共查询到20条相似文献,搜索用时 0 毫秒
1.
OBJECTIVE: The purpose of the present study was to evaluate the impact of HIV infection on the clinical presentation of tuberculosis. METHODOLOGY: We retrospectively studied the impact of HIV infection on the clinical presentation of tuberculosis. A total of 60 consecutive patients co-infected with HIV and tuberculosis were identified. RESULTS: Majority were male (88.3%) and the most common transmission category was heterosexual contact (80%). Most were in the advanced stage of HIV infection; 93% had CD4 cell count less than 200/mm3. Concerning the site of tuberculosis involvement, 37% had pulmonary involvement alone, 13% had extrapulmonary disease involving one single site, 50% had both pulmonary and extrapulmonary involvement. Fifteen (25%) patients also met the criteria of disseminated tuberculosis, who had a significantly lower mean CD4 cell count than those with pulmonary involvement alone (mean 40 vs 102; P = 0.048). Chest radiographs comprised a wide spectrum of manifestations. A considerable proportion had primary pulmonary tuberculosis pattern (38%) and normal radiographs (8.5%). CONCLUSIONS: Our patients generally had advanced HIV infection; 93% of those had CD4 lymphocyte count < 200/mm3. Extrapulmonary involvement and disseminated disease were common. Radiographic manifestations of pulmonary tuberculosis were often 'atypical' due to the greater proportion of primary tuberculosis among our patients. 相似文献
2.
3.
C.-H. Chen J.-D. Lian C.-H. Cheng M.-J. Wu W.-C. Lee K.-H. Shu 《Transplant infectious disease》2006,8(3):148-156
BACKGROUND: Tuberculosis (TB) is one of the major causes of morbidity and mortality worldwide. Post-transplant (post-Tx) TB is a problem in successful long-term outcome of renal transplantation recipients. It is a life-threatening opportunistic infection that is frequently encountered, but the diagnosis is often delayed. With the emergence of newer potent immunosuppressive regimens and an increased incidence of TB in the general population, post-Tx TB among transplant recipients can be anticipated. Our objective was to describe the pattern and risk factors of TB infection, and the prognosis in an endemic area. METHODS: This study was a retrospective review of the records of 756 renal transplant recipients in our hospital during the period from January 1983 to December 2003. The demographic data, transplant characteristics, clinical manifestations, diagnostic criteria, treatment protocol, and long-term outcome of this cohort of patients were analyzed. RESULTS: Thirty-one episodes developed into TB in 29 patients (3.8%) with a mean age of 45.5 (range: 24.2-66.2) years and a mean post-Tx period of 57.9 (range: 1.2-145.2) months. The forms of the diseases were pulmonary in 22/31 (71%), disseminated in 1/31 (3%), miliary in 1/31 (3%), and extrapulmonary in 7/31 (23%). All patients initially received 4-drug combination therapy, and then dosage was adjusted based on clinical condition. Because of drug interaction, a mean 2-fold increase in the dose of calcineurium inhibitor, but no change in steroid, was required. Twenty-two patients (71%) had an elevated creatinine (Cr) level, and 6 (19%) patients did not recover owing to tissue-proof acute rejection (3 cases) and chronic allograft nephropathy (3 cases), respectively, after treatment. The serum Cr level on diagnosis of TB was 1.9+/-0.7 mg/dL; it then deteriorated to 2.4+/-1.5 mg/dL (P=0.134). Hepatotoxicity developed in 11 patients (35.5%) during treatment. Twenty-five patients were successfully treated, 2 patients remain under treatment, and 4 (12.9%) died. Based on univariate analysis, we found the post-Tx TB risk factors were diabetes and more than 3 episodes of rejection, modalities for acute rejection (high-dose steroid and anti-lymphocyte globulin), and maintenance therapy with steroid. CONCLUSION: Post-Tx TB is a serious problem worldwide, and a high index of suspicion is warranted to ensure early diagnosis and prompt initiation of treatment for TB among renal transplant patients. The use of optimal immunosuppressive agents to minimize acute rejection seems reasonable to prevent TB infection in endemic areas like Taiwan. More than 9 months of treatment may be necessary to prevent recurrence. 相似文献
4.
