激光共聚焦显微镜诊断棘阿米巴角膜炎

目的 探讨激光共聚焦显微镜(LSCM)在棘阿米巴角膜炎(AK)快速诊断及随访中的价值。方法 回顾分析4例(4眼)AK患者的临床表现、角膜组织刮片镜检及培养、LSCM检查结果。结果 4例患者中,2例裂隙灯检查见角膜混浊、浸润,基质雾状水肿,后弹力层皱褶,角膜溃疡形成;2例表现为典型角膜基质环形浸润。角膜真菌刮片镜检及培养均无阳性病例。LSCM显示,棘阿米巴包囊位于角膜上皮下或浅层基质150μm以内;1例患者角膜内查见多个包囊,余均见1个包囊;包囊形态为圆形至椭圆形高回声结构,双层囊壁,大小为25～150μm,内核形态类圆形。经治疗,2例患者包囊消失、基质炎症减退;2例包囊变小,形态发生改变,双层囊壁结构不清;仅在1例中查见滋养体。结论 AK检查手段较多,传统角膜刮片镜检及培养等方法易受角膜取材等因素影响,阳性率较低。LSCM可用于感染角膜快速无创的活体检查,具有高分辨率、准确深度定位、动态观察、纵向断层扫描等优势,是AK病原学快速诊断及随访的重要手段。     

社区人群感染性角膜炎的认知及健康教育调查

目的 了解社区人群对感染性角膜炎的认知现状,为开展健康教育提供依据。方法 对310名社区居民进行问卷调查,利用χ2检验对数据进行统计学分析。结果 被调查者对感染性角膜炎的知晓率为32.6%,健康教育是影响认知水平的主要因素（P＜0.01）。社区人群最希望通过咨询医生的方式接受健康教育（46.5%）,最希望获取角膜炎预防方面的知识（69.1%）。结论 社区人群对感染性角膜炎的认知水平不高,应开展多种形式的健康教育,以降低感染性角膜炎的发病率。     

角膜共焦显微镜在真菌性角膜炎诊断中的优势

目的 研究角膜共焦显微镜在真菌性角膜炎诊断中的优势。方法 门诊诊断为真菌性角膜炎的患者32例均行病灶角膜组织刮片、真菌培养及角膜共焦显微镜检查,比较结果。结果 32例角膜炎患者,共焦显微镜检查检出率为94.3%;刮片查到菌丝或孢子,检出率为42.8%;真菌培养发现真菌菌落,检出率为54.3%,共焦显微镜检出率明显高于刮片及真菌培养。结论 在真菌性角膜炎的诊断中,角膜共焦显微镜具有操作简便,检查快捷,可在活体直接进行检查,可重复性高,扫描结果可直接同步显示到电脑屏幕,图像清晰,直观、无创等优势,对临床诊治真菌性角膜炎有极大的帮助。     

改良穿透性角膜移植术治疗真菌性角膜炎

真菌性角膜炎是一种常见的感染性角膜病变。因没有特效的药物，许多患者最终需行穿透性角膜移植术（PKP），但术后仍有复发。现将我院多年来治疗此类疾病的经验报告如下。     

穿透性角膜移植术中前房积脓的处理

穿透性角膜移植术是治疗严重感染性角膜疾病的有效方法。大多数患者伴有前房积脓,脓液内常含真菌或（和）细菌。术中如不能将积脓清除干净,则术后极易出现真菌性角膜炎复发。2005年2月至2007年1月,我们应用改良术式处理前房积脓78眼,效果优于传统的术中处理方法,报告如下。     

