艾滋病合并多重机会性感染48例临床研究

目的了解艾滋病合并多重机会性感染的临床情况。方法分析48例艾滋病机会性感染患者的临床资料,总结多重机会性感染的发生率与治疗效果。结果48例患者中,多重感染29例（60．4％）,其中3例感染4种病原体,10例感染3种,16例感染2种。针对不同病原体给予不同的药物治疗,22例患者同时给予高效抗逆转录病毒治疗。39例机会性感染患者治愈或好转;9例患者死亡。均为多重感染。结论艾滋病合并多重机会性感染率较高,高效抗逆转录病毒治疗有重要价值。     

艾滋病合并肺部感染49例临床分析

目的探讨艾滋病合并肺部感染的临床特征。方法回顾性分析49例艾滋病合并肺部感染患者的临床表现及胸部X线表现。结果艾滋病患者易发生多种病原感染,包括革兰阳性杆菌、霉菌、病毒及原虫。卡氏肺孢子虫肺炎是最常见的严重肺部感染之一。结论肺部感染是艾滋病最常见的机遇性感染,是患者就诊、入院和致死的最重要原因之一。其临床表现、对药物治疗的反应及预后均与一般肺部感染有所不同。因此了解艾滋病合并肺部感染的临床特点及影像特征,对艾滋病患者的早诊断、早治疗具有重要的意义。     

误诊为间质性肺疾病的艾滋病合并肺部感染13例分析

目的 对误诊为间质性肺疾病（ILD）的艾滋病（AIDS）合并肺部感染患者临床、影像学及病理学特征进行探讨,以提高对AIDS合并肺部感染的认识.方法 收集我院2005年3月～2010年12月AIDS合并肺部感染患者13例,均具有完整临床资料和肺间质性改变,并复习相关文献.结果 13例患者均为男性,平均年龄50.76岁.HIV感染途径为经输血3例（23.1％）,性传播10例（76.9％）.临床表现为发热8例（61.5％）,进行性加重的呼吸困难9例（69.2％）,咳嗽5例（38.4％）,体重下降7例（53.8％）.有吸烟史9例（69.2％）.最初诊断为非特异性间质性肺炎5例,肺泡蛋白沉积症2例,过敏性肺炎3例,肺组织细胞增生症1例.胸部影像学表现为双侧肺间质纹理改变4例（30.8％）,斑片状磨玻璃影9例（69.2％）.结论 AIDS合并肺部感染临床表现无特异性,临床遇有发热、呼吸困难、低氧血症、体重下降,胸部影像学检查提示间质纹理改变或斑片影等肺间质性改变时,应警惕AIDS合并肺部感染,及时行HIV抗体检查.     

艾滋病患者肺部感染136例临床分析

目的探讨HIV/AIDS合并肺部感染的临床特点。方法回顾性分析我院临床确诊的136例HIV/AIDS肺部感染临床表现,以及免疫功能,影像学表现。结果 HIV/AIDS肺部感染最常见的类型是肺结核,共73例（占53.7%）,其次是PCP33例（占22.8%）和细菌性肺炎23例（占21.3%）。其临床特点、X线和CT表现具有一定的特征。结论肺部感染是艾滋病患者晚期的主要机会性感染。临床表现复杂多样,诊断困难,治疗效果差,预后差。     

11例汉族艾滋病相关性卡波西肉瘤病人的临床特点

目的回顾性分析广州八院收治的汉族艾滋病相关性卡波西肉瘤病人的临床、病理特点及诊治情况,总结其临床特点和诊治经验。方法回顾性分析2007年1月至2013年1月住院诊治的11例汉族艾滋病相关性卡波西肉瘤病人的临床资料。结果 111例卡波西肉瘤病人中男性10例（90.9%）,中位年龄31岁（25～38岁）,治疗前CD＋4T淋巴细胞计数中位数47个/μL（9~497个/μL）;2所有病人均合并有感染,其中72.7%为肺部感染,6例病人存在2种及以上机会性感染;3所有病人均有皮肤损害,其中4例起始于下肢,其他还包括颌下、躯干、腹股沟、足底、鼻梁、手指（各1例）;1例女性病人以阴唇为首发皮损部位;4病理分型以斑点型（4例）和结节性（5例）为主;511例病人中有3例在发现卡波西肉瘤前已启动抗病毒治疗（ART）,经过ART后病人病情均好转;余8例在发现卡波西肉瘤后启动ART,其中6例病人因合并多种机会性感染或播散至内脏（3例）死亡,另外2例经治疗后好转。结论汉族人艾滋病相关性卡波西肉瘤好发于中青年男性,病人基础免疫功能低下,均有不同程度的皮损表现,多数并发机会性感染,病理分型以斑点型和结节性多见,尽早ART有助于改善预后。     

