艾滋病合并结核病的诊断与治疗

目的 探讨艾滋病合并结核病的临床特点和治疗方法 .方法 对1995～2000年期间在本院诊断的10例艾滋病合并结核病的患者进行分析.结果 (1)临床分型血行播散型肺结核合并结核性脑膜炎3例,淋巴结结核4例(其中肠系膜淋巴结结核1例、纵隔淋巴结结核+颈部淋巴结结核1例、颈部淋巴结结核2例),原发型肺结核3例,同时合并其它机会性感染如卡氏肺孢子虫肺炎(PCP)等.(2)免疫功能检测和结核菌素试验CD+4(2～87)×106/L,其中7例CD+4＜50×106/L,平均CD-4(33±13)×106/L.10例结核菌素(PPD)试验均阴性.(3)治疗5例联合抗结核+高效抗逆转录病毒治疗(HLAART),5例单用抗结核治疗,其中HAART组CD+4细胞上升明显,与单独抗结核治疗相比,差异有显著性(P＜0.05).结论 CD+4细胞下降可能是艾滋病并发结核病的主要原因.结核菌素试验对诊断无帮助.艾滋病合并结核病的患者,血行播散型肺结核多、肺外结核多、合并症多、临床表现复杂多样、治疗时间长.联合高效抗逆转录病毒治疗能缩短病程,改善艾滋病合并结核病的预后.     

31例AIDS病人腹部结核的CT影像学特征

目的探讨艾滋病(AIDS)病人腹部结核的CT表现特征。方法收集2008年4月至2012年3月,重庆市公共卫生医疗救治中心收治的31例AIDS合并腹部结核病人的CT影像及临床资料,分析其CT影像特征。结果 31例AIDS合并腹部结核病人中,表现为腹部多部位结核,以淋巴结结核最常见(26例),其次依次为结核性腹膜炎(22例)、肠结核(10例)、肝脏结核(5例)、脾脏结核及腹壁结核(各2例)。淋巴结结核主要分布于腹腔干及腰3椎体以上腹主动脉周围,96.8%环形强化,其中7例淋巴结肿大融合呈多房状及花环样强化。结核性腹膜炎病人中,4例出现高密度腹腔积液(CT值20HU)。其余部位结核表现无明显特异性。结论艾滋病合并腹部结核常表现为腹部多脏器受累,淋巴结结核病灶范围广泛且易多部位同时发生。     

160例成人HIV/AIDS临床表现与血CD4+细胞相关性分析

目的分析中国成人HIV/AIDS临床症状与周围血CD_4~+细胞数之间的关系。方法对1990年-2001年在本院就诊的160例成人HIV/AIDS CD_4~+、CD_8~+及临床症状进行跟踪分析。结果①共检测CD_4~+、CD_8~+ 516例次:CD_4~+≥200/μl 278例次(53.9％),CD_4~+<200/μl 238例次(46.1％);②在CD_4~+≥200/μl的278例次中,临床症状表现为乏力66例次(23.7％),记忆力下降51例次(18.3％),脱发65例次(23.4％),体征中表现为淋巴结肿大128例(46.3％),出现带状疱疹65例次(23.3％);CD_4~+<200/μl的238例次中,临床症状表现为发热228例次(95.8％),腹泻216例次(90.8％),口腔霉菌感染合并口腔溃疡192例次(80.7％),皮疹67例次(28.2％),体重下降168例次(70.6％)。结论中国成人HIV/AIDS患者在CD_4~+≥200/μl时临床症状较少,主要表现为乏力、脱发、记忆力下降等非特异性症状,体征主要表现为淋巴结肿大;CD_4~+<200/μl时临床症状集中表现为发热、腹泻、口腔霉菌感染合并口腔溃疡、体重下降等。     

人类免疫缺陷病毒感染/艾滋病合并分枝杆菌肺病133例临床分析

目的 探讨人类免疫缺陷病毒(HIV)感染/艾滋病(AIDS)合并分枝杆菌病的临床特点、诊断和治疗方法.方法 对2006年10月～2007年9月住院的HIV,/AIDS合并分枝杆菌病患者的临床资料进行分析.结果 人类免疫缺陷病毒感染/艾滋病合并分枝杆菌肺病以发热和咳嗽为主要表现,结核病约占2/3,非结核分枝杆菌(NTM)病约占1/3,其中肺结核78例,淋巴结结核26例,同时伴有两个部位以上结核者30例.CD 4T淋巴细胞平均值为55×106/L,胸片异常93例,痰抗酸杆菌涂片阳性17例,培养阳性57例,经治疗后总死亡率为9.8%.结论 HIV/.AIDS合并分枝杆菌感染率高,诊断困难.患者免疫功能差,合并症多,经过抗结核、抗病毒等治疗后大部分患者有明显好转.     

