肾移植术后并发奴卡氏菌感染三例

３例患者肾移植术后并发奴卡氏菌感染。一例发生于移植术后半个月，另一例发生在急性排斥时，还有一例发生在慢性排斥移植肾失功后。３例患者均死亡。经病理解剖评实，１例为肺部奴卡氏菌感染，２例为全身播散性奴卡氏菌感染。认为肾移植术后并发奴卡氏菌感染的病例虽少，但其预后不佳，值得重视。     

艾滋病合并肺星形奴卡菌感染一例

患者女,29岁,待业,确诊艾滋病3年,反复咳嗽、发热1年,加重伴气促10余天,于2011年3月24日入院.患者于2010年11月29日到我院门诊就诊,胸部x线示双肺弥漫浸润影伴左肺下叶空洞形成,诊断为肺结核,按2herz/4hr方案抗结核治疗.患者自觉咳嗽症状稍有好转,于2011年1月26日复查胸片示病灶有吸收,继续抗结核治疗至今.入院后查体:体温37.0℃,脉搏106次/min,呼吸20次/min,血压96/63 mm hg(1 mm hg=0.133 kpa),慢性面容,神清,皮肤巩膜黄染,皮肤干燥,右侧颈部触及一约绿豆大小的肿大淋巴结,边缘清楚,表面光滑,无压痛,活动度好.     

2例皮肤型奴卡氏菌病的护理

奴卡氏菌是一种条件致病菌,广泛存在于自然界土壤中。皮肤型奴卡氏菌病是奴卡氏菌通过破损的皮肤引起的一种真菌病。其病程较长,临床较为罕见。我科于1995～1998年收治了2例,治疗效果满意。护理体会如下。1　病例简介2例患者为农民,女,年龄分别为31、49岁。发病过程和临床...     

腰骶椎奴卡氏菌感染并脓肿一例

患者男性,65岁,农民.于2000年2月无明显诱因下出现左腰臀部肿胀、疼痛、活动受限1天.在当地医院住院治疗,期间未见咳嗽、咳痰、胸部闷痛不适等症状.当地医院未予明确诊断,摄腰椎CT示腰椎间盘突出不明显,腰骶椎未见明显破坏.遂予以抗炎、止痛等对症处理,症状无好转.遂于第5天转我院求治,门诊以腰痛查因收住院.     

盖尔森基兴奴卡菌引起的皮下脓肿及颅内感染一例

患者女,43岁,因＂双下肢水肿近1年,发现右臀部包块10 d＂,拟＂膜性肾病（Ⅱ～Ⅲ期）、肺部感染、软组织包块待查：感染？ 脂肪瘤？＂于2017 年3月24日收治于江苏省人民医院肾脏内科. 患者1年前无明显诱因出现双下肢水肿、泡沫尿,至我院就诊,肾活检病理示：膜性肾病（Ⅱ～Ⅲ期）,诊断为肾病综合征. 予泼尼松30 mg 1 次/d、环孢素50 mg 1次/12 h等治疗,水肿好转出院. 患者2月前出现肺部感染,至上海华东医院,诊断真菌感染可能,停用环孢素,使用伏立康唑抗感染至今,肺部感染好转. 10 d前,患者发现右臀部蚕豆大小包块,并迅速增大至鸡蛋大小,有压痛,表面无红肿,右小腿也出现类似包块,遂至我科治疗. 患者既往有1 年2型糖尿病史,目前使用诺和灵30R 早16 U、晚6 U,血糖控制尚可;5 年高血压病史,服用厄贝沙坦片150 mg 1次/d控制;否认药物、食物过敏史;无传染病及遗传病史.     

HIV患者合并星形奴卡菌肺炎的实验室诊断研究

星形奴卡菌为革兰阳性需氧菌,常具有抗酸性。星形奴卡菌引起的呼吸系统感染,主要是吸入星形奴卡菌而引起。星形奴卡菌易引起免疫功能低下、慢性消耗性疾病以及使用肾上腺皮质激素的患者感染。由于奴卡菌生长缓慢,十分容易漏诊,因此在涂片染色时要注意观察,涂片镜检对于奴卡菌的最终检出十分重要。     

一例布鲁菌病的病原学诊断

布鲁菌病是由布鲁菌属细菌所致的人畜共患变态反应性传染病,多见于内蒙古、东北和西北等牧区[1]。本院收治布鲁菌病患者1例,回顾该病例实验室诊断过程,总结该菌的微生物学及流行病学特点,以提醒本地区微生物实验室人员在布鲁菌病诊断时提高警惕,为临床提供及时、准确的病原微生物学鉴定,指导临床合理用药治疗。     

