肺部真菌病诊断及治疗

本文讨论了最常见和重要的肺部真菌病，重点从发病危险因素、临床诊断的方法和标准、抗真菌药物治疗和综合治疗等方面进行介绍。     

强直性脊柱炎的放射学诊断

早期采用放射学方式对强直性脊椎炎进行诊断,需结合病理知识,掌握不同的影像学特征,对本病的治疗和预后具有非常重要的意义。     

肺部感染的病原学诊断方法

院内肺炎（ＮｏｓｏｃｏｍｉａｌＰｎｅｕｍｏｎｉａ）在病原学方面的诊断缺乏可靠的标准（ＧｏｌｄＳｔａｎｄａｒｄ），临床及放射学方面的诊断对治疗的指导很有限，特别是对于气管插管进行机械通气的病人来说，肺部的浸润性阴影可能是由于感染也可能是非感染因素造成的...     

肺部感染病原学定量诊断研究

为建立实用的肺部感染病原学定量诊断方法，采用防污染毛刷（ＰＳＢ）定量采集４２例肺部感染者的肺内分泌物标本，微生物自动检诊系统（ＡＭＳ）快速诊断病原微生物。结果表明，肺部感染者平均每例有１．７±０．３株细菌感染，平均细菌浓度５．１×１０５ＣＦＵ／ｍｌ。提示：用ＰＳＢ定量采集肺内分泌物，ＡＭＳ快速诊断病原微生物可作为临床定量诊断肺部感染病原菌的可靠方法。     

急性中毒者合并肺部感染的早期诊断

各种原因所致的急性中毒患者,常合并呼吸道感染,早期诊断对及时使用抗生素与改善预后非常重要,本文旨在探讨合并呼吸道感染早期诊断的临床价值.     

肺部真菌感染CT诊断

目的:探讨肺部真菌感染的CT表现。方法:回顾性分析20例经病理、真菌培养及随访证实肺部真菌感染患者的CT影像资料。结果:肺部炎性浸润实变17例,病灶分布多个肺叶或肺段,CT表现为斑片状或片状模糊影,密度不均,5例可见空气支气管征;肺部单发结节2例,呈类圆形,直径0.8～1.5 cm,多发结节16例,结节大小不等,边缘轮廓欠光整,肺部肿块6例,直径3～5 cm,形态不规则,密度欠均匀,9例结节及肿块内可见空洞形成,洞壁厚薄不一,外壁清晰,内壁较光滑,2例见"含气新月征"。结论:肺部真菌感染CT表现具有共同特点,CT有助于肺部真菌感染诊断。     

肺部真菌感染CT诊断

目的：探讨肺部真菌感染的CT表现。方法：回顾性分析20例经病理、真菌培养及随访证实肺部真菌感染患者的CT影像资料。结果：肺部炎性浸润实变17例,病灶分布多个肺叶或肺段,CT表现为斑片状或片状模糊影,密度不均,5例可见空气支气管征;肺部单发结节2例,呈类圆形,直径0.8～1.5 cm,多发结节16例,结节大小不等,边缘轮廓欠光整,肺部肿块6例,直径3～5 cm,形态不规则,密度欠均匀,9例结节及肿块内可见空洞形成,洞壁厚薄不一,外壁清晰,内壁较光滑,2例见＂含气新月征＂。结论：肺部真菌感染CT表现具有共同特点,CT有助于肺部真菌感染诊断。     

PCR-based diagnosis of human fungal infections

PCR is a very appealing technology for the detection of human pathogens, but the detection of fungal pathogens is particularly challenging. Fungi have cell walls that impede the efficient lysis of organisms and liberation of DNA, which can lead to false-negative PCR results. Conversely, some human pathogens are also ubiquitous environmental saprophytes that can contaminate PCR reagents and cause false-positive results. We examine the quality of PCR-based studies for fungal diagnostics using 42 variables within the Minimum Information for Publication of Quantitative Real-Time PCR Experiments guidelines. This review focuses on taxon-directed PCR assays for the diagnosis of invasive aspergillosis, candidiasis and Pneumocystis pneumonia. Finally, we evaluate broad-range fungal PCR assays capable of detecting a wide spectrum of human pathogens.     

胸部CR与CT诊断肺结核瘤的对照研究

目的：评价胸部CR与CT在肺结核瘤诊断中的价值.方法：36例均作了胸部CR和CT扫描，其中胸部CR含平片和CR断层；19例作了增强CT扫描.结果：（1）胸部CR显示病灶内钙化3例，空洞5例，胸膜增厚4例，卫星病灶7例.（2）CT平扫病灶内钙化11例，空洞8例，胸膜增厚21例，卫星病灶27例，支气管扩张4例，合并肺门淋巴结肿大者2例.19例CT增强扫描，8例无强化，11例不同程度不同形态强化.（3）病灶内部钙化CT显示11例，CR 3例（χ^2=12.32，P＜0.01）；卫星病灶CT所见27例，CR见7例（χ^2=28.62，P＜0.01）；胸膜增厚CT所见21例，CR见4例（χ^2=28.14，P＜0.01）；病灶周围支气管扩张CT所见4例，CR均未能发现（χ^2=4.42，P＜0.05）.2种影像学检查差异具有统计学意义.结论：CT，特别是增强CT扫描是确诊本病的首选方法.     

