小儿颅内真菌感染的药物治疗

目的阐述小儿颅内真菌感染的临床表现、影像学诊断方法以及药物治疗方法，分析药物治疗小儿颅内真菌感染的安全性和可靠性。方法选取2009年2月至2012年6月在威县人民医院进行治疗的60例儿童颅内真菌感染病例，分为对照组和观察纽，观察组予氟康唑、两性霉素B和地塞米松注射液治疗，对照组仅予氟康唑治疗，连续用药3个月后观察两组疗效。结果本文60例小儿颅内真菌感染的致病菌为白色念珠菌、克柔念珠菌、光滑念珠菌、链格孢霉和烟曲菌。氟康唑、5-氟胞嘧啶、伊曲康唑、两性霉素B等药物治疗效果较为明显。结论小儿颅内真菌感染通过联合应厨鞘内注射两性霉素B、氟康唑和地塞米松注射液治疗效果较好，长期使用不良反应不明显，非常适合临床应用。     

老年慢性肺源性心脏病患者痰真菌培养和药敏结果分析

目的探讨老年慢性肺源性心脏病（肺心病）患者真菌感染的菌种分布及耐药现状。方法采用科玛嘉博赛显色平板对真菌进行菌种鉴定,并用ATBFUNGUS试剂盒进行药敏试验。结果从81例肺心病患者痰真菌培养阳性结果显示,以白色念珠菌为主,占61株（75．3％）,光滑念珠菌8株（9．9％）,热带念珠菌5株（6．2％）,克柔念珠菌3株（3．7％）,其他真菌4株（14．8％）。而在体外药敏结果中显示,两性霉素B对所有真菌耐药率仅为2．5％,依他康唑、伏立康唑和氟胞嘧啶的总耐药率分别为11．1%、12．7％及18．5％,而氟康唑的耐药率最高,为28．4％。结论近年来真菌感染有上升趋势,对临床上治疗老年慢性肺心病合并真菌感染,两性霉素B、依他康唑、伏立康唑等抗真菌药物有很好的疗效。     

113例病灶分泌物真菌分布及药物敏感试验结果

目的 分析113例病灶分泌物真菌分布及药物敏感试验结果,更好地为临床提供确切的治疗药物。方法 收集113例真菌感染病灶分泌物标本,对其进行真菌鉴定及药物敏感试验。结果 113例真菌感染病灶分泌物标本中,白色念珠菌75株(66.4%),都柏林念珠菌29株(26.7%),近平滑念珠菌6例(5.3%),克柔念珠菌3例(2.7%)。5-氟胞嘧啶和两性霉素B对白色念珠菌的敏感度较高,分别为94.7%和97.3%;两性霉素B对都柏林念珠菌的敏感率为93.1%;伏立康唑和两性霉素B对近平滑念珠菌的敏感率均为83.3%;5-氟胞嘧啶和两性霉素B对克柔念珠菌的敏感率均为100.0%。结论 加强用药前病灶分泌物的真菌培养和药物敏感试验,合理应用抗菌药物有助于患者的治疗。     

两性霉素B治疗白血病合并真菌感染的护理

我科近3a来应用两性霉素B治疗白血病合并真菌感染25例，护理体会如下。 1临床资料 1．1一般资料 本组男15例，女10例，年龄16-42（平均29）岁。所患疾病中慢性粒细胞性白血病13例，急性淋巴细胞白血病5例，急性髓细胞性白血病4例，急性单核细胞性白血病3例。其中行异基因造血干细胞移植20例。病原菌白色念珠菌12例，近平滑念珠菌5例，热带念珠菌5例，克柔念珠菌2例，毛霉菌1例。     