人类免疫缺陷病毒合并结核分枝杆菌感染者的抗结核细胞免疫功能

目的 评价HIV合并结核分枝杆菌潜伏感染或合并活动性结核患者的抗结核细胞免疫功能.方法 应用早期分泌性抗原靶蛋白(ESAT)-6和培养滤出蛋白(CFP)-10诱导的结核酶联免疫斑点法对云南地区100例明确诊断的HIV感染者的血液标本进行结核分枝杆菌特异性T淋巴细胞检测,同时应用流式细胞仪检测外周血CD3+CD4+T淋巴细胞和CD3+CD8+T淋巴细胞的绝对计数水平.采用Mann-Whitney检验进行非参数统计分析.结果临床上无活动性结核感染证据的HIV感染者中合并结核分枝杆菌潜伏感染的感染率高达67.6%.HIV合并结核分枝杆菌潜伏感染者的外周血CD3+CD4+T淋巴细胞(532×106/L)和CD3+CD8+T淋巴细胞(473×106/L)绝对计数与单纯HIV感染者(406×106/L和504 × 106/L)相比,差异无统计学意义.HIV合并活动性结核感染者的外周血CD3+CD4+T淋巴细胞绝对计数平均值为189 × 106/L,CD3+CD8+T淋巴细胞绝对计数平均值为293×106/L,均显著低于单纯HIV合并结核潜伏感染组和HIV组(U=168.0,U=163.0;U=147.0,U=374.0;均P<0.01).HIV合并活动性结核感染者的ESAT-6和CFP-10抗原特异性斑点形成细胞数(31/106细胞和82/106细胞)显著低于HIV合并结核分枝杆菌潜伏感染者(92/106细胞和109/106细胞.U=507.0,U=529.5,均P<0.01).结论 我国无活动性结核临床证据的HIV感染人群中有较高的结核潜伏感染率,HIV合并活动性结核感染者的总体细胞免疫应答功能及特异性抗结核免疫应答功能均严重受损.     

急性冠脉综合征病人外周血Th17细胞与CD_4~+CD_(25)~+Foxp3~+Treg细胞水平变化及临床意义

目的观察急性冠脉综合征(ACS)病人外周血辅助性T细胞(Th17细胞)、CD_4~+ CD_(25)~+Foxp3~+Treg调节性T细胞(Treg细胞)水平。方法选择105例冠心病病人,包括稳定型心绞痛(SA,30例)、非ST段抬高型急性冠脉综合征(NSTEACS,45例)、ST段抬高型急性心肌梗死(STEAMI,30例),另选取30例冠状动脉造影正常病人作为对照组。采用流式细胞仪分析4组Th17细胞、CD_4~+ CD_(25)~+Foxp3~+Treg细胞水平,采用ELISA法检测4组转化生长因子-β(TGF-β)、白介素-10(IL-10)、白介素-6(IL-6)水平,并分析Th17细胞、CD_4~+ CD_(25)~+Foxp3~+Treg细胞比例与TGF-β、IL-10、IL-6水平的相关性。结果 STEAMI组和NSTEACS组外周血Th17细胞比例、IL-6水平升高,CD_4~+ CD_(25)~+Foxp3~+Treg细胞比例、TGF-β、IL-10降低(P0.05)。与SA组和对照组比较,STEAMI组和NSTEACS组Th17/CD_4~+ CD_(25)~+Foxp3~+Treg升高,且STEAMI组高于NSTEACS组,NSTEACS组高于SA组(P0.05)。NSTEACS组和STEAMI组Th17细胞比例与TGF-β、IL-10水平呈负相关(P0.05);Gensini评分和C反应蛋白与IL-6呈正相关(P0.05);CD_4~+ CD_(25)~+Foxp3~+Treg细胞比例与TGF-β和IL-10水平呈正相关(P0.05),与IL-6呈负相关(P0.05)。NSTEACS组和STEAMI组Gensini评分、低密度脂蛋白胆固醇(LDL-C)、C-反应蛋白与CD_4~+ CD_(25)~+Foxp3~+Treg细胞比例呈负相关(P0.05),与Th17细胞比例呈正相关(P0.05)。结论 STEAMI和NSTEACS病人血Th17/CD_4~+ CD_(25)~+Foxp3~+Treg比例失衡,Th17、CD_4~+ CD_(25)~+Foxp3~+Treg细胞可能通过影响TGF-β、IL-10、IL-6水平影响ACS的发生发展。     