乌司奴单抗治疗克罗恩病肛瘘的研究进展

<正>克罗恩病肛瘘(perianal Crohn’s disease pCD)的发病机制，目前尚无统一定论，有限的研究证据表明，克罗恩病相关肛周瘘管的发生、发展和维持涉及宿主、微生物和环境因素之间复杂的相互作用^[1]。同时，其治疗相当复杂，抗肿瘤坏死因子(tumor necrosis factor TNF)-α治疗在促进症状缓解和黏膜修复方面已被证明有效^[2]。然而，约1/3的克罗恩病患者最初对抗TNF-α单抗没有反应，或随着时间推移，     

布氏菌病并发呼吸系统感染患者的护理

目的探讨布氏菌病并发呼吸系统感染患者的护理方法。方法对24例布氏菌病并发呼吸系统感染患者密切观察病情,做好呼吸道感染、疼痛的对症护理,积极防治并发症,观察药物疗效。结果 22例好转出院,2例患者放弃治疗,自动出院,住院时间为3~23d,平均9.8d。结论密切观察患者病情变化,注意有无并发症的出现,并及时采取相应的治疗和护理措施,可有效减少布氏菌病并发症的发生,提高治愈率。     

脑脓肿的MRI表现与临床病理对照研究

目的探讨脑脓肿的MRI影像学特征。方法对46例经病理证实的脑脓肿的MRI影像学表现进行回顾性分析,并与病理结果进行对照研究。结果46例脑脓肿单发36例(占78.2%),类圆形36例(占78.2%)。增强扫描后全部病灶均有明显的环形强化,内侧缘光整占84.6%。外侧缘光整占73.1%,厚度均匀占80.7%。一环形强化病变中30例环内部出现液液平面征,3例出现壁结节,23例出现子环征,未出现分房征,34例出现T2WI低信号环征,环形强化病变周围出现Ⅱ度水肿有28例。临床征象20例有感染中毒症状。结论环形强化、T2WI低信号环征或分层低信号环、环内液液平面征、子环征是脑脓肿的特有征象。环内外侧缘光整、环壁厚度均匀、无壁结节及临床上有感染病史有助于脑脓肿的诊断。     

Successful liver transplantation for congenital absence of the portal vein complicated by intrapulmonary shunt and brain abscess

A 27-day-old boy had convulsion associated with brain abscesses and severe hypoxemia at the age of 3 months. Congenital absence of the portal vein (CAPV) and some associated anomalies were detected by radiological examinations. Brain abscess and hypoxemia were thought to be serious complications resulting from CAPV and were successfully corrected by living donor liver transplantation at the age of 4 months. This is the first report of a successful transplantation indicated for intrapulmonary shunt and brain abscess in an infant with CAPV.     

Primary <Emphasis Type="Italic">Nocardia farcinica</Emphasis> brain abscess with secondary meningitis and ventriculitis in an immunocompetent patient,successfully treated with moxifloxacin

Summary We report a rare case of Nocardia farcinica occipital brain abscess in an immunocompetent patient with no underlying risk factors successfully treated with the antibiotic moxifloxacin. The patient underwent craniotomy and abscess drainage. Initial post-operative treatment with co-trimoxazole produced a limited response. Despite the development of skull base meningitis and ventriculitis subsequent addition of moxifloxacin produced an excellent outcome. Correspondence: Dr. R. P. D. Cooke, FRCPath, Department of Clinical Microbiology, University Hospital Aintree, Lower Lane, Fazakerley, Liverpool L9 7AL, UK.     

腹腔镜治疗盆腔脓肿32例临床分析

目的:探讨腹腔镜手术治疗盆腔脓肿的临床效果及可行性。方法:回顾分析32例因盆腔脓肿行腹腔镜手术患者的临床资料。手术范围根据病变范围、患者年龄、一般状况等全面考虑。输卵管积脓、卵巢积脓患者,以切除病灶为主;年龄较大、双侧附件受累或附件脓肿反复发作的患者,可行全子宫及双附件切除术。结果:术后3 d患者体温均恢复正常,临床症状迅速消失。术后24～36 h恢复排气,3～5 d复查白细胞恢复正常。无一例术后感染及复发,术后7 d治愈出院。结论:腹腔镜手术更精确、彻底、微创,患者痛苦小,术后康复快,住院时间短,更利于保护生育功能,患者易接受,具有良好的临床效果及可行性,值得推广应用。     

Microwave ablation of liver metastasis complicated by Clostridium perfringens gas-forming pyogenic liver abscess (GPLA) in a patient with past gastrectomy

IntroductionGas-forming pyogenic liver abscess (GPLA) caused by C. perfringens is rare but fatal. Patients with past gastrectomy may be prone to such infection post-ablation.Presentation of caseAn 84-year-old male patient with past gastrectomy had MW ablation of his liver tumors complicated by GPLA. Computerised tomography scan showed gas-containing abscess in the liver and he was managed successfully with antibiotic and percutaneous drainage of the abscess.DiscussionC. perfringens GPLA secondary to MW ablation in a patient with previous gastrectomy has not been reported in the literature. Gastrectomy may predispose to such infection. Even in high-risk patients, empirical antibiotic before ablation is not a standard of practice. Therefore following the procedure, close observation of patients’ conditions is necessary to allow early diagnosis and intervention that will prevent progression of infection.ConclusionPotential complication of liver abscess following MW ablation can never be overlooked. The risk may be enhanced in patients with previous gastrectomy. Early diagnosis and management may minimise mortality and morbidity.     