加速型角膜胶原交联术治疗真菌性角膜炎的临床研究

目的 评价角膜胶原交联术(CXL)治疗真菌性角膜炎的安全性和临床效果。 方法 对2017年1月-2019年12月期间济南市第二人民医院眼表疾病科确诊为“真菌性角膜炎”的患者92例(92眼),进行CXL治疗(观察组);同时回顾性分析2016年1月~2017年2月本院真菌性角膜炎单纯应用药物治疗的患者47例(47眼)的临床资料(对照组)。入组标准:病变深度<角膜厚度2/3;浅层的角膜溃疡,病变未累及的正常角膜厚度>400 μm;病变直径在3~6 mm范围、病变位置均偏离或少量影响瞳孔区;共聚焦显微镜可见真菌菌丝,真菌培养结果为镰刀菌。对两组治疗效果进行对比分析。 结果 观察组在术后2周开始,最佳矫正视力有显著改善,治疗效果优于对照组,差异有统计学意义(P<0.001);术后3个月最佳矫正视力较术前有显著提高,效果优于对照组,差异有统计学意义(P<0.001);观察组治疗2周后所有患眼的病变范围均保持稳定或缩小,术后3个月时,全部患眼病变区域均形成云翳,检查上皮愈合良好;观察组术后2周和术后1个月的真菌检出阳性率明显低于对照组,两组差异有统计学意义(P<0.001);随访期间,观察组所有患者均无真菌性疾病复发,且无并发症出现。 结论 针对范围较小、偏中心的真菌性角膜炎,CXL可以显著缩短病程,提高视力,是一种安全有效的治疗方法。     

我国慢性鼻-鼻窦炎患者的表型特殊性

慢性鼻-鼻窦炎(CRS)或简称慢性鼻窦炎,泛指鼻腔、鼻窦黏膜持续时间在12周以上的非特异性感染性炎症.最近10年来CRS的研究取得了很大的进展,直接导致了治疗策略的改进和临床疗效的提升[1-3].大量的资料证实,鼻黏膜先天免疫的改变、微生物(如细菌、病毒、真菌等)的定植和刺激能够影响适应性免疫、T细胞反应、炎性细胞浸润和组织重塑,可能在CRS的发生、发展中发挥了重要作用[1].但是由于CRS存在高度的异质性,迄今为止引起CRS发病的关键环节(如变态反应、超抗原、骨炎、细菌生物膜等的作用)仍然不很清楚,导致一部分CRS患者在强化的药物和手术治疗后疗效也不够理想,呈现难治性的临床特点[4],成为困扰医生和患者的重要问题.     

真菌性鼻-鼻窦炎病原微生物、病理及分子生物学研究

真菌性鼻-鼻窦炎是临床常见疾病,随着发病率的增高,该病已引起耳鼻咽喉科学者们的高度重视。现就真菌性鼻-鼻窦炎致病真菌病原微生物学、病理学及分子生物学方面的研究进展做一综述。     

儿童急性中耳炎中耳液中的细菌和病毒可促进组织胺的产生

急性中耳炎（AOM）是儿科的常见病之一。早已证实，AOM多由细菌感染引起，并可用抗生素治疗，但无效率及复发率很高，近年研究表明，病毒也是AOM的重要致病因子，可单独或／和细菌一起引起感染，有人认为在AOM中，病毒可干扰抗生素对细菌的作用，但机制不清。几种研究发现，分泌性中耳炎中耳液（MEF）中的组织胺含量增高，这支持了组织胶在分泌性中耳炎发病中的重要作用。然而，AOM患者MEF中组织破的存在与否及病毒性中耳炎中组织胺伪作用不详。对248例儿童AOM患者纷MEF进行了检测，在抗生素治疗前、治疗3～5天、治疗10～30天各…     

角膜基质层注射治疗真菌性角膜炎

目的 观察角膜基质层注射氟康唑注射液治疗真菌性角膜炎的临床效果。方法 将诊断为真菌性角膜炎的70眼随机分为对照组和实验组,每组35眼。对照组：碘酊烧灼角膜溃疡后用重组牛碱性成纤维细胞生长因子眼胶及氟康唑眼膏包眼。实验组：角膜基质层注射氟康唑注射液于角膜溃疡后用重组牛碱性成纤维细胞生长因子眼胶及氟康唑眼膏包眼。观察和对比碘酊烧灼和角膜基质层注射氟康唑注射液治疗真菌性角膜炎的临床可行性。结果 实验组所有溃疡愈合,病程缩短,效果优于对照组(P(<0.05)。两组治疗前后视力平均值差异有统计学意义(P<0.05)。结论 角膜基质层注射氟康唑注射液治疗真菌性角膜炎可以明显提高治愈率,是一种高效、安全的治疗方法。     