人类免疫缺陷病毒感染者CD4+T淋巴细胞计数与结核分枝杆菌共感染的相关性

目的 探讨HIV合并结核分枝杆菌感染患者外周血CD4+T淋巴细胞的变化及其对酶联免疫斑点试验(ELISPOT)的影响.方法 应用结核酶联免疫斑点试验(T-SPOT.TB)对云南省和上海地区193例明确诊断的HIV感染者的血标本进行结核分枝杆菌特异性T淋巴细胞检测,同时应用流式细胞仪检测外周血CD4+T淋巴细胞计数,采用t检验进行统计学分析.结果 HIV感染者中潜伏性结核发生率达30.6％.HIV合并活动性结核患者的外周血CD4+T淋巴细胞计数平均值为190×106/L,显著低于HIV合并潜伏性结核组的484×106/L(t=6.665,P＜0.01).根据CD4+T淋巴细胞计数＞500×106/L、200×106～500×106/L、＜200×106/L进行分层分析发现,活动性结核组和潜伏性结核组构成比依次为1∶16.2、1∶1.3、5.6∶1.79例T-SPOT.TB阳性的病例中,共有20例HIV合并活动性结核患者,其中14例患者CD4+T淋巴细胞计数平均值＜200×106/L,5例为200×106/L～500×106/L,1例＞500×106/L.59例潜伏性结核患者中,52例CD4+T淋巴细胞计数＞200×106/L.结论 我国HIV感染人群中有较高的潜伏性结核发生率,HIV合并活动性结核患者的总体细胞免疫应答功能严重受损,随着CD4ˉT淋巴细胞计数的下降,HIV患者合并的潜伏性结核更易进展为活动性结核.当CD4+T淋巴细胞＜200×106/L时,对T-SPOT.TB检测结果可能有影响.     

23例艾滋病合并结核病患者的临床特点

目的探讨艾滋病合并结核病的临床特点、治疗及预后.方法对1997年～2004年7月间我院收治的23例艾滋病合并结核病的患者进行临床分析.结果 23例患者多为青壮年(94.3%),半年内病死11例(47.8%).人类免疫缺陷病毒(HIV)感染途径以性乱史(15例,占65.2%)为主.持续1个月以上的临床表现有发热、体重下降5～15 kg 者23例(100%),咳嗽15例(65.2%).多并发多种机会性感染.23例患者中以单纯肺结核14例(60.9%)及淋巴结结核8例(34.8%)为主;12例浸润型肺结核患者X线表现为病灶多位于双肺,多为较均匀一致的片絮状阴影,无一例出现空洞.蛋白纯化衍生物(PPD)试验弱阳性2例(8.7%),痰涂片、痰培养查抗酸杆菌仅1例阳性(4.4%).23例患者治疗前CD+4明显低于其他未合并结核病的艾滋病患者(P<0.05);而23例中,病死患者治疗前CD+4也较存活患者明显降低(P<0.05).23例患者的HIV RNA定量值明显高于未合并结核病的艾滋病患者(P<0.05).23例患者中,同时采用抗结核及抗HIV病毒药物治疗的患者,病死率较两种药物均未采用或单用抗结核药物治疗的患者明显降低(P<0.05).结论艾滋病合并结核病患者PPD试验阳性率低,肺结核X线表现不典型,淋巴结结核较多见,病死率高;治疗前CD+4明显降低,且与病死率相关;结核分枝杆菌感染可促进HIV病毒的复制;临床应尽可能同时进行抗结核与抗HIV病毒治疗.     