COPD继发肺部真菌感染的耐药性监测

目的分析我院COPD（慢性阻塞性肺病）患者继发肺部真菌感染的菌种分布及耐药现状。方法选择诊断为COPD患者的痰液标本，连续3次培养，使用CANDIFAST真菌二合-检测试剂做鉴定及药敏。结果300例COPD患者共有132例（44．0）出现了继发性肺部真菌性感染，具有较高的感染率且有逐年上升趋势。菌种分布：白假丝酵母74．2％、热带假丝酵母12．0％、近平滑假丝酵母9．1％、克柔氏假丝酵母3．0％、类星形假丝酵母1．7％。对七种常用药物进行耐药性分析，发现两性霉素B、制霉菌素、5-氟胞嘧啶、酮康唑对试验真菌具有良好的体外活性；益康唑、氟康唑、咪康唑活性较差。结论COPD患者更易继发肺部真菌感染且有逐年增加趋势应引起重视。其中仍以白假丝酵母为主。两性霉素B、制霉菌素、5-氟胞嘧啶等抗真菌药物有很好的疗效。     

慢性肺心病急性加重期并发下呼吸道肺部真菌感染78例临床分析

[目的]探讨慢性肺源性心脏病(肺心病)急性加重期患者下呼吸道肺部真菌感染的发病因素、病原学分布及其临床诊治特点.[方法]对78例慢性肺心病急性加重期并发下呼吸道肺部真菌感染患者的临床资料进行回顾性分析.[结果]老年、住院日的延长、广谱抗生素及激素的不合理应用、营养不良、合并多种慢性疾病是主要危险因素;病原菌感染以白色念珠菌为主(占74.4%); 治疗首选氟康唑,其次两性霉素B.[结论]减少或避免导致下呼吸道肺部真菌感染的各种因素,及时正确诊断并给予积极有效的治疗对改善患者预后十分重要.     

肺隐球菌病3例报告并文献复习

目的 提高对肺隐球菌病的诊断和治疗水平.方法 对3例肺隐球菌病患者的临床资料进行分析,并进行文献复习.结果 3例患者均行经皮肺穿刺活检,组织病理学确诊.1、2例为轻症,第3例为重症.痰培养和支气管镜检查均阴性,血清隐球菌荚膜乳胶凝集实验均阳性,第3例脑脊液压力升高,乳胶凝集实验阳性.1、2例应用氟康唑治疗,第3例应用两性霉素B治疗,均临床治愈.结论 肺隐球菌病临床误诊率高.采用血清隐球菌荚膜乳胶凝集实验和经皮肺穿刺活检相结合的方法,可明显提高诊断率.对于免疫功能正常和轻症患者,首选氟康唑,对于免疫受损和重症患者,首选两性霉素B.     

肺毛霉病临床诊断学特征分析并文献复习

目的通过分析肺毛霉病的临床症状、影像学表现、诊断、治疗和预后,提高对该病的认识。 方法回顾性分析2007年1月至2015年12月收治的6例肺毛霉病患者的临床资料并复习国内外文献。 结果6例均为中老年患者,病程26 d至14个月。1例无基础疾病,1例有肺结核病史,1例有慢性阻塞性肺疾病病史,1例有免疫性血小板减少症,3例有血糖升高,其中1例发病时合并有糖尿病酮症酸中毒。临床症状有咳嗽、咳痰、发热、咯血等。影像学表现：双肺团块、结节影2例,双肺多发斑片状阴影1例,单一团块病灶伴空洞2例,双肺结节伴空洞1例,胸腔积液3例,心包积液2例。6例均通过病原学或组织病理确诊,并应用两性霉素B或两性霉素B脂质体治疗,5例症状好转;1例合并有脑毛霉感染,联合应用泊沙康唑治疗,肺部症状有缓解,最终死亡。 结论肺毛霉病临床及影像学表现缺乏特异性,通过气管镜或肺穿刺进行病原学诊断是该病的有效确诊手段。治疗的关键在于早期诊断、控制基础疾病、及时应用两性霉素B。     