G实验和真菌培养联合检测对临床深部真菌感染的诊断价值

目的评估血清1,3-β-D-葡聚糖定量分析(G实验)和真菌培养联合检测对临床深部真菌感染的诊断意义。方法通过回顾性分析75例怀疑深部真菌感染住院患者的G实验和真菌培养结果,分别计算两种方法及联合检测的灵敏度、特异度、阳性和阴性预测值。结果 G实验和真菌培养联合检测的灵敏度、特异度、阳性和阴性预测值分别为88.0%、96.0%、91.7%和94.1%。G实验的灵敏度和阳性预测值高,真菌培养的特异度高。结论G实验和真菌培养联合检测可提高实验的灵敏度,减少假阴性的发生,对早期诊断深部真菌感染有一定临床意义。     

深部真菌感染诊断治疗进展

近20余年来深部真菌感染呈持续增多趋势,1980—1990年,美国医院获得性深部真菌感染率由2‰增加至3.8‰,念珠菌血流感染增加5倍。据欧洲一份报道在教学医院的尸检病例中,真菌感染由1978—1982年的1.6%增加至1988—1992年的4.1%。美国医院感染监测资料(NNIS)显示:1995—2002年期间念珠菌菌血症占医院获得血流感染中的第4位,但病死率居首位。美国疾病预防与控制中心(CDC)于1992—1993年进行的大系列流行病学研究显示,深部真菌感染的年发病率为178.3/百万。其中,念珠菌病年发病率为72.8/百万,隐球菌病为65.5/百万,曲霉病为12.4/百万,球孢子菌病为15.3/百万,组织胞浆菌病为7.1/百万[1]。CDC同期进行的另一项大系列流行病学研究显示念珠菌血症的年发病率为8~10/10万,病死率29%~40%,1岁以下婴幼儿年发病率高达75/10万,65岁以上老年人年发病率达45/10万[2]。深部真菌感染预后差,病死率高,例如侵袭性念珠菌病的病死率为10%~49%,侵袭性曲霉病可高达62%~85%,粒细胞缺乏患者曲霉感染病死率超过90%,镰刀菌属感染病死率更可高达79%~...     

New perspectives in the diagnosis of systemic fungal infections

Profound and prolonged neutropenia following chemotherapy is a major risk factor for systemic fungal infections. Mortality associated with disseminated fungal infection is high, and treatment with conventional amphotericin B is complicated by renal toxicity. Candida and Aspergillus are among the major pathogens in these patients. Many patients remaining neutropenic over a prolonged period of time will receive empirical antifungal therapy. The clinical and laboratory diagnoses of these infections are neither sensitive nor specific and are generally limited in the early detection of invasive fungal infection. However, several new approaches to diagnosis are being developed, which should be translated into routine practice, based on a greater understanding of the pathogenesis of systemic fungal infection and virulence determinants of fungal pathogens. These include antigen detection and polymerase chain reaction. Patients with presumed fungal infection require more intense and accurate monitoring for signs of disseminated infection. Early diagnosis may guide appropriate treatment and prevent mortality. Continued development of commercial tests should help achieve the objective of definitive diagnostic tests for systemic fungal infections.     

侵袭性真菌感染的诊治现状

近20年来侵袭性机会真菌感染显著增多,同时其患病率和病死率也增高,机会感染的主要病原真菌为白念珠菌、新型隐球菌和烟曲霉。但近年来其他机会真菌亦日益重要,如非白念珠菌属、除烟曲霉外的其他曲霉属、毛孢子菌属、红酵母属、接合菌属(根霉、毛霉等)、镰刀霉属、赛多孢菌属以及各种暗色真菌等。一、侵袭性真菌感染的流行病学念珠菌属是机会感染最重要的病原真菌,据报道约占医院感染中血流感染的8%~10%,并且其发生率在持续增加。也是医院ICU、骨髓移植、器官移植病房最常见的病原真菌。据国外统计,侵袭性念珠菌病使病死率增加10%~49%,住…     

重视鼻腔鼻窦真菌感染的病理诊断

真菌性鼻窦炎(FS)是头颈部深部真菌感染性疾病,近年来随着基础疾病的增加其发病率有升高趋势.本文对真菌性鼻窦炎的分类、致病机制、致病真菌类型、临床病理学表现、诊断与鉴剔诊断及治疗与预后加以介绍,旨在提高对真菌性鼻窦炎的认识及病理诊断水平.     

Genitourinary fungal infections

Genitourinary fungal infections have become increasingly common in clinical practice. We review the literature on such infections, emphasizing recognition of fungal disease, predisposing factors, pathogenesis, and approaches to therapy.     

Emerging fungal infections

Trends in Medical Mycology is one of the most attractive international meetings completely dedicated to clinical and fundamental research in the field of medical mycology. It is organized by the European Confederation of Medical Mycology and the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer. Approximately 1500 participants, mainly microbiologists, clinicians and basic researchers, from more than 40 countries exchanged the most important advances in mycology from basic science to clinical research. A quick focus on some relevant clinical presentations is presented here.