艾滋病合并结核病患者的免疫功能临床研究

目的　了解艾滋病 (AIDS)合并结核病患者的免疫功能受损情况和治疗转归。方法 分析1997年5月—2004年 3月住院的 11例AIDS合并结核病患者的CD4、CD8、HIV-RNA及PPD试验并与同期住院结核病 31例和AIDS 27例相比较。结果 AIDS合并结核病组、AIDS组与结核病组比较则CD4、CD8有显著性差异、CD3无显著性差异,而AIDS合并结核病与AIDS比较CD3、CD4、CD8均无显著性差异。 11例AIDS合并结核病中 6例检测HIV-RNA＞3.0×10⁶ copy/ml,5例HIV-RNA＜3.0×10⁶ copy/ml。而 27例AIDS中 3例HIV-RNA＞3.0×10⁶ copy/ml,24例HIV-RNA＜3.0×10⁶ copy/ml,比较有显著性差异。 结论 AIDS合并结核病者免疫功能严重受损,与结核病比较差异显著,但与AIDS比较则无明显差异。合并结核病者HIV-RNA较未合并者高,说明合并结核病者病毒复制量大,尤其是当AIDS合并血行播散性肺结核者死亡率高,抗结核治疗疗效差。     

M受体拮抗剂对提高慢性阻塞性肺疾病患者调节性T细胞表达的影响

目的 观察COPD稳定期患者体内是否存在CD_8~+CD_(25)~+Foxp_3~+调节性T细胞(Treg细胞),以及M受体拈抗剂噻托溴铵对其表达的影响.方法 2007年10月至2008年3月,选择23例COPD稳定期患者,每日1次吸入噻托溴铵18 μg,连续治疗3个月.分别在治疗前后榆查患者的肺功能和检测外周血中T细胞亚群的数量.两组间均数比较采用配对t检验,相关分析采用直线相关分析.结果 COPD稳定期患者在吸入噻托溴铵治疗后,外周血巾CD_4~+为(36±46)%,CD_8~+CD_(25)~+Treg 细胞为(21±21)%,明显高于治疗前的(28±10)%和(8±8)%;CD_4~+CD_(25)~+为(4±3)%,明显低于治疗前的(10±7)%,差异均有统计学意义(t值为2.72～3.78,P<0.01和P<0.05).CD_8~+、CD_8~+CD_(25)~+和CD_4~+CD_(25)~+Treg细胞均有表达,但治疗前后无明显变化.治疗后肺通气功能得到明显改善,FEV_1、FEV_1占预计值%和FEV_1/FVC分别由(1.0±0.3)L、(35±10)%和(41±8)%提高到(1.1±0.3)L、(40±11)%和(45±11)%,差异均有统计学意义(t值为2.37～2.65,均P相似文献   

Diagnosis of abdominal tuberculosis： Experience from 11 cases and review of the literature

AIM: To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis.METHODS: The records of 11 patients (4 males, 7 females,mean age 39 years, range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed.RESULTS: Ascites was present in all cases. Other common findings were weight loss (81%), weakness (81%), abdominal mass (72%), abdominal pain (72%), abdominal distension (63%), anorexia (45%) and night sweat (36%). The average hemoglobin was 8.2 g/dL and the average ESR was 50 mm/h (range 30-125). Elevated levels of cancer antigen CA-125 were determined in four patients. Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymph nodes (mesenteric, para-aortic) in 2. CT scans showed ascites in all, pelvic mass in 5, retroperitoneal lymphadenopathy in 4, mesenteric stranding in 4, omental stranding in 3,bowel wall thickening in 2 and mesenteric lymphadenopathy in 2. Only one patient had a chest radiograph suggestive of a new TB lesion. Two had a positive family history of pulmonary TB. None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two. Laparotomy was performed in 6 cases, laparoscopy in 4 and ultrasoundguided fine needle aspiration in 2. In those patients subjected to operation, the findings were multiple diffuse involvement of the visceral and parietal peritoneum, white‘miliary nodules‘ or plaques, enlarged lymph nodes, ascites,‘violin string‘ fibrinous strands, and omental thickening.Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes. Both were negative for acid-fast bacilli by staining. PCR of ascitic fluid was positive for Mycobacterium tuberculosis ( M. tuberculosis) in all cases.CONCLUSION: Abdominal TB should be considered in all cases with ascites. Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.     

