蠊缨滴虫感染一例

本例患者咳嗽7d,发热2d,最高体温达38.5 ℃,纤维支气管镜检查发现左肺下叶基底段见大量乳白色脓性分泌物涌出,肺泡灌洗液在光学显微镜下可见活动的蠊缨滴虫.予以哌拉西林钠他唑巴坦钠、盐酸左氧氟沙星和吗啉硝唑氯化钠联合治疗后,患者症状好转.目前,蠊缨滴虫的传播途径、导致呼吸道感染的发病机制尚未明确,且临床医师对蠊缨滴虫...     

蠊缨滴虫致肺部感染一例

患者男，39岁。因反复咳嗽、咳脓痰5年，加重伴哮喘1周于2006年4月12日入院。既往有慢性阻塞性肺疾病（COPD）合并肺气肿、肺大泡、支气管扩张病史，曾在我院多次住院。本次住院前1周咳嗽、咳痰症状明显加重，多为白色黏痰且不易咳出，并有哮喘发作，胸闷、烧灼感、烦躁不安，咽部及胸骨后有虫爬样感觉，自觉与往日发病症状不同。     

26例肺部疾病患者合并蠊缨滴虫感染的诊断和治疗

对26例痰中检出蠊缨滴虫的患者进行诊断与治疗，探讨蠊缨滴虫的致病性特点。患者临床表现为咳嗽、胸闷气短及白色黏液丝样痰。实验室检查，痰涂片及支气管肺泡灌洗液镜检见活体蠊缨滴虫。影像学检查，双肺可见肺间质性改变及肺泡渗出，斑点状透光影及纤维条索影，肺门密度增高。甲硝唑抗虫治疗有效。     

支气管肺蠊缨滴虫感染1例报告及文献复习

目的分析目前支气管肺蠊缨滴虫感染的现状，进一步提高认识。方法报道1例长期随访病例的治疗情况，结合文献报道的16例，分析在治疗过程中的经验和不足。结果17例中，有12例报道用甲硝唑治疗临床观察提示有效，但有2例长期随访的病例提示甲硝唑类药物及其他抗原虫药物治疗无效。4例有支气管哮喘发作应用肾上腺皮质激素治疗能缓解症状。经支气管镜治疗可以作为辅助治疗方法。结论虽然甲硝唑治疗支气管蠊缨滴虫感染的药理作用机制不明，长期观察也有无效病例，但首次治疗仍应作为首选药物。肾上腺皮质激素能减轻变态反应，可适量使用。     

呼吸道感染患者痰内发现蠊缨滴虫1例

本文报道了呼吸道感染患者痰内检到蠊缨滴虫。患者主要临床表现为发热、喘憋和咳嗽。CT确诊为右下肺炎。用抗生素头孢哌酮2 g和左旋氧氟沙星0.2 g静脉滴注bid治疗无效,止咳化痰中药汤剂也不起作用。实验室检查,发现患者血液中嗜酸粒细胞和中性粒细胞增高,并在患者咯出的痰内检到蠊缨滴虫。停用抗生素和中药,改用甲硝唑500 mg静脉滴注bid,5 d后患者治愈。     

上颌窦蠊缨滴虫感染1例北大核心

蠊缨滴虫（Lophomonas blattarum Stein,1860）隶属于超鞭毛纲（Hypermastigida）超鞭毛目（Hypermastigida）缨滴虫科（Lophomonadae）,通常寄生于白蚁和蜚蠊的消化道内,人体感染少见。1993年国内首次报道了人体感染蠊缨滴虫的病例,后又陆续报道了60余例。报道的病例多为肺部感染,鼻窦感染极少见,现报道1例上颌窦感染病例。患者,女,54岁,汉族,河北省涿鹿县食品加工厂工人。     