氟康唑雾化吸入治疗老年肺部真菌感染的疗效观察

1　对象和方法1.1　对象　2 0 0 1- 0 1～2 0 0 3- 0 9我院肺部真菌感染6 5例。男4 1例,女2 4例,年龄5 6～94岁,平均6 9.2岁。其中慢性阻塞性肺病2 4例,支气管哮喘11例,肺癌10例,肺结核并糖尿病7例,肺结核并毁损肺5例,肺间质纤维化5例,肺炎3。本组痰培养真菌6 8株,其中白色念珠菌2 6株,热带念珠菌12株,近平滑念珠菌8株,克柔念珠菌7株,酵母样菌5株,毛霉菌3株,曲菌2株。其中2 8例患者同时还分离出其他致病菌30株,分别为铜绿假单胞菌11株,不动杆菌5株,嗜麦芽窄食单胞菌4株,肺炎克雷伯杆菌3株,金黄色葡萄球菌5株。随机分为治疗组和对照组各32例…     

肾移植术后真菌感染诊治探讨

目的：探讨肾移植术后真菌感染的临床防治措施.方法：回顾性分析42例肾移植术后继发肺部真菌感染患者的临床资料.结果：合并真菌感染多与使用多联广谱抗生素及大量激素有关,真菌类型多为白色念珠菌,使用氟康唑与两性霉素B序贯性方法治疗肺部真菌感染安全、可靠.结论：对肾移植术后肺部感染病例,及早进行痰、血真菌培养检查,做到肺部真菌感染早期发现并及时治疗.对诊断为肺部真菌感染合理使用抗真菌药和果断停用免疫抑制剂,尽量减少激素用量是提高肾移植术后肺部真菌感染诊治成功率的关键.     

Clinical experience with amphotericin B in acute myelogenous leukemia

The empirical use of amphotericin B in febrile leukemic patients not responding to antimicrobial agents has previously led to a significant decrease in fatal fungal infections and a significant increase in complete remissions. In this series of 66 patients receiving induction therapy for acute myelogenous leukemia (AML), 49 (74%) received amphotericin B. The median interval between institution of antibiotics and amphotericin B was ten days. Fifteen patients had clinical evidence of fungal infection, but only two (3%) died of fungal infection during induction therapy for AML. We discontinued amphotericin B upon granulocyte recovery (greater than 500/cu mm) unless a pulmonary infiltrate was present. Even though only five of 15 patients with probable fungal infection received more than 1,000 mg of amphotericin B, no patient had recurrent fungal disease while in remission. The incidence of clinically suspected fungal pneumonia during consolidation therapy and reinduction therapy also suggested that our therapy was adequate. An increased incidence of late fungal pneumonia in patients receiving reinduction was associated with prolonged neutropenia (greater than 50 days). This study supports the empirical use of amphotericin B during induction therapy for AML, and suggests that doses can be smaller than those generally recommended for fungal infection.     

Aspergillosis in liver transplant recipients: successful treatment and improved survival using a multistep approach

BACKGROUND: Invasive aspergillosis is a life-threatening complication in liver transplant recipients, with a reported mortality rate of more than 90%. Treatment is difficult, and no single agent is uniformly effective in treating this patient population. METHODS: We retrospectively reviewed all fungal cultures from 200 liver transplant patients between 1996 and 1999 at a single tertiary referral center. RESULTS: A diagnosis of aspergillosis was made in 6 patients. Five patients had pulmonary involvement; 1 presented with an inguinal mass. Time from transplant to infection ranged from 1 week to 34 months. Treatment included surgical intervention and medical treatment. All patients infected with Aspergillus fumigatus were treated with a sequential protocol of lipid complex amphotericin followed by itraconazole. The major side effect of treatment was worsening renal function. One patient died of intracranial hemorrhage during treatment. CONCLUSION: Successful treatment of aspergillosis in liver transplant recipients should include early diagnosis, sequential medical treatment with lipid amphotericin B and itraconazole, and surgical intervention for invasive disease.     

Fungal infection and liposomal amphotericin B (AmBisome) therapy in liver transplantation: a 2 year review.