艾滋病合并粟粒性肺结核的临床特点

目的探讨艾滋病合并粟粒性肺结核的临床特点、治疗及转归。方法对临床确诊艾滋病合并粟粒性肺结核8例患者的临床资料进行回顾性分析。结果8例中伴有肺外结核7例，合并多重感染5例，CD4T淋巴细胞均低于12个／μl，出现药物性肝炎5例，死亡4例，失访2例，痊愈2例。随访2例存活者，临床症状、体征均消失，肺部病灶全部吸收1例。结论艾滋病合并栗粒性肺结核具有中毒症状重，病情变化快，合并症多，预后差，病死率高等特点，治疗上更应慎重。     

艾滋病合并结核病40例临床分析

目的提高对艾滋病合并结核病的认识,降低双重感染的发病率及死亡率,提高患者的生存质量。方法对2005～2010年收治的40例艾滋病合并结核病患者进行分析。结果免疫状况：CD4＋T〉350／μl 4例（10％）,CD4＋T200～350／μl 10例（25％）、CD4＋T100～200／μl 16例（40％）,CD4＋T50～100／μl 5例（12．5％）,CD4＋T〈50／μl5例（12．5％）。影像表现：肺结核24例（60％）、结核性胸膜炎15例（37％）、原发综合症1例（3％）。转归：治愈30例（75％）、好转4例（10％）死亡6例（15％）。诊断途径：HIV／AIDS筛查结核检出17例（42.5％）、结核病发病检出HIV／AIDS23例（57．5％）。常合并多种病原菌感染。结论结核病是艾滋病病毒感染者和艾滋病病人最常见的可治愈的机会性感染,也是晚期艾滋病死亡的常见原因、结核病能促进艾滋病病程进展。对可疑结核病人进行艾滋病筛查,对HIV／AIDS患者定期筛查结核,早诊断、早治疗,能有效降低双重感染的发病率和死亡率,提高患者的生存质量。     

AIDS合并肺部感染116例临床分析

目的探讨AIDS合并肺部感染的临床特点。方法回顾性分析我院临床确诊的116例合并肺部感染的AIDS患者的临床表现、实验室资料、影像学表现及治疗预后。结果最常见的是细菌性肺炎(54例,46.6%),其次是肺结核(40例,34.5%)、肺孢子菌肺炎(14例,12.1%)、马尔尼菲青霉菌肺炎(3例,2.6%)、隐球菌肺炎(2例,1.7%)、淋巴细胞间质性肺炎(2例,1.7%)和巨细胞病毒性肺炎(1例,0.9%)。死亡12例(10.3%),另有12例(10.3%)因病情加重自动出院。结论肺部感染是AIDS的主要机会性感染,病原学的复杂性导致诊疗更加困难,影像学检查可能有助于诊断。AIDS患者如发生肺部感染,尤其是合并其他并发症时,预后不良。     

艾滋病合并中枢神经系统疾病的诊疗体会

目的 探讨艾滋病合并中枢神经系统疾病的临床特点.方法 对2004年8月-2012年4月收治9例的艾滋病合并中枢神经系统疾病患者进行回顾性分析.结果 同期收治的132例艾滋病患者中,合并中枢神经系统疾病9例,发病率6.8%,其中合并隐球菌脑膜炎3例(33.3%),弓形虫脑炎2例(22.2%),结核性脑膜炎1例(11.1%),化脓性脑膜炎1例(11.1%),脑梗死1例(11.1%),原因不明的中枢神经系统感染1例(11.1%).7例患者CD4T淋巴细胞＜100个/mm3,2例未测.好转出院5例,自动出院2例,住院期间死亡2例.结论 中枢神经系统病变是艾滋病患者常见的并发症,病情重,病死率高.在临床中应提高警惕,早诊断,及时治疗可以改善艾滋病患者的预后.     