A clinical and magnetic resonance spectroscopy study of a brain tumor in a patient with segmental neurofibromatosis

Introduction

Segmental neurofibromatosis 1 (segmental NF-1) is a rare genodermatosis caused by somatic mutations in the NF-1 gene. It consists of localized characteristic skin lesions. A serial study using magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) of a brain tumor in a 16-year-old patient with segmental NF-1 is reported.

Case report

A 16-year-old boy with congenital dorsal scoliosis and segmental NF-1 was evaluated for bilateral optic atrophy. Neurological examination showed an isolated tetra pyramidal syndrome. The cerebral MRI showed a bilateral brain lesion involving the basal ganglia, optic pathways, temporal lobes, and the midbrain. Serial MRSs showed a decreased N-acetylaspartate (NAA)/creatine ratio and increased choline/creatine ratio. An increase in the myoinositol (MYO)/creatine ratio and the presence of a lipid/lactate peak were also recorded. A neuroimaging follow-up with MRI and MRS performed 2 years later showed similar findings.

Comments and conclusion

We describe an MRS study of a brain tumor in a patient with segmental NF-1 for the first time. The MRS study showed similar findings, described earlier in rare studies of patients with the classic form of NF-1. MRS is a noninvasive technique for detecting the presence of tumor tissue in the brain through its metabolic activity. MRS plays an important role in clinical studies and it can be used to differentiate malignant and nonmalignant brain lesions from normal brain tissue.     

Diagnostic dilemma of sacral abscess presented with seizure and altered conscious level in a patient with spinal cord injury

Context: Infection and septicaemia may clinically presented with seizure and altered conscious level. In spinal cord injury (SCI) population, they are at risk of having pressure ulcer which can be complicated further with infection and septicaemia.

Findings: A 40-year-old man with complete T4 SCI and multiple clean and non-healing pressure ulcers at sacral and bilateral ischial tuberosity regions was initially admitted for negative pressure wound therapy (NPWT) dressing. He had an episode of seizure and subsequently had fluctuating altered conscious level before the diagnosis of deep-seated sacral abscess was made and managed. Prior investigations to rule out common possible sources of infections and management did not resolve the fluctuating event of altered consciousness.

Clinical relevance: We presented an unusual case presentation of septicemia in a patient with SCI with underlying chronic non-healing pressure ulcer. He presented with seizure and fluctuating altered conscious level. Even though a chronic non-healing ulcer appeared clinically clean, a high index of suspicion for deep seated abscess is warranted as one of the possible sources of infection, especially when treatment for other common sources of infections fails to result in clinical improvement.     

左氧氟沙星联合利福平治疗哺乳期乳腺脓肿MRSA感染的临床分析及研究

目的 总结利福平加左氧氟沙星治疗乳腺脓肿社区耐甲氧西林金黄色葡萄球菌（MRSA）感染的有效性、安全性及其机理研究。方法 收集2010年1月~2018年12月乳腺脓肿MRSA感染病例共86例,分为左氧氟沙星+利福平（左利组）、万古霉素（万古组）抗感染治疗组, 观察各组的治愈率、MRSA清除率、治疗时间、抗菌药物治疗费用及抗菌药物的不良反应;分别制作浓度梯度变化的左氧氟沙星、利福平及上述两药联合的琼脂M-H平皿,接种MRSA细菌后分别测定其最低抑菌浓度（MIC）、防耐药突变浓度（MPC）以及耐药突变选择窗（MSW）。结果 左利组和万古组治愈率分别93%、97%,无统计学差异（P>0.05）;MRSA清除率均为100%;治疗时间分别8.8、9.1天,无统计学差异（P>0.05）;抗菌素费用分别700元、2000元,有统计学差异（P<0.05）;左利组药物不良反应发生率11.4%,万古组12.2%,无统计学差异（P>0.05）。体外细菌实验表明左氧氟沙星和利福平联合应用,可以缩小各自对MRSA的MIC及MPV,缩窄MSW,其中利福平较为明显。结论 对于社区感染的乳腺脓肿MRSA感染患者,利福平联合左氧氟沙星治疗治愈率高、费用低、副作用少,可作为是临床医师重要选择之一;同时联合用药后降低其对MRSA的MPV,缩窄MSW是其抗菌的重要机理之一。