支气管肺蠊缨滴虫感染二例并文献复习

目的 提高对支气管肺蠊缨滴虫病的认识与诊断水平.方法 分析武警部队上海总队医院呼吸内科确诊的2例支气管肺蠊缨滴虫病的临床资料,结合1993-2006年文献报道的13例共15例进行文献复习.结果 (1)2例患者中,1例表现为重症哮喘,反复夜间发作咳嗽、胸闷、气喘,肺部听诊可闻及哮鸣音,支气管镜检查提示右上叶支气管狭窄、黏膜充血水肿;1例表现为支气管扩张伴感染迁延不愈,患者反复咳嗽、咳痰伴低热,胸部X线片、CT示双肺多个叶段支气管扩张伴感染,支气管镜检查提示支气管黏膜充血水肿,管腔狭窄,支气管管腔内可见白色坏死样物.2例均经支气管镜检查采集标本检验后明确诊断.(2)文献报道的13例均经病原学检查并由寄生虫病专家鉴定,诊断依据确凿.支气管肺蠊缨滴虫病最常见的症状是发热(64.3%)和咳嗽、咳痰(71.4%),半数患者外周血嗜酸性粒细胞数增多,X线胸片及胸部CT影像以肺炎样改变多见(占摄片数83.3%),慢性患者可表现为支气管哮喘、支气管扩张、肺脓肿等.痰液和经支气管镜检查采集标本,直接涂片检查是明确病原的方法.结论 支气管肺蠊缨滴虫病为新发感染性疾病,感染人体的蠊缨滴虫的宿主、传播途径、易感人群等尚不清楚,治疗亦需进一步研究.     

支气管肺蠊缨滴虫病的临床诊治进展

支气管肺蠊缨滴虫感染是一种新的寄生虫疾病,1993年至2008年国内共确诊48例,临床诊断和治疗有一定进展,但蠊缨滴虫感染病例的临床表现缺少特征性,蠊缨滴虫自然宿主、传播途径、流行区域及致病机制等多个方面也尚不明确,其生物学分类地位也有争议,国内还没有建立抗原抗体检测或分子生物学鉴定方法.     

蠊缨滴虫肺部感染1例

患者,女性,59岁,浙江省绍兴市越城区人。患者因反复咯血15年,近1个月再次咯血(呈色红,量约50ml),伴胸痛1d,于2011年12月15日入院绍兴市人民医院。查体:体温36.7℃,脉搏88次/min,血压145/86 mm Hg,呼吸20次/min。患者有Ⅱ型糖尿病史10余年,神志清,精神可,颈静脉无怒张,浅表未触及肿大淋巴结。正常成年胸,两肺呼吸动度对称,叩诊清音,     

一种新发机会性感染致病病原——蠊缨滴虫

据国外文献报告,蠊缨滴虫是一种寄生于白蚁、蟑螂(包括森林树木中的蟑螂)肠道的单细胞原虫.20世纪末,国内陆续有从人呼吸道检出蠊缨滴虫的报道,近年来该类病例报道明显增多.部分免疫功能低下感染蠊缨滴虫的患者常需呼吸机辅助呼吸,常用抗生素治疗无效,及时应用甲硝唑类抗生素治疗可使肺部感染得以控制.根据现有的报道我们认为蠊缨滴虫所致呼吸道感染可能是一种新发的、人们尚未完全认识的机会性感染寄生虫病.     

Gastroduodenal cytomegalovirus infection is common in kidney transplantation patients

Objective Cytomegalovirus (CMV) infection is known to cause ulcerations, erosion and mucosal haemorrhage in the gastrointestinal tract. The aim of this study was to report the CMV findings in the gastroduodenal mucosa of kidney transplantation patients and immunocompetent controls.

Material and methods Forty-six kidney transplant patients with upper gastrointestinal symptoms and 43 immunocompetent, dyspeptic patients (controls) prospectively underwent oesophagogastroduodenoscopies (OEGDs), with biopsies from the duodenum and stomach. CMV was demonstrated by immunohistochemistry, both in frozen sections using a monoclonal antibody against CMV-specific antigens (pp65 matrix protein) and in paraffin sections by means of a monoclonal antibody against the delayed early protein (p52).

Results CMV was detected in the gastric mucosa in 30% of the kidney transplant patients and in 9% of the controls (p<0.05) and in the duodenal mucosa in 70% and 35%, respectively (p<0.01). The total frequency of CMV findings was similar in patients who underwent OEGDs <1 year and >1 year after transplantation. CMV inclusions were found only in transplantation patients <1 year after transplantation (n=9). CMV findings, especially inclusions, in the gastric biopsies were associated with nausea and upper gastric pain. Histopathological findings in CMV-positive samples were non-specific, focal inflammation in haematoxylin-eosin-stained preparations, while CMV p52 staining showed inclusions in either the epithelial or endothelial cells.

Conclusions CMV could be detected in the gastroduodenal mucosa in 74% of kidney transplantation patients and in 40% of immunocompetent controls (p<0.01). CMV diagnostics are always recommended when gastroduodenal biopsies of kidney transplantation patients are performed.     