Abdominal tuberculosis in children. Report of 10 cases

BACKGROUND: Abdominal tuberculosis is a rare location of this infection with a lot of diagnostic difficulties. The aim of this study was to review our experience of pediatric abdominal tuberculosis with that of the literature data. PATIENTS AND METHODS: A retrospective study was conducted over a 7-year period; 10 cases of abdominal tuberculosis in children were reviewed (6 girls and 4 boys, mean age: 11 years, extremes 4-14). Eight patients enrolled in this study satisfied the following criteria: a positive culture for mycobacterium tuberculosis on samples of ascites fluid, sputum, urine, abscess puncture and/or caseating granulomas on histologic examination of biopsies obtained by endoscopy, percutaneous aspiration or needle biopsy or exploratory laparotomy. Two other patients (patients No 1 & 5) had a favorable response within 10 weeks of antituberculous therapy. RESULTS: We observed 8 cases of peritoneal tuberculosis and 2 cases of intestinal tuberculosis. Extra-abdominal tuberculosis was found in 4 of those patients. Two patients had a contact with a tuberculosis positive individual. Nine children had BCG immunization. The main clinical features were abdominal distension (6 cases) and abdominal pain (6 cases). Abdominal ultrasonography visualized mesenteric lymphadenopathies (6 cases), an abdominal mass (5 cases), free (1 case) and localized ascites (1 case). Barium enema and small bowell series showed small bowel stenosis (1 case) and ileal ulcerations (1 case). Exploratory laparotomy, performed in 3 patients, showed whitish granulations and peritoneal abscesses with caseous necrosis on histology. Quadruple therapy with tuberculostatic agents was prescribed in all patients, associating isoniazid, rifampicin, pyrazinamide combined at the start of the treatment with streptomycin (7 cases) and ethambutol (3 cases). Short term outcome was favorable with no deaths. The long term outcome was complicated by persistent ascites (1 case) and the development of portal hypertension (1 case). CONCLUSION: Abdominal tuberculosis remains a rare localization with a lot of diagnostic difficulties.     

浅表淋巴结肿大的151例艾滋病患者淋巴结病理学分析

目的 探讨浅表淋巴结肿大的HIV/AIDS患者的淋巴结病理类型及其特点.方法 取浅表淋巴结肿大的151例HIV/AIDS患者的淋巴结组织进行病理学检查,通过HE、抗酸、过碘酸雪夫和淀粉酶消化后过碘酸雪夫染色,光学显微镜下观察,描述和分析其病理结果及其与CD4+T淋巴细胞计数的关系.数据行卡方检验.结果 在151例HIV/AIDS患者的淋巴结病理结果中,表现为良性病变的有145例,占96.0%,表现为恶性肿瘤的有6例,占4.0%,其中结核病72例,淋巴结反应性增生34例,淋巴真菌感染23例(其中青霉病19例),AIDS相关淋巴结病14例,非霍奇金淋巴瘤5例,良性纤维组织细胞病1例,结核伴发真菌感染1例,间叶性恶性肿瘤1例.在所有患者中,CD4+T淋巴细胞计数<100×106/L的有83例,占55.0%.青霉病随着CD4+T淋巴细胞计数的减少,发病率明显升高(x2=7.757,P=0.021).结论 HIV/AIDS患者浅表淋巴结肿大的原因大多数为感染性疾病,主要为结核病及真菌感染,且多数发生在CD4+T淋巴细胞计数低下的患者,最常见的恶性肿瘤为非霍奇金淋巴瘤.