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。     

艾滋病肺部合并症六例分析

目的　提高对艾滋病肺合并症的认识。方法　对１９９２ 年３ 月～１９９７ 年８ 月间诊断的６例艾滋病患者进行分析。结果　并发卡氏肺囊虫性肺炎（ Ｐ Ｃ Ｐ）５ 例（ 其中１ 例为艾滋病首发表现） ,其临床表现为发热（５／５） ,呼吸困难（４／５） 和低氧血症（５／５） ,平均动脉血氧分压为５８ ｍｍ Ｈｇ（１ ｍｍ Ｈｇ ＝０１３３ ｋ Ｐａ ） ,胸部 Ｘ 片显示,两肺弥漫间质或肺泡性浸润。另有支气管真菌感染、肺结核和淋巴结结核各１ 例（ 痰抗酸杆菌阳性、结核菌素试验阴性） 。结论　艾滋病容易发生各种肺合并症,尤以 Ｐ Ｃ Ｐ多见。对既往身体健康的青壮年,如突然发生肺炎和呼吸衰竭应警惕 Ｐ Ｃ Ｐ 发生。对特定情况下发生的肺机会性感染应警惕艾滋病,并及时检查血抗人类免疫缺陷病毒（ Ｈ Ｉ Ｖ） 抗体。     

艾滋病合并重症卡氏肺孢子虫肺炎25例临床病例分析

目的探讨艾滋病(AIDS)合并重症肺孢子虫肺炎(PCP)的临床特点、诊断和治疗。方法分析重庆市公共卫生救治中心收治的25例AIDS合并重症PCP患者的临床资料。结果发热、咳嗽、进行性呼吸困难是最常见的临床症状,CD4+T淋巴细胞数为:2～68个/ul;典型影像表现是肺部磨玻璃影;25例重症PCP患者经过复方磺胺甲基异噁唑联合强的松治疗,如合并其他机会感染予以相应的治疗,14例好转,11例死亡,死亡患者大都同时合并其他病原菌感染。结论 AIDS合并重症PCP患者病情重,常合并多种病原菌及多系统感染,疗效欠佳,故采用合理有效的抗HIV治疗措施以减少其发病。     

Concurrent bacterial lung infection in patients with AIDS, PCP, and respiratory failure.

STUDY OBJECTIVES: To determine and compare the incidence of concurrent bacterial lung infection in intubated and nonintubated patients with the acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP) requiring medical intensive care unit (MICU) admission for support of their respiratory function. DESIGN: Retrospective review of medical records. SETTING: A large university hospital and AIDS treatment center. PATIENTS: All AIDS/PCP patients admitted to the MICU for support of oxygenation and/or ventilation between 1985 and 1989. Survival was defined as discharge from the hospital; nonsurvival was defined as death any time during the hospitalization. Patients with acute spinal cord injury (SCI) were used as controls to determine the incidence of nosocomial pneumonia in ICU patients of similar age without AIDS. MEASUREMENTS AND RESULTS: Twenty-nine AIDS/PCP patients met study criteria; eight (28 percent) were survivors and 21 (72 percent) were nonsurvivors. There was no significant difference in duration of intubation or duration of ICU stay between survivors and nonsurvivors with or without intubation. The incidence of bacterial concurrent lung infection (CLI) in AIDS/PCP patients overall was 7 percent and in intubated AIDS/PCP patients it was 10 percent. There was no statistically significant difference in the incidence of bacterial CLI between the survivors and nonsurvivors or between intubated and nonintubated patients with AIDS/PCP. The incidence of nosocomial pneumonia in SCI overall was 17 percent and in intubated SCI patients it was 30 percent. CONCLUSIONS: The incidence of bacterial lung infections in our retrospective study of AIDS patients with PCP is remarkably less than in the general ICU population with respiratory failure and in our control patients with SCI, although the differences did not attain statistical significance. This finding may be related to antimicrobial therapy directed against P carinii. Endotracheal intubation in patients with AIDS and PCP, who were undergoing appropriate antimicrobial therapy, did not result in a significantly higher incidence of bacterial lung infections than in those who were not intubated. There was no significant difference in the incidence of bacterial lung infections between those AIDS/PCP patients who survived episodes of severe respiratory failure and those who did not. Endotracheal intubation should not be delayed or withheld from this patient population due to concerns of pulmonary bacterial superinfection.     