We reviewed the use of liposomal amphotericin B in 30 patients receiving therapy following liver transplantation over a 2 year period. Five of these patients were treated for presumed invasive aspergillosis: four of them died despite therapy, each having combined renal and respiratory failure at the time of diagnosis of presumed aspergillosis. Post-mortem examination of three of these patients confirmed the diagnosis of aspergillosis. Twenty-five patients were treated empirically; 11 died and supportive evidence for invasive fungal infection following commencement of therapy was found in only one case. Following liver transplantation, the use of liposomal amphotericin B following confirmation of aspergillus infection or for empirical therapy is of uncertain value, and strategies based on selective prophylaxis for high-risk cases may be preferable.     

Cerebral aspergillosis in the critically ill: two cases of successful medical treatment

Objective Invasive aspergillosis is associated with a poor prognosis, especially in critically ill patients with cerebral involvement. We present two cases of cerebral invasive aspergillosis successfully treated in the intensive care unit with combination antifungal therapies and without surgery.Case presentation The first patient was a 49-year-old man with rheumatoid arthritis who received corticosteroid and cyclophosphamide treatment and developed pulmonary and cerebral invasive aspergillosis. After failure of voriconazole the patient had a successful outcome with voriconazole and liposomal amphotericin B therapy. The patient returned home after an 8-month hospital stay. The second patient was a 54-year-old woman with pulmonary neoplasia and corticosteroid treatment who developed pulmonary and cerebral invasive aspergillosis. After failure of voriconazole and liposomal amphotericin B therapy the patient had a favorable outcome with liposomal amphotericin B and caspofungin therapy. The patient died 10 months after initial diagnosis of cardiac tamponade unrelated to fungal infection.Discussions These cases illustrate the improving prognosis of invasive aspergillosis due to the availability of new treatments, especially in cases of cerebral involvement. It also demonstrates that the outcome of critically ill patients requiring mechanical ventilation for invasive aspergillosis can be favorable. The treatment of patients with invasive cerebral aspergillosis in the intensive care setting should be encouraged.     

伏立康唑治疗老年白血病合并侵袭性肺部真菌感染的临床效果

目的探讨伏立康唑治疗老年白血病合并侵袭性肺部真菌感染的临床效果。方法选择2014年3月至2018年12月在我院住院治疗的68例老年白血病合并侵袭性肺部真菌感染患者作为研究对象,按照入院顺序将其分为对照组和观察组,各34例。对照组给予两性霉素B治疗,观察组给予伏立康唑治疗。比较两组临床疗效、不良反应发生情况、血清炎症因子水平及真菌感染清除率。结果观察组治疗总有效率为94.12%,高于对照组的76.47%,差异具有统计学意义(P<0.05)。治疗后,两组TNF-α、IL-12水平均较治疗前降低,IL-10水平较治疗前升高,且观察组优于对照组,差异具有统计学意义(P<0.05)。观察组的不良反应总发生率为11.76%,低于对照组的32.35%,差异具有统计学意义(P<0.05)。观察组真菌感染清除率为82.35%,高于对照组的67.65%,差异具有统计学意义(P<0.05)。结论伏立康唑和两性霉素B治疗老年白血病合并侵袭性肺部真菌感染患者均有效,且均可改善患者的血清炎症因子水平,但伏立康唑治疗效果更佳,使用更为安全。     

Synergistic action of amphotericin B and rifampin against Rhizopus species.

A 16-year-old diabetic patient developed Rhizopus pneumonia and was initially treated with amphotericin B for 7 days. Because of clinical deterioration of the patient, rifampin was added empirically. The patient improved clinically, and lung tissue removed surgically 8 weeks later showed no fungal elements by histopathological studies or by culture. An in vitro study of amphotericin B alone and in combination with rifampin against the isolate from the patient and 11 additional isolates of Rhizopus spp. was designed. The activity of amphotericin B in the presence of rifampin (10 or 5 micrograms/ml) increased fourfold against 9 of 10 clinical and 1 of 2 environmental isolates. Amphotericin B activity in the presence of 2 micrograms of rifampin per ml increased fourfold against 6 of 10 clinical isolates and increased twofold against an additional 3 clinical isolates. Amphotericin B in the presence of 1 microgram of rifampin per ml inhibited 9 of 10 isolates at a concentration of one-half the MIC of amphotericin B alone. These findings were confirmed by dose-response curves calculated from fungal dry weight determinations of Rhizopus spp. incubated in serial dilutions of amphotericin B combined with rifampin. These observations demonstrate in vitro, and possibly in vivo, synergy between amphotericin B and rifampin against Rhizopus spp.     