Abstract：

Objective To investigate the pathological types and features of lymph nodes in human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS)patients with superficial lymphadenectasis.Methods The tissues of lymph nodes were obtained from 151 HIV/AIDS patients with superficial lymphadenectasis for pathological examination.The pathological results were observed by light microscope after Hematoxylin-Eosin(HE),acid-fast,periodic acid-Schiff (PAS),and digested-PAS(D-PAS)staining.The pathological results of lymph nodes were described and the correlation between pathological changes and CD4+T lymphocyte count was analyzed.Chisquare test was used for the statistic analysis.Results The benign lesions were found in 145 patients (96.0%),while the malignant tumors were found in 6 patients(4.0%).The pathological findings in the 151 HIV/AIDS patients included tuberculosis(72 patients),lymph node reactive hyperplasia(34patients),lymphatic fungal infections(23 patients,including penicillium diseases in 19 cases),AIDSrelated lymphadenectasis(14 cases),non-Hodgkin lymphoma(5 cases),benign fibrous histiocytoma (1 case).In addition,there were 83 patients(55.0%)with CD4+T lymphocyte count lower than 100×106/L.The frequency of penicillium diseases was higher in patients with lower CD4+T lymphocyte count(x2=7.757,P=0.021).Conclusions The major reasons for superficial lymphadenectasis in HIV/AIDS patients are infectious diseases,such as tuberculosis and fungal infections,which are common in patients with lower CD4+T lymphocyte counts.Non-Hodgkin lymphoma is the most common malignant tumor in this patient population.     

CD44v6基因变异体在胃癌中的表达及其与淋巴结转移的关系

探讨胃癌中ＣＤ_（４４）ｖ６基因变异体的表达及其与淋巴结转移的关系。方法：采用免疫组织化学技术,对７５例手术切除胃癌标本中的ＣＤ_（４４）ｖ６基因变异表达产物进行检测。结果： ７５例胃癌标本中,５６例ＣＤ_（４４）ｖ６基因变异体呈阳性表达,占７４．７％;而５５例有淋巴结转移的标本中４６例呈阳性表达（８３．６％）,２０例无淋巴结转移的标本中１０例呈阳性表达（５０％）,差异有显著性（Ｐ＜０．００１）;正常胃粘膜不表达ＣＤ_（４４）ｖ６基因变异体。这一结果提示,ＣＤ_（４４）ｖ６基因变异体的表达与胃癌的淋巴结转移关系密切。结论：含ｖ６外显子的ＣＤ_（４４）变异表达产物可作为预测胃癌淋巴结转移潜能较可靠的分子标记物。     

Abdominal lymph node tuberculosis: diagnostic value of echography and x-ray computed tomography

The aspects of abdominal ultrasonography and computed tomography (CT) were studied in 4 patients (3 African and 1 Haitian) with abdominal tuberculosis. All were markedly debilitated and three patients had protracted fever. Tuberculosis was documented in all cases by demonstrating Mycobacterium tuberculosis in cultures of lymph nodes taken during laparotomy and/or cultures of products of gastric aspiration. Ultrasonography showed enlarged lymph nodes in the pancreatic and peripancreatic areas and also in the mesenteric, perivascular and hepatic pedicle areas. CT showed hypertrophied lymph nodes with low tissue density ranging from 20 to 35 Hounsfield units. Although non pathognomonic, these aspects were suggestive of tuberculosis. Intravenous contrast medium administration failed to increase the density in the center of lymph nodes but disclosed the existence of a thick hyperdense rim surrounding the hypodense center of the caseous lymph nodes. Repeated ultrasound and CT examination allowed to control the efficacy of antituberculous chemotherapy.     

Molecular and histopathologic evidence for systemic infection by Mycobacterium bovis in a patient with tuberculous enteritis, peritonitis, and meningitis: a case report

Mycobacterium bovis infection has been reported in several patients with AIDS in other countries. The prevalence of tuberculosis in Taiwan is higher than the World Health Organization standard. However, reports of M. bovis infection are rare. A 47-year-old male had the habit of drinking uncooked fresh deer's blood and unpasteurized deer's milk. He suffered from acute abdominal pain and underwent emergency laparotomy. Pathology demonstrated tuberculosis enteritis with colon perforation. The molecular diagnosis by nested polymerase chain reaction assay and single-strand conformation polymorphism assay showed M. bovis infection in the small intestine, mesenteric lymph nodes, and cerebrospinal fluid (CSF). Our results suggest that the most likely portal of entry of M. bovis is the gastrointestinal rather than the respiratory tract. Ingested M. bovis from unpasteurized deer's milk probably entered the mucosal macrophages of the intestine and then the draining mesenteric lymph nodes. As immunity declined, bacilli from the mesenteric lymph nodes disseminated to other organs and into the CSF.     

