支气管肺超鞭毛虫感染1例及文献复习

目的提高临床医生对超鞭毛虫致支气管一肺部感染的认识。方法报道1例超鞭毛虫肺部感染临床特点,对本病临床资料进行分析。结果超鞭毛虫近年来在国内有散在发病,以温暖潮湿南方地域多见,北方则尚无报道;呼吸道分泌物涂片见虫体为诊断依据;抗原虫药物治疗有效。结论1超鞭毛虫致呼吸道感染常伴有基础呼吸道疾病,单一抗原虫治疗效果欠佳,应同时加强基础疾病治疗。2对规范化抗菌素治疗效果不佳患者应注意是否存在原虫感染。3应提高检验人员对原虫的识别能力。     

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。     

胺碘酮性肺炎合并超鞭毛虫肺部感染一例及文献复习

目的提高对胺碘酮性肺炎、超鞭毛虫肺部感染及两病合并临床特点的认识。方法结合1例胺碘酮性肺炎合并超鞭毛虫肺部感染患者的临床资料及文献复习，对本病的临床表现、实验室检查、影像学、诊断和治疗进行分析。结果该患者在胺碘酮性肺炎基础上合并超鞭毛虫感染，临床症状为活动后胸闷、气急；实验室检查主要为肺弥散能力下降，支气管肺泡灌洗液中查到泡沫样巨噬细胞和超鞭毛虫；影像表现既有间质性改变又有肺泡渗出；因难以取得病理，诊断主要依赖临床；通过停用胺碘酮及应用抗原虫药物治疗超鞭毛虫感染，患者的临床症状明显缓解。结论胺碘酮性肺炎合并超鞭毛虫肺部感染非常罕见，其原因可能为胺碘酮性肺炎患者局部免疫功能下降，易并发肺部感染。     

肺结核合并超鞭毛虫支气管肺感染1例报道及文献复习

肺结核合并超鞭毛虫支气管肺感染非常罕见,至今国内外文献未见报道。现将我院确诊的1例肺结核合并超鞭毛虫支气管肺感染的临床资料进行分析,结合相关文献讨论,以提高对超鞭毛虫支气管肺感染的认识。1病历资料患者女,32岁,护士。因间断咳嗽、咳痰1年,加重伴低热3个月,于2006-11-     

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.     

超鞭毛虫肺部感染1例

超鞭毛虫属原生物门,鞭毛一动鞭毛纲,超鞭毛门,寄生于蟑螂、白蚁等昆虫体内,引起人类呼吸道感染的报道极少见。现回顾分析福建中医药大学附属厦门第三医院呼吸二科诊治的1例超鞭毛虫肺部感染病例,报告如下。     

超鞭毛虫肺部感染一例

患者 ,男 ,5 6岁 ,退休教师。因“高热、咳嗽 6d”于 2 0 0 3年 6月 18日入院。患者 6d前因受凉出现畏寒、高热( 39℃ ) ,无寒战 ,伴咳嗽、咳白色黏痰 ,血常规 :白细胞 8 8×10 9/L ,中性 0 70 3。X线胸片示右上肺大片状阴影 (图 1a)。头孢曲松钠、环丙沙星静脉点滴 4d ,体温无下降 ,咳嗽加重 ,痰色转黄 ,X线胸片提示病灶较前扩大 ,因而入院。既往有“多发性结肠息肉”史 5年 ,“帕金森病”史半年 ,1年前因“颈椎病”行手术治疗。入院体检 :体温 :38 9℃ ,血压 :135 / 85mmHg( 1mmHg =0 133kPa) ,神志清楚 ,消瘦 ,皮肤无黄染、皮疹及出…     

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.     

支气管冲洗治疗狼疮肺胸膜伴严重肺部感染(附4例报告)

系统性红斑狼疮 (简称 SL E)是由免疫复合物所致的自身免疫性疾病。肺和胸膜因抗原抗体复合物的沉积而常发生病理改变 [1 ] 。一旦确诊需用皮质类固醇和免疫抑制剂药物 ,又因患者免疫功能紊乱 ,极易导致肺部感染。本院自 1988年～ 2 0 0 1年5月共收治的 SL E6 6例 ,其中 4例 SL     

肺海绵状血管瘤二例并文献复习

目的探讨肺海绵状血管瘤(cavernous hemangioma)的临床特点、诊断及治疗方法。方法报告我院2例肺海绵状血管瘤,并结合国内1981年1月至2010年10月近30年间文献报道的41例患者的临床资料进行分析。结果 43例患者中女32例,男11例,发病年龄13～72岁,平均(44.3±15.9)岁。临床表现为咳嗽、咳痰、痰中带血、咯血、胸闷、胸痛以及突发呼吸困难和休克等,也可无临床症状,于体检发现。临床诊断3例患者为血管瘤,其余误诊为肺癌、结核、炎性假瘤、肺囊肿、肺隔离症、何杰金氏病、错构瘤及自发性血气胸等。43例患者均行手术治疗,无手术死亡。结论肺海绵状血管瘤是一种肺部罕见良性肿瘤,临床表现缺乏特异性,术前误诊率高,影像资料有助于诊断,确诊依靠病理诊断,手术切除治疗疗效确切。     