支气管镜检查对艾滋病患者肺部感染病原学的诊断价值

目的 评价支气管镜检查在艾滋病患者肺部感染病原诊断中的临床应用价值,探讨艾滋病合并肺部感染患者的病原谱及其分布.方法 收集2006年8月至2009年9月就诊于北京地坛医院的120例艾滋病合并肺部感染的患者,均行支气管镜检查及肺泡灌洗,收集BALF送检细菌培养及细胞病理检查;镜下可见明显组织异常者取支气管黏膜活检行病理学检查,并对患者的临床资料进行综合分析.结果 120例艾滋病合并肺部感染患者的BALF中,分枝杆菌抗酸染色阳性者30例,细菌培养阳性25例,肺孢子菌阳性12例,真菌培养阳性5例,巨细胞病毒阳性3例,阴性结果45例.26例行支气管黏膜活检,其中慢性炎性改变12例,鳞癌4例,腺癌2例,符合肉芽肿性炎性改变7例,淋巴瘤1例.结论 气管镜检查对艾滋病患者肺部感染病原学诊断具有明确的诊断价值.目前艾滋病合并肺部感染患者以结核病、细菌感染及肺孢子菌肺炎为主.     

Pulmonary complications in patients with AIDS: a report from a Beijing hospital

OBJECTIVE: The aim of this study was to improve the awareness of pulmonary complications in patients with AIDS. METHODOLOGY: Nine patients with AIDS with pulmonary involvement from March 1992 to March 2000 were analysed. RESULTS: Of the nine cases, there were eight cases complicated with Pneumocystis carinii pneumonia (PCP). The clinical presentation of PCP was fever (8/8), dyspnoea on exertion or at rest (7/8), and hypoxaemia with a mean PaO2 of 58 mmHg. Chest X-ray films showed bilateral diffuse interstitial or alveolar infiltrates. Pulmonary tuberculosis, tuberculous lymphadenitis and bronchial fungal infection were found in three cases. CONCLUSIONS: AIDS patients are at high risk of suffering from pulmonary complications, of which PCP is most common. If young patients who were healthy in the past suddenly suffered from pneumonia and respiratory failure, PCP should be considered. When opportunistic pulmonary infection is diagnosed under special circumstances, one should be alert to the possibility of AIDS and examine serum antihuman immunodeficiency virus (HIV) antibody.     

Cavitary lung disease in AIDS: etiologies and correlation with immune status

To investigate the etiology and differential features of cavitary lung disease in patients with acquired immune deficiency syndrome (AIDS), chest computed tomography (CT) records from a 2-year period were reviewed to identify all human immunodeficiency virus (HIV)-positive patients with cavitary lung disease. Medical records were reviewed for the documentation of specific causes of lung cavitation and the CD4 count at the time of imaging. Of 25 HIV-positive patients with cavitary lung disease, 20 had specific diagnoses. Infection was the etiology in all the cases. Polymicrobial infection was found in 17 patients (85%) and unimicrobial in 3 (15%). Seventeen patients (85%) had bacterial organisms, 10 of whom had other pathogens as well. Mycobacteria were isolated in 8 patients (40%), fungi in 3 (15%), cytomegalovirus (CMV) in 3 (15%), and Pneumocystis carinii pneumonia (PCP) in 1 (5%). Mediastinal or hilar lymphadenopathy and additional noncavitary ill-defined nodular opacities were found more frequently in patients with mycobacterial pathogens. Mean CD4 count in patients with cavitary disease because of bacterial pathogens alone was significantly higher than in patients with nonbacterial pathogens (alone or combined with bacterial pathogens) (203 vs. 42, p < 0.05). Four patients expired during the diagnostic hospital admission; 2 of them had pulmonary cavitary disease associated with Nocardia asteroides. Cavitary lung disease in patients with AIDS undergoing chest CT should be assumed infectious and is generally polymicrobial.     