Lophomonas blattarum infection presented as acute exacerbation of chronic obstructive pulmonary disease

The present case described a 70-year-old male who was initially diagnosed and treated as acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Ultimately Lophomonas blattarum (L. blattarum), a rare protozoan causing opportunistic infection, was found in suction sputum smear. Bronchoscopy showed a lot of purulent sputum in airways, diffusely swelling and friable mucus on bronchus. After single tinidazole treatment, symptoms and image showed marked improvement. It indicates though in the untraditional immunocompromised case, the suspect of opportunistic diseases is necessary, especially in the cases failed to improvement under empirical treatment. It also supports the tinidazole treatment is efficacy in L. blattarum infection.     

肾移植术后移植肾带功死亡原因分析

目的：分析19例肾移植术后移植肾带功死亡原因，为临床防治移植肾带功死亡提供参考。方法：回顾性分析19例移植肾带功死亡者的临床资料。结果：感染死亡12例，其中肺部感染10例(5例混合感染、2例单纯感染、3例不明原因的肺部感染)，术后尿漏引起菌血症2例(均为混合感染)；心脑血管意外死亡5例，均为50岁以上(其中脑出血2例、急性左心衰2例、DIC 1例)；恶性肿瘤死亡2例(均为淋巴瘤)。结论：感染是移植肾带功死亡的最常见原因，与术后免疫状态低下和手术并发症有关，其中肺部感染最重要，移植后肺间质纤维化可能与感染或某些免疫抑制剂有关；心脑血管意外多发生于老年人，术前术后多有难治性高血压及心功能不全；恶性肿瘤的发生与术后免疫力低下有关。防止肾移植术后带功死亡的关键在于预防，对于引起术后带功死亡原因要早发现、早诊断、早治疗，合理调整免疫抑制剂。     

Immunosuppressive therapy and infection after kidney transplantation

J. Fortun, P. Martin‐Davila, J. Pascual, C. Cervera, A. Moreno, J. Gavalda, J.M. Aguado, P. Pereira, M. Gurguí, J. Carratala, M. Fogueda, M. Montejo, F. Blasco, G. Bou, J. Torre‐Cisneros; RESITRA Transplant Network. Immunosuppressive therapy and infection after kidney transplantation.
Transpl Infect Dis 2010: 12: 397–405. All rights reserved Abstract: Background. The role of immunosuppressive drugs in the development of infection in transplant recipients has been poorly analyzed. Objective. To evaluate the possible association between infection and immunosuppression regimens in a large cohort of renal transplant recipients. Methods. All renal transplant recipients included in the RESITRA prospective cohort from August 2003 to February 2005 with a minimum follow‐up of 3 months were studied. An intention‐to‐treat analysis was performed and patients were analyzed in groups according to the type of induction and initial maintenance therapy. Viral, bacterial, and fungal infections occurring during this period were evaluated. Results. A total of 1398 renal transplant recipients were studied. A maintenance regimen containing sirolimus was independently associated with a lower risk of cytomegalovirus (CMV) infection (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.05–0.54) and with a higher rate of surgical site infection (OR, 3.21; 95% CI, 1.26–8.21). Excluding treatment used for acute rejection episodes, no other factors related to the immunosuppression regimens were associated with the development of bacteremia, urinary infections, pneumonia, or other infections. Conclusion. The use of sirolimus as maintenance therapy in kidney recipients is associated with a low rate of CMV infection and with a higher risk of surgical site infection.     

Rhabdomyolysis associated with cytomegalovirus infection in kidney transplant recipients

Rhabdomyolysis is a pathological syndrome caused by skeletal muscle cell damage that affects the integrity of the cellular membrane and leads to the release of toxic intracellular constituents into the bloodstream. Although cytomegalovirus (CMV) has rarely been reported as a cause of rhabdomyolysis, CMV infection could be considered as a possible cause because of its clinical significance in kidney transplant recipients (KTRs). We report 2 cases of rhabdomyolysis associated with CMV infection in KTRs. A 64‐year‐old woman (Case 1) and a 65‐year‐old man (Case 2), who had each received a kidney from a living unrelated donor, were admitted with complaints of weakness in both legs and myalgia. Laboratory findings revealed highly increased creatine phosphokinase and myoglobinuria. In both cases, no recent alterations of medications had occurred, and other causes of rhabdomyolysis—such as trauma, alcohol, drugs, and electrolyte abnormalities – were excluded. CMV pp65 antigen was positive, and patients were diagnosed with rhabdomyolysis associated with CMV infection. Both patients recovered without complications after ganciclovir treatment. In conclusion, CMV infection should be considered as a possible cause of rhabdomyolysis in KTRs.