Cross-contamination and cross-infection risk of otoscope heads

Adequate disinfection level of the medical equipments should be maintained to prevent cross-contamination between patients. Otoscope specula are usually cleaned and disinfected appropriately after each use by disinfectant solutions. However, since otoscope heads are electrical instruments with irregular inner surface they may still harbor pathogenic microorganisms. According to manufacturers’ instructions, otoscope heads can be cleaned externally with a damp cloth and they can be disinfected with aldehydes, tensides, and alcohols. Instrument heads should not be placed in liquids. Alcohols cannot be used on glass surfaces. How often an otoscope head must be cleaned to limit contamination is not well established. This study aimed to determine whether the otoscope heads harbor pathogenic microorganisms or not. A total of 53 otoscope heads were included in the study. Swab samples were obtained from the inner parts of the otoscope heads. For bacteriological examination, cotton swabs were inoculated onto 5 % sheep blood agar, chocolate agar, and eosine methylene blue agar plates. For fungal evaluation, cotton swabs were inoculated onto Sabouraud dextrose agars. Cultured microorganisms were evaluated macroscopically and microscopically. Of the 53 otoscope heads, 22 were found to be contaminated with bacteria and/or fungi. Eleven of them were colonized by one organism, 11 were colonized by more than one organism. Only one Pseudomonas species isolated as gram-negative microorganism. Gram-positive microorganisms were isolated from the remaining 19 samples. Staphylococcus species were the most common bacteria isolated. The most common fungal isolates were Aspergillus species. Two cultures were positive with Candida albicans. The results show that decontamination of the otoscope heads is usually ignored. However, they can harbor considerable amount of pathogenic microorganisms. The probability of contamination and the risk of cross-infection is high if they are used by otolaryngologists. In order to prevent cross-contamination between patients, guidelines indicating appropriate methods and frequency of cleaning and disinfection of otoscope heads needed to be described.     

耳部炎性疾病的细菌学及药物敏感性分析

目的了解慢性化脓性中耳炎及外耳道炎主要病原菌的分布及药物敏感性,用以指导临床用药。方法取238例慢性化脓性中耳炎及外耳道炎患者外耳道深部或鼓室内脓性分泌物,行细菌及霉菌培养和药物敏感试验。结果分离出病原菌206株,包括金黄色葡萄球菌 （34.95％）、耐甲氧西林凝固酶阴性葡萄球菌（20.38％）、绿脓杆菌（7.28％）、真菌 （18.45％）。药物敏感性因菌种而异。结论慢性化脓性中耳炎及外耳道炎的病原菌以金黄色葡萄球菌为主,耐甲氧西林凝固酶阴性葡萄球菌次之,真菌比例明显增高。不同病原菌对药物的敏感性及耐药性不同,对临床常用抗生素存在耐药性。对耳部炎性疾病应行分泌物培养及药物敏感试验,以便采取针对性治疗。     

免疫组织化学法在鼻窦真菌球诊断中的价值

OBJECTIVE: To study the pathogens of fungus balls in paranasal sinuses and establish an immunohistochemical test by which the main opportunistic fungi could be identified. METHODS: Twenty-five patients with fungal balls were treated by surgical removal of the fungus ball in the infected sinuses. The pathogenic fungi on the specimens were identified by means of routine PAS and immunohistochemical staining methods, and the sensitivity of the two methods were compared. RESULTS: The most commonly infected sinus was the maxillary sinus, followed by sphenoid sinus. Pathogens of fungal balls were found to be aspergillus (92%, 23/25) and candida 2 cases (8%). Aspergillus and candida albicans in infected sinuses could be specifically identified by immunostainning. There was no statistically significant differences of sensitivity between immunostainning and PAS stain. CONCLUSIONS: The main pathogen of the fungus ball was aspergillus. Immunostainning was a rapid and reliable method to identify fungi in infected tissues of paranasal sinuses. It should be widely used in the diagnosis of fungal sinusitis.     

