性肺结核2例；合并肺外结核5例，其中结核性心包积液、结核性脑膜炎各2例，胸腔积液1例；合并多重感染者5例。(3)11例1：2000PPD试验均为阴性。(4)治疗：7例抗病毒与抗结核联合治疗，临床表现明显改善；3例仅抗结核治疗者中1例有效、2例死亡；1例未经任何治疗，6月死亡。结论 艾滋病合并结核病临床表现多样，血行播散性肺结核多，肺外结核多，多重感染多见，抗病毒与抗结核联合治疗有效。     

30例艾滋病合并弓形虫脑病的临床特征分析

目的总结分析艾滋病合并弓形虫脑病的临床特点。方法采用SPSS 13.0统计软件,对艾滋病(AIDS)合并弓形虫脑病患者的临床特征进行计数总结,用复方磺胺甲基异恶唑联合克林霉素治疗弓形虫脑病,观察疗效。结果 30例病人中,CD4>200个/μL 3例,CD4≤200个/μL 27例。血清弓形虫IgG阳性17例。24例行脑脊液检查:4例压力升高,8例白细胞升高(以淋巴细胞升高为主),23例蛋白升高,5例葡萄糖降低,9例氯化物降低。16例头颅CT检查,累计病灶27个;14例头颅MRI检查,累计病灶43个。病灶多位于大脑半球,小脑和脑干次之。复方磺胺甲基异恶唑联合克林霉素抗弓形虫治疗结果:24例好转出院,3例死亡,2例自动出院。结论艾滋病合并弓形虫脑病,多发于CD4<200个/μL的患者,但CD4>200个/μL也可引发弓形虫脑病。弓形虫抗体IgG阴性不能除外弓形虫感染。脑脊液检查无特异性。与CT相比MRI更能够发现较多的病灶,对疑似弓形虫脑病的患者,建议行MRI检查。复方磺胺甲基异恶唑联合克林霉素治疗弓形虫脑病临床效果显著,值得借鉴。     

艾滋病合并结核病的临床分析

目的　探讨艾滋病合并结核病的临床特点。方法 对1998年至2002年11例艾滋病合并结核病进行临床分析。结果 (1)艾滋病感染途径:输血感染者8例,其他途径各1例。(2)合并肺结核病6例,其中继发性肺结核3例,原发性肺结核1例,血行播散性肺结核2例;合并肺外结核5例,其中结核性心包积液、结核性脑膜炎各2例,胸腔积液1例;合并多重感染者5例。(3)11例1:2000PPD试验均为阴性。(4)治疗:7例抗病毒与抗结核联合治疗,临床表现明显改善;3例仅抗结核治疗者中1例有效、2例死亡;1例未经任何治疗,6月死亡。结论 艾滋病合并结核病临床表现多样,血行播散性肺结核多,肺外结核多,多重感染多见,抗病毒与抗结核联合治疗有效。     

新疆人群弓形虫与艾滋病合并感染情况分析

弓形虫病是一种人兽共患的寄生虫病。无年龄、性别之限 ,感染表现为全身多脏器损害 ,但常无明显体征。新疆是全国重要的畜牧业基地 ,人畜接触的机会较多 ,人群弓形虫感染率为 5 %～ 10 % 〔1〕,而艾滋病近年来在新疆人群中的感染呈明显上升趋势 ,有资料显示 :国际上艾滋病与弓形虫的合并感染率高达 15 % [2 ] ,而两种病之间的关系极为密切与复杂 ,为探讨新疆艾滋病病毒感染与弓形虫感染之间的关系 ,我们于 2 0 0 0年 1～ 4月间对近年来收集到的不同民族的 5 0例ＨＩＶ抗体阳性血清 ,进行了Ｔｏｘｏ -ＩｇＧ、Ｔｏｘｏ -ＩｇＭ抗体的检测 ,并…     

艾滋病合并常见原虫感染的诊断治疗

原虫感染是艾滋病患者重要的机会性感染之一。为了提高临床医生对艾滋病合并原虫感染的认识,本文对艾滋病合并弓形虫脑炎、隐孢子虫病、微孢子虫病及等孢球虫病的诊断治疗现状进行综述。     