急诊中对肺血栓栓塞症的诊断及误诊病例分析

目的　探讨急诊肺血栓栓塞症 ( PTE)的鉴别诊断问题 ,以提高 PTE的正确诊断率。方法　对安贞医院心肺血管医疗抢救中心 2 0 0 0年 1月— 2 0 0 3年 8月底收治的 PTE病例进行分析。对将 PTE诊断为肺炎、心脏病、脑供血不足的病例和其他疾病误诊为 PTE的病例进行举例分析。结果　外院将 PTE误诊为细菌性肺炎者 5例 ,心脏病 7例 ,脑供血不足或神经系统疾患 3例。肺或纵隔肿瘤被疑似为 PTE4例 ,细菌性肺炎疑似为 PTE2例 ,支气管扩张症被误诊为 PTE1例。结论　 PTE的鉴别诊断至关重要 ,应引起高度重视 ,特别是急诊一线的医务人员更应掌握 PTE的基本诊断方法 ,减少误诊和漏诊     

Amphotericin B or ketoconazole therapy of fungal infections in neutropenic cancer patients.

Fungal infections in neutropenic cancer patients have increased in frequency and constitute an important cause of morbidity and mortality. Empiric antifungal therapy is often administered to those patients who have failed to respond to antibacterial antibiotics. We conducted a prospective, randomized trial of amphotericin B and ketoconazole for 172 neutropenic cancer patients with presumed or proven fungal infections. Overall, amphotericin B and ketoconazole were equally effective. Amphotericin B may have been more effective than ketoconazole for the treatment of pneumonia. Also, five of eight Candida tropicalis infections treated with amphotericin B responded, whereas all eight infections treated with ketoconazole failed to respond (P = 0.03). Response rates for localized fungal infections were similar with both drugs. Ketoconazole should not be used as empiric antifungal therapy at institutions where there is a high frequency of infections caused by Aspergillus spp. or C. tropicalis because this agent lacks activity in vitro against these species.     

造血干细胞移植后真菌感染的防治

目的 回顾性分析我院造血干细胞移植患者感染并发症的发生及防治情况.方法 分析我院1990年9月至2000年3月收治的150例次各种类型造血干细胞移植病例感染并发症的发生及防治情况,根据移植类型、感染发生与否、预防用药、病原学及感染部位等分组并进行统计学分析.结果 150例次病例感染的发生率为89.3%(134/150),3例患者死于感染,感染病死率为2%(3/150),这3例均为真菌感染.80例预防或治疗中用过泰能或头孢他啶的病例,真菌感染发生率为32.5%(26/80),而未用过泰能或头孢他啶的病例真菌感染的发生率仅为15.7%(11/70),差异有统计学意义(X2=12.0471,P<0.05).12例真菌感染病例采用小剂量两性霉素B(10 mg/d)治疗,治愈率为100%.结论 预防性应用广谱强力的抗生素并不能减少感染发生率,反而可能增加真菌感染的机会;小剂量两性霉素B是治疗真菌感染新的、有效而安全的方法 .     

重庆市艾滋病患者新型隐球菌临床分离株基因分型和临床特点分析

目的 了解重庆市艾滋病患者临床分离新型隐球菌的基因型和药敏谱,分析病例的临床特征,为新型隐球菌感染的诊断和治疗提供依据.方法 收集重庆市公共卫生医疗救治中心感染科2017年3月1日—2018年7月31日送检的艾滋病患者行真菌培养的体液标本,对培养分离出的真菌采用商品化真菌鉴定和抗菌药物MIC试剂盒进行菌种鉴定,对两性霉...