Pacemaker infection due to Aspergillus: report of two cases and literature review

BACKGROUND: Aspergillus infections of pacing systems are extremely uncommon, and most cases reported are characterized by an aggressive behavior that may lead to death of the patient. HYPOTHESIS: The study was undertaken to assess the incidence of pacemaker infection due to Aspergillus in a defined population. METHODS: A retrospective review of the case histories of all patients who underwent pacemaker implantation in the reference center for a defined population over a 13-year period was undertaken. A literature review of pacemaker infections due to Aspergillus was conducted. RESULTS: Of the 1,321 patients who required pacemaker implantation at Hospital Xeral-Calde in the Lugo region of northwestern Spain, 38 suffered a pacemaker infection. A pacemaker pocket infection due to Aspergillus fumigatus was found in two patients. Both patients had a previous history of diabetes mellitus. Cultures from pacemaker pocket inflammatory fluid yielded positive results. Following pacemaker explantation and antifungal therapy, clinical improvement was achieved. A literature review showed another five cases of pacemaker infection due to Aspergillus. However, two peculiarities were found in our patients: In both cases an etiological diagnosis was achieved prior to surgery and, to the best of our knowledge, they also constitute the first cases of pacemaker pocket infection due to Aspergillus. CONCLUSION: Although pacemaker infections due to Aspergillus species are uncommon, they should be considered in immunocompromised patients.     

误诊为肺部感染的肺栓塞2例分析并文献复习

目的 分析误诊肺栓塞患者的临床特点,提高对肺栓塞的认知水平.方法 对误诊为肺部感染的2例肺栓塞病例进行临床回顾性分析及文献复习.结果 2例在外院及本院误诊为肺部感染患者均经计算机断层摄影肺血管造影确诊为肺栓塞.例1大面积肺栓塞,经溶栓、抗凝治疗病情好转出院;例2为深静脉血栓并肺栓塞,经抗凝治疗好转出院.结论 老年心肺疾病患者警惕肺栓塞可能,及时溶栓、抗凝治疗可减少患者病死率.     

巨气管支气管症三例并文献复习

目的 分析3例巨气管支气管症(tracheobronchomegaly,TBM),即莫-昆综合征(Mounier-Kuhn syndrome)患者的临床特征,以提高对该病的认识,从而有利于早期诊断和治疗并发症,改善预后.方法 回顾性分析北京朝阳医院确诊的3例TBM患者的临床特点、影像学和病理特征,并结合文献报道进行总结.结果 3例患者均为男性,年龄分别为58、65和71岁.从出现症状到确诊的时间,分别为2个月、1年和2年.主要症状为反复咳嗽和咳痰,偶有咯血;疾病后期肺功能受损时出现呼吸困难和呼吸衰竭的相应表现.所有患者均通过X线胸片和胸部CT发现显著的气管、支气管扩张确诊.经抗感染治疗病情均能控制.TBM是一种罕见的、先天性疾病,特征性的改变为气管、主支气管的弹力纤维和平滑肌组织萎缩、纤细,导致气管支气管显著扩张,可合并远端支气管扩张.男性好发,发病年龄多为30～40岁.临床表现无特异性,常见症状为反复咳嗽和咳痰,偶有咯血.影像学特征为气管和主支气管扩张.当疾病进一步进展,可出现呼吸困难或呼吸衰竭.治疗主要是预防和控制感染,原发病缺乏有效的治疗手段.结论 早期诊断并及时控制反复发生的支气管肺部感染,可以阻止TBM患者肺功能的下降,对改善预后至关重要.

Abstract：

Objective To analyze the clinical, radiological, and pathological characteristics of tracheobronchomegaly (TBM, Mounier-Kuhn syndrome ).Methods The clinical, radiological and pathological characteristics of 3 cases of TBM were analyzed, and the literatures were reviewed.Results All 3 patients were men, between the age of 58 -71 years old.From the onset to diagnosis, the shortest time was 2 months, and the longest 43 years.The most usual presentations included recurrent cough and sputum,and occasional haemoptysis.In the advanced stage of the disease, patients would present shortness of breath and the symptoms associated with respiratory failure because of the reduction in pulmonary function.All the diagnoses were confirmed by X-ray and CT of the chest finding that the trachea and the main bronchi dilated markedly.After anti-infection treatment, all patients recovered.Mounier-Kuhn syndrome was a rare congenital abnormality characterized by atrophy or absence of elastic fibers and thinning of smooth muscle layer in the trachea and main bronchi.These airways were thus flaccid and markedly dilated on inspiration and collapsed on expiration.The usual presentation was recurrent respiratory tract infections with a broad spectrum of functional impairment ranging from minimal disease with preservation of lung function to severe disease in the form of bronchiectasis, emphysema and pulmonary fibrosis, ultimately culminating in respiratory failure and death.Computed tomography scan of the chest was used for the diagnosis.Treatment was mainly supportive with chest physiotherapy and antibiotics.Conclusions Mounier-Kunh syndrome should be suspected in patient with recurrent respiratory infections and chronic sputum production.A careful analysis of the central airways at the chest radiograph of these patients is required.