弓形虫病性心律失常的临床疗效观察

弓形虫病是一种人兽共患病,其临床表现复杂多样,但以心律失常为主要表现的病例少见报道。为探讨其临床治疗效果,我院心血管内科自1991年1月～1995年1月对弓形虫病性心律失常进行了观察治疗,现报道如下。临床资料　　一、病例选择　　1991年1月至1994年1月对我院拟诊为原因不明性心律失常的48例患者,进行了血清弓形虫抗体测定(ELISA测定IgG)。其中9例为阳性,抗体滴度为1∶128～1∶512,并对抗体阳性患者的抗体滴度进行动态观察,间隔1～1.5月测定1次共3次,全部抗体阳性病例的抗体滴度均逐渐增加,最高达1∶1024。9例弓形虫抗体阳性患者中男性…     

Diagnosis of cerebral toxoplasmosis in association with AIDS using the polymerase chain reaction

Two AIDS patients were provisionally diagnosed as having cerebral toxoplasma infection on the basis of compatible clinical presentation, serological evidence of exposure to toxoplasma and the detection of multiple space occupying lesions on CT scan. Initial response to conventional antitoxoplasma therapy was poor. Brain biopsy was performed and toxoplasma nucleic acid detected in the cerebral tissues utilising the polymerase chain reaction (PCR). Specific therapy was continued and a satisfactory clinical and radiological response was achieved in each case. The PCR represents a method of potential value for the diagnosis of cerebral toxoplasmosis associated with AIDS. Further studies are required to assess the sensitivity, specificity and prognostic value of this technique in comparison with established diagnostic methods.     

New methods in the diagnosis and management of cerebral toxoplasmosis associated with the acquired immune deficiency syndrome

Cerebral toxoplasmosis is a life-threatening condition associated with the acquired immune deficiency syndrome (AIDS). Current diagnostic and therapeutic methods have serious limitations. The diagnosis of cerebral toxoplasma infection in a patient with AIDS was assisted by the detection of specific IgM in a highly sensitive immunosorbent agglutination assay and by the demonstration of Toxoplasma gondii nucleic acid in a brain biopsy specimen by means of the polymerase chain reaction. Following initial failure of the patient to respond to treatment with sulphadiazine and pyrimethamine, clinical improvement was observed during treatment with clindamycin followed by dapsone. Further assessment of novel methods in the management of cerebral toxoplasmosis is required.     

Cerebral toxoplasmosis in HIV-positive patients in Brazil: clinical features and predictors of treatment response in the HAART era

A prospective study of 55 confirmed or presumptive cases of cerebral toxoplasmosis in HIV positive patients in Brazil was performed to describe clinical characteristics and to identify predictive factors for clinical response to the anti-Toxoplasma treatment. Cerebral toxoplasmosis led to the diagnosis of HIV infection in 19 (35%) patients, whereas it was the AIDS defining disease in 41 (75%) patients. Of these, 22 (54%) patients were previously know to be HIV-positive. At diagnosis of cerebral toxoplasmosis, only 4 (7%) patients were on highly active antiretroviral therapy (HAART), and 6 (11%) were receiving primary cerebral toxoplasmosis prophylaxis. The mean CD4+ cell count was 64.2 (+/- 69.1) cells per microliter. Forty-nine patients (78%) showed alterations consistent with toxoplasmosis on brain computed tomography. At 6 weeks of treatment, 23 (42%) patients had complete clinical response, 25 (46%) partial response, and 7 (13%) died. Alteration of consciousness, Karnofsky score less than 70, psychomotor slowing, hemoglobin less than 12 mg/dL, mental confusion, Glasgow Coma Scale less than 12 were the main predictors of partial clinical response. All patients were placed on HAART within the first 4 weeks of diagnosis of cerebral toxoplasmosis. One year after the diagnosis, all available patients were on HAART and toxoplasmosis prophylaxis, and only 2 patients had relapse of cerebral toxoplasmosis. In Brazilian patients with AIDS, cerebral toxoplasmosis mainly occurs as an AIDS-defining disease, and causes significant morbidity and mortality. Signs of neurologic deterioration predict an unfavorable response to the treatment. Early start of HAART seems to be related to better survival and less relapses.     

Ventriculitis: a rare case of primary cerebral toxoplasmosis in AIDS patient and literature review.

Cerebral toxoplasmosis remains the most important neurological opportunistic infection and the most common cause of intracerebral mass lesion in patients with acquired immunodeficiency syndrome (AIDS). We report a case of an adult AIDS patient with an atypical pattern of toxoplasma encephalitis, presenting with ventriculitis and obstructive hydrocephalus without any focal parenchymal lesion.     

