艾滋病合并肺结核患者临床分析

目的 提高对人类免疫缺陷病毒感染/艾滋病（HIV/AIDS）合并肺结核的认识。方法 分析了12例AIDS合并肺结核患者有关资料。结果 12例AIDS合并肺结核者X线胸片显示病灶超过4个肺野9例。出现空洞6例，痰抗酸菌涂片阳性3例，9个月短化方案（2HRZE/7HR）治疗肺结核。5例完全疗程，停药观察1-2年半，病灶稳定，生活质量良好，死亡4例。结论 肺结核合并HIV/AIDS时胸片病灶广泛，痰抗酸菌涂片阳性率较低，9个月短化方案抗结核治疗有效。     

10例艾滋病合并马尔尼菲青霉病的临床病理特征

目的 分析艾滋病(AIDS)合并马尔尼菲青霉病(Penicilliosis marneffei,PSM)患者的临床资料及病理组织学特点,探讨PSM的诊断及鉴别诊断.方法 对10例淋巴结活检标本进行HE及PAS染色,观察马尔尼菲青霉菌(Penicillium marneffei,PM)在组织中的形态特点,并结合相关文献进行讨论.结果 HE染色:淋巴结内淋巴细胞显著减少,组织细胞增生,并见大量类圆形病原体;PAS染色:少数为腊肠状病原体,偶见横隔.结论 HIV主要破坏CD4 淋巴细胞,导致机体免疫功能下降而感染PM.因此,临床上有发热、淋巴结肿大、CD4 淋巴细胞﹤50/μl的患者,要考虑AIDS合并PSM的可能;组织病理学检查,PM具有较典型的形态结构.     

艾滋病合并皮肤马尔尼菲青霉感染4例

目的探讨艾滋病（AIDS）合并皮肤马尔尼菲青霉感染的临床及实验室特征。方法分析2005年1月至2006年6月本院收治的明确诊断为AIDS合并皮肤马尔尼菲青霉感染的4例患者临床特征；取皮损、血和骨髓分别在25℃和37℃进行真菌培养。观察菌落形态、显微镜下特征；对皮肤活检组织行HE及六胺银染色。观察镜下皮损组织学及马尔尼菲青霉的特征。结果AIDS合并皮肤马尔尼菲青霉感染伴多系统损害。皮损特征：早期表现为淡红色丘疱疹、糜烂性丘疹，继而为坏死性丘疹、传染性软疣样丘疹、皮肤溃疡及血痂。37℃培养呈酵母相，25℃呈菌丝相。皮肤病理活检六胺银染色（＋）。使用二性霉素B、伊曲康唑治疗。3例临床症状缓解、皮疹消退出院。1例死亡。结论AIDS合并皮肤马尔尼菲青霉感染皮损特征：坏死性丘疹、传染性软疣样丘疹。皮损25℃、37℃真菌培养结合皮肤病理活检是确诊的关键。二性霉素B、伊曲康唑是目前治疗AIDS合并皮肤马尔尼菲青霉感染的首选药物。     

艾滋病的病理学检查及自我防护

艾滋病即获得性免疫缺陷综合征（ＡＩＤＳ），是一种严重危害人类健康的疾病。全世界已有３３４０万例人类免疫缺陷病毒（ＨＩＶ）感染者〔１〕。我国于１９８５年发现首例艾滋病患者，截至１９９８年年底，全国３１个省市都发现ＨＩＶ感染者，累计达１２６３９例，包括ＡＩＤＳ４１７例，估计实际感染者达４０万人，增长速度很快〔２〕。艾滋病的潜伏期一般为７～１０年。早年发生的ＨＩＶ感染者。近年将陆续进入发病期。对于临床和病理医师来说，艾滋病的诊断和治疗已经或正在成为不可回避的现实问题。病理学检查是艾滋病诊断和研究必不可…     

艾滋病合并马尔尼菲青霉病2例诊断分析

目的 提高艾滋病合并马尔尼菲青霉病的诊断率。方法 分析2例明确诊断为艾滋病合并马尔尼菲青霉病病例的临床及病理资料并复习相关文献。结果 艾滋病合并马尔尼菲青霉病以“发热、淋巴结肿大、肺部阴影”为主要临床表现;淋巴结病变主要为“淋巴细胞显著减少,淋巴结内组织细胞增生并见大量类圆形病原体,少数为腊肠状病原体,偶见横膈,胞质嗜酸性,核弱碱性。结论 HIV主要破坏CD4阳性T细胞,导致机体免疫功能下降而感染马尔尼菲青霉菌;马尔尼菲青霉病又成为艾滋病的表征之一