40例耐药肺结核病人,经肺切除或附加胸廓成形术治疗。病变以空洞和肺毁损为主。二药以上耐药率87.5%,对RFP的耐药率80%。半数以上病人合并对侧肺病灶。手术并发率15%,其中脓胸瘘管并发率7.5%。术后痰菌阴转率87.5%,无手术死亡。出院随访35例,34例痰菌复查阴性,20例恢复正常工作。 相似文献
5.
6.
目的探讨肺结核合并支气管结核的外科治疗效果和手术适应症。方法总结1973年1月至2007年底手术切除的205例肺结核合并支气管结核的临床疗效。全组肺结核包括:原发综合征3例、浸润性肺结核19例、空洞性肺结核53例、慢性纤维空洞性肺结核45例、结核瘤或干酪性肺炎48例、结核性支气管狭窄27例、毁损肺10例。按照支气管结核分型,I型30例、Ⅱ型91例、川型50例、IV型34例。结果全肺切除术15例、全肺切除+胸廓成形术(胸改术)32例、肺叶切除术106例、肺叶切除术+胸改29例、支气管袖状成形术14例,其他手术9例。全组临床治愈率93.0%,手术并发症率为11.2%,手术死亡率为0.05%。结论虽然肺结核合并支气管结核是以抗结核药物为主要治疗方法,但目前仍有部分患者需要外科治疗。手术可提高肺结核合并支气管结核的临床治愈率。 相似文献
7.
8.
9.
黄国楼 《实用心脑肺血管病杂志》2009,17(2):106-107
目的了解惠州市结核杆菌茵株的耐药状况,为结核患者的有效治疗提供参考依据。方法运用药物敏感检测和回顾性调查相结合,采用SPSS12.0统计软件分析各因素与结核患者菌株的耐药比例以及耐药顺序。结果惠州市结核菌株的总耐药比例为33.60%;不同性别、不同市以及初治与复治结核患者的耐药比例间差异有统计学意义(P〈0.05);结核患者对四种抗结核药物的耐药以异烟肼和利福平为主。结论惠州市结核患者耐药状况仍然严重,应加强耐药结核的监测和有效治疗。 相似文献
10.
11.
奉贤县10余年来防痨实践阐明了治而不管或管理不善将导致防治工作的"负效应"。只有做好初治菌阳病人的化疗管理,才能提高治愈率、降低慢性传染源发生率,使疫情稳步下降。1980~1989年病人管理复盖率为98%~100%,痰菌阴转率为97%左右,复发率<3%。预测2000年菌阳患病率可能是7.5/10万,菌阳发病率为12.5/10万,年感染率为0.2%,死亡率约0.65/10万。 相似文献
12.
惠州市肺结核患者耐药谱分析 总被引:1,自引:0,他引:1
目的分析惠州市肺结核患者耐药谱,了解其耐药程度及耐药趋势。方法选择本所结核科2009年1月—2014年5月收治的肺结核患者1 810例,其中初治者1 020例(初治组),复治者790例(复治组)。对所有患者的菌株进行11种体外药敏试验,包括:异烟肼(INH,H)、链霉素(SM,S)、利福平(RFP,R)、乙胺丁醇(EMB,E)、卡那霉素(KM)、丁胺卡那(AM)、卷曲霉素(CM)、左氧氟沙星(LOF)、氧氟沙星(OFX)、对氨基水杨酸(PAS)、丙硫异烟胺(TH1321),并分析患者耐药谱。结果 1 810例肺结核患者分离菌株对一线抗结核药物耐药率为50.8%(920/1 020),对二线抗结核药物耐药率为20.3%(367/1 020)。初治组患者耐多药率〔7.2%(73/1 020)〕和7种二线抗结核药物耐药率〔20.2%(206/1 020)〕均低于复治组〔31.1%(246/790)、20.4%(161/790)〕(P0.05)。耐多药肺结核患者的耐药菌株对S、E的初始耐药率和获得耐药率较高,复敏率较低;对AM、CM、PAS、TH1321的初始耐药率和获得耐药率较低、复敏率较高;KM、LOF、OFX有较高的复治耐药率。结论惠州市肺结核患者对一线抗结核药物耐药率较高,需进一步加强对耐药肺结核的防控。复治肺结核患者耐药率仍处于较高水平,对耐药肺结核的临床治疗和管理应给以足够的重视。建议耐多药治疗方案中推广使用AM、CM、PAS、TH1321。实时监测耐多药肺结核患者的耐药谱,获取更新更全面的药敏资料,有助于合理制定个体化治疗方案,减少广泛耐药肺结核的产生。 相似文献
13.