酶联免疫吸附试验检测弓形虫体IgA抗体及其临床应用的初步研究

试用弓形虫膜抗原ELISA对先天性弓形虫感染的畸形围产儿和后天获得性弓形虫感染者进行了特导性IgA抗体检测。11例先天性弓形虫宫内感染畸形围产儿的15份标本,6份检出IgA抗体,7份同时检出IgA;IgM抗体,两份仅检出IgM抗体。8份弓形虫抗体阳性的孕妇血清皆检出较强的IgA抗体。后天获得性弓形虫近期感染者32份血清,IgA抗体阳性3份,IgA、IgM抗体阳性8份,IgM抗体阳性21份;30份慢性感染者血清未有测到IgA抗体。对照组30份抗体阴性的孕妇血清及其围产儿的脐血检测结果抗体皆为阴性。IgA抗体是弓形虫感染早期的一个重要标志物,与IgM、IgG抗体同时检测,对临床急性弓形虫感染的诊断和疗效观察有着极其重大意义。     

Cytomegalovirus infections and toxoplasmosis in heart transplant recipients in Sweden.

The morbidity of cytomegalovirus (CMV) infection and toxoplasmosis was evaluated in 75 heart transplant recipients. Among the 73 patients who survived more than one week after transplantation, 16 (22%) acquired primary CMV infection and 30 (41%) had evidence of secondary infection. All CMV seronegative recipients receiving hearts from seropositive donors developed CMV infection. The majority of infections (42/46) occurred during the first 4 months after transplantation. Overall, the incidence of symptomatic CMV disease was 44%. The infections were generally mild and only 1 death was attributed to primary CMV disease complicated by bacterial septicaemia and multiple organ failure. The severity of CMV disease was greatest among those with primary infection. There were 3 cases of toxoplasmosis. Two patients were toxoplasma seronegative before transplantation and developed clinical and serological signs of infection 2-3 months after transplantation despite receiving organs from seronegative donors. Of toxoplasma seronegative recipients receiving allografts from seropositive donors 3/4 were prophylactically treated with pyrimethamine for 6 weeks. None developed clinical or serological signs of toxoplasmosis while one patient who received trimethoprim-sulfamethoxazole had a subclinical infection.     

Toxoplasmosis, a severe complication in allogeneic hematopoietic stem cell transplantation: successful treatment strategies during a 5-year single-center experience.

Toxoplasmosis is a rare but often fatal complication that occurs after patients undergo allogeneic hematopoietic stem cell transplant. At our institution, toxoplasmosis was diagnosed in 8 of 301 patients who received stem cell transplants. Disseminated toxoplasmosis with a rapid fatal course was observed in 2 patients. Six patients had cerebral toxoplasmosis diagnosed on the basis of neurological signs and observation of the patients' mental confusion, seizures, and typical lesions (which were assessed by computed tomography, magnetic resonance imaging, or both). Seroconversion of antitoxoplasma immunoglobulin and a discovery of toxoplasma deoxyribonucleic acid in the cerebrospinal fluid (confirmed by use of polymerase chain reaction) were documented in all patients. Treatment consisted of clindamycin therapy (for 2 patients) and of pyrimethamine-clindamycin therapy, sulfadiazine therapy, or both (for 5 patients). Patients showed improvement after therapy, as assessed by clinical and radiological means. Three of 8 patients survive-1 without any residual neurological symptoms and 2 with minimal neurological symptoms.     

Failure to diagnose fatal disseminated toxoplasmosis in a bone marrow transplant recipient: the possible significance of declining antibody titres

A 46-year-old patient with acute myelogenous leukaemia developed lethal disseminated toxoplasmosis 8 weeks after allogeneic bone marrow transplantation. Clinical features included pulmonary infiltrates, respiratory insufficiency and neurological signs. Post-transplantation toxoplasma serological tests were characterised by declining IgG titres and failure to detect IgM, whereas titres of IgG against the various herpes viruses remained constant and even increased over the same period. Circulating toxoplasma antigen could not be detected. Post mortem, specific immune complexes were identified in serum. Autopsy revealed widely disseminated toxoplasmosis with several foci in the brain, lungs and various other organs as well as concomitant infection with cytomegalovirus.     

Toxoplasma gondii: How fatal is it in pediatric allogeneic bone marrow transplantation setting?

Toxoplasmosis is a disease of the immunocompetent population. However, cases of toxoplasma infection associated with immunosuppression have been reported, especially the first months after transplantation. Limited data are available about toxoplasma infection, occurring even many months post‐transplant in pediatric patients with nonmalignant and malignant diseases. We report the cases of three patients with early and late disseminated toxoplasmosis and review the literature.