Bronchoalveolar lavage as the exclusive diagnostic modality for Pneumocystis carinii pneumonia. A prospective study among patients with acquired immunodeficiency syndrome

Pneumocystis carinii pneumonia (PCP) is the most common life-threatening opportunistic infection among patients with the acquired immunodeficiency syndrome (AIDS). Because retrospective studies suggested that bronchoalveolar lavage (BAL) compared favorably to lung biopsy in the diagnosis of PCP, we prospectively evaluated the utility of BAL in 40 consecutive patients with AIDS or risk of AIDS who presented with respiratory complaints. The BAL revealed P carinii in 36 of 42 episodes of pneumonia (86 percent) among 40 patients. Clinical follow-up of the six patients whose BAL was negative for PCP suggested only one possible false negative BAL for PCP. Therefore, BAL detected PCP in 36 of 37 patients for a sensitivity of 97 percent. BAL detected cytomegalovirus in 15 of 38 patients, as well as Mycobacterium avium-intracellulare and Cryptococcus (each in one patient). By virtue of accuracy and lack of morbidity demonstrated in our study, BAL should supplant lung biopsy techniques in the evaluation of AIDS patients with pulmonary symptoms.     

小儿AIDS合并肺部感染的临床和影像学分析

目的 探讨小儿艾滋病(AIDS)合并肺部感染的临床特点和影像表现。方法 收集援博茨瓦纳医疗队临床确证的小儿常见肺部感染67例，对其临床资料和影像表现进行综合分析。结果 小儿AIDS合并肺部感染最常见的类型为淋巴细胞间质性肺炎(LIP，34例)、卡氏肺囊虫肺炎(PCP，15例)、重症肺炎(13例)和肺结核(PTB，5例)，临床表现以咳嗽、发热和气促最为多见。(1)LIP最为常见，病变以慢性间质性变化为主；(2)PCP发病急，进展快，典型影像表现为双肺门周围弥漫磨玻璃样浸润或网织结节状影；(3)重症肺炎常表现为双侧散在斑片状实变，一般经过2周积极治疗可明显吸收好转，但易复发；(4)反复发作的呼吸道感染难以治愈，应考虑小儿AIDS合并PTB的可能，胸片可表现为肺内实变、粟粒结节、空洞、气胸和肺门淋巴结肿大等。结论 小儿AIDS易反复合并肺部机会性感染，临床症状和影像学表现具有一定的特点。提高对小儿AIDS的认识是早期诊断、及时治疗和提高患儿生存率及生活质量的关键。     

Pulmonary pathology in patients with AIDS: an autopsy study from Mumbai

Objective Although India has a high prevalence of HIV/AIDS, the associated pathologies responsible for morbidity have not been evaluated previously in a representative study. Hence, an autopsy study was carried out to analyse the spectrum of pulmonary lesions in patients with HIV/AIDS. Methods A retrospective and prospective autopsy study was carried out during 1988–2000 at Mumbai, India. Lungs from 143 adults, with at least 10 sections from each case, were examined using routine and special stains. Results The risk factors for 97 men (68%) and 38 women (27%) included: heterosexual sex with multiple partners (135 cases, 95%); blood transfusions (three cases; 2%); sex between men (two cases; 1%); and unknown risk factors (three cases, 2%). Pulmonary pathology was observed in 126 (88%) cases. The lesions identified were tuberculosis (85 cases, 59%), bacterial pneumonia (26 cases, 18%), cytomegalovirus (CMV) infection (10 cases, 7%), cryptococcosis (eight cases, 6%), Pneumocystis carinii pneumonia (seven cases, 5%), aspergillosis (four cases, 3%), toxoplasmosis (two cases, 1%), Kaposi's sarcoma (one case, 1%), squamous cell carcinoma (one case, 1%). Two or more infections were observed in 18 (13%) cases. Conclusions Pulmonary diseases and risk factors among patients with AIDS in India differ from those reported in industrialized countries. Tuberculosis was the most frequently observed pulmonary infection, followed by bacterial pneumonia and CMV pneumonitis. In contrast with industrialized countries, PCP remains less common in our patients. The information on opportunistic infections obtained in this study will be useful for managing HIV/AIDS cases at district level hospitals where diagnosing specific HIV‐associated diseases is not always possible.