Microbial adherence to and disinfection of laryngoscopes used in office practice

This study reports the appropriate disinfection methods for flexible and rigid laryngoscopes when used in an outpatient setting. This investigation presents evidence that an appreciable number of laryngoscopes are contaminated during use. A brief tap water rinse serves to eliminate gross soil of host origin known to interfere with disinfectant efficacy. Disinfection with 3.2% glutaraldehyde (Cidexplus) for 10 minutes effectively eliminated microbial contaminants. Since potentially harmful microorganisms were included among the more than 100 isolates during our baseline experiments, the need to eliminate bacteria, viruses, fungi, and protozoa from laryngoscopes is obvious and can be attained readily.     

The clinical microbiology of Waldeyer's ring

The role of microorganisms in infections of Waldeyer's ring is reviewed. The agents involved are aerobic and anaerobic bacteria, viruses, chlamydia, fungi, parasites, and rickettsia. The therapeutic implications of the presence of beta-lactamase-producing bacteria are discussed.     

免疫组织化学法在鼻窦真菌球诊断中的价值

目的　研究鼻窦真菌球的主要致病菌种 ,探索组织切片中快速鉴定主要条件致病真菌的组织病理学方法。方法　 2 5例鼻窦真菌球患者接受鼻窦病变清除术 ,对其组织病理标本分别进行了碘酸雪夫染色 (paraaminosalicylic ,PAS)和免疫组织化学染色 ,并比较两种方法的敏感性。 结果鼻窦真菌球以上颌窦发病率最高 ,其次是蝶窦。致病真菌检测 :曲霉菌感染 2 3例 (92 % ) ,白色念珠菌感染2例 (8% )。鼠抗曲霉单克隆抗体、兔抗白色念珠菌多克隆抗体可以分别鉴定组织中的曲霉菌和白色念珠菌。免疫组化和PAS染色的敏感性差异无显著性 (χ2 =0 2 72 ,P >0 0 5 )。结论鼻窦真菌球感染以曲霉菌属多见 ,免疫组化技术具有抗原特异性强、诊断快速的特点 ,为确定鼻窦组织的真菌感染以及鉴定真菌菌属提供了新的可靠方法     

Sampling for indoor fungi: what the clinician needs to know

PURPOSE OF REVIEW: A great deal of concern has arisen recently regarding the potential adverse effects of indoor fungi. Our understanding of this complex problem has been hampered by a lack of standardized protocols for performing an indoor assessment for fungi. Without such standards, it is difficult to compare results from one study with those from another or to measure the effect of indoor fungal contamination on a building and its occupants. RECENT FINDINGS: References were identified that were relevant to indoor fungal sampling, health effects or remediation by searching Pubmed using the keywords 'indoor fungi.' Fungi cause three primary adverse effects: (a) they can damage a building, (b) they can render a building unpleasant to live in by looking and smelling bad, and (c) they might cause adverse health effects in sensitive individuals. Sampling methods used to evaluate indoor environments include air sampling for spores, measurement of allergens in house dust, and determination of microbially generated volatile organic compounds, ergosterols, glucans, and mycotoxins, as well as environmental conditions that lead to fungal contamination. SUMMARY: Prevention of fungal contamination involves removal of moisture sources and humidity and early identification. If fungi are found on indoor surfaces, they can be removed using a dilute bleach/detergent solution that both kills the microorganisms and denatures allergens and toxins. Larger areas require professional remediation.