AIDS-defining illnesses: a comparison between before and after commencement of highly active antiretroviral therapy (HAART)

Attempts to address the significant impact of HAART on medical variables on the Malaysian HIV/AIDS population have yet to be evaluated. This study aims to analyze the proportions of AIDS-defining illnesses (ADIs) before and after HAART. A retrospective study was carried out on 128 new cases of HIV infected patients who first commenced HAART in 2004 at the national HIV reference center. Before commencement of HAART, 76 clinical episodes of ADIs were recorded in 52 patients. Most common being pulmonary Mycobacterium tuberculosis (28.9%), PCP (27.6%) and disseminated and extrapulmonary Mycobacterium tuberculosis (11.8%). During HAART, 8 clinical episodes of ADIs were documented in 7 patients with a median time of onset of 10 weeks after initiation of HAART (range, 4-36 weeks). The median CD4 count at the time of the commencement of HAART for these patients was 11 cells/mm(3). ADIs reported include PCP (2 episodes), disseminated and extrapulmonary Mycobacterium tuberculosis (2 episodes), extrapulmonary cryptococcosis (1 episode), esophageal candidiasis (1 episode), recurrent pneumonia (1 episode) and disseminated or extrapulmonary histoplasmosis (1 episode). Three (37.5%) of these occurred despite a reduction of viral load by at least 2 log(10) and an increased in the CD4 cell count. In conclusion, ADIs can still present after the initiation of successful HAART especially in those with CD4 counts below 100 cells/mm(3). In Malaysia, ADIs are the major causes of HIV/AIDS associated morbidity and mortality, thus increased awareness on the management of these illnesses is warranted especially in the months following HAART.     

伴胸部受累的淋巴瘤25例临床分析

目的 分析伴胸部受累的淋巴瘤的临床特点与诊断方法,以提高其诊断率.方法 回顾性分析2000-2007年北京大学第三医院确诊的有胸肺病变的淋巴瘤患者25例,收集患者确诊前的症状、体征、实验室检查结果、影像学资料、确诊方法和病理诊断.结果 25例患者中位年龄46岁,发热(13例)、6个月内体重减轻10%以上(11例)、咳嗽(10例)、气短(9例)、浅表淋巴结无痛性肿大(16例)是最常见的临床表现.72.7%的患者ESR增快;81%的患者血清乳酸脱氢酶(LDH)升高.25例患者中纵隔肺门淋巴结肿大者16例;影像学显示肺受累15例,包括斑片或实变表现、团块、多发结节、弥漫磨玻璃影、粟粒样病变;另外胸腔积液10例,心包积液4例,胸壁肿物2例;上述表现中有2种以上同时存在的患者18例.胸膜受累患者的胸腔积液外观呈黄色浑浊、血性或乳糜性,黏蛋白试验均阳性,比重1.031,白细胞6.72×10~9/L,淋巴细胞86%,中性粒细胞14%,蛋白31.4g/L,LDH 296 U/L,腺苷脱氨酶(ADA)67.4 U/L.外科手术活检确诊16例,其中浅表淋巴结活检确诊12例;超声或CT引导穿刺活检确诊5例;骨髓穿刺确诊1例;胸腔镜胸膜活检和纵隔镜纵隔肿物活检确诊各1例;经支气管镜黏膜活检确诊1例,而接受支气管镜气道黏膜活检和(或)经支气管肺活检(TBLB)确诊共8例.病理诊断除1例霍奇金淋巴瘤外,其余24例均为非霍奇金淋巴瘤.结论 伴胸部受累的淋巴瘤患者临床表现缺乏特异性,同时存在浅表或纵隔淋巴结肿大较为多见,血清学检查、胸腔积液性质和影像学检查亦有一定特点.浅表淋巴结手术活检是确诊淋巴瘤简便易行的方法;微创活检方法如超声或CT引导下浅表肿物、胸膜、肺、肝、脾、深部淋巴结活检及胸腔镜和纵隔镜胸膜、肺、纵隔病变活检亦具有较好的诊断价值,而经支气管镜获取气道黏膜和肺组织确诊率低.