14.
本文介绍了江苏省在全省范围内开展结核病归口管理的实施情况和初步效果,认为要搞好结核病归口管理工作,必须通过行政干预,发布法规文件,协调好预防和医疗部门的互相配合关系,有明确的管理要求和目标考核以及加强专业机构和队伍的自身建设。 相似文献
15.
目的了解四川贫困地区空洞性肺结核的流行状况,为卫生主管部门制定结核病防控政策提供参考。方法采用定基比、环比发展速度及季节指数对四川南充2个国家级县2001-2009年报告的空洞性肺结核病例进行分析。结果 2001-2009年2个国家级贫困县空洞性肺结核报告率在2006年以前呈上升趋势,2006年报告率达到最高,为7.00/10万;2006年后逐年下降,2009年报告率为最低,为1.49/10万;报告的空洞性肺结核病患者中涂阳患者占87.5%,男性多于女性;患者年龄集中在20~60岁;各月份均有发病,6月份发病达到高峰。结论空洞性肺结核病患者中涂阳比例较高,2001-2009年2个贫困地区空洞性结核病防治已取得一定效果,仍需加强涂阳空洞性肺结核的防控。 相似文献
16.
目的探讨老年肺结核的X线特征。方法对300例老年肺结核的X线表现进行分析,包括病变部位、范围、病灶类型、性质、形态等。结果本组X线表现特征主要为病变范围广,以浸润型为主,同时伴有空洞和并发症较多。结论老年肺结核症状及部位均不典型,影像科医生须结合临床、实验室及纤支镜检查,做出正确的诊断。 相似文献
17.
18.
Tuberculosis before hematopoietic stem cell transplantation in patients with hematologic diseases: report of a single‐center experience 下载免费PDF全文
K.‐S. Eom D.‐G. Lee H.‐J. Lee S.‐Y. Cho S.‐M. Choi J.‐K. Choi Y.‐J. Kim S. Lee H.‐J. Kim S.‐G. Cho J.‐W. Lee 《Transplant infectious disease》2015,17(1):73-79
19.
目的了解本地区肺结核常用治疗药物的耐药状况并探讨减少耐药发生的方法。方法对2006年1月~2009年10月期间门诊收治并且资料完整的30例耐药肺结核病例进行回顾性分析。结果痰结核菌培养显示:对一种及多种抗结核药物耐药的病例同时存在;30例患者中,治愈24例;耐药种类越多,疗效越差。结论耐药及耐多药的肺结核病发病率逐渐增高,应引起足够重视。 相似文献
20.
肺结核合并糖尿病80例分析 总被引:1,自引:1,他引:0
目的 探讨两种疾病合并存在的相关规律.方法 对2006~2008年来在市结核病防治所完成规则全疗程的肺结核合并糖尿病患者80例相关临床资料进行分析.结果 肺结核病情严重程度治疗效果控制水平有关.结论 肺结核合并糖尿病患者有病变范围广、痰菌涂阳率、空洞率高,其预后通常较差;通过积极控制血糖水平,早期合理抗结核药物治疗,能提高肺结核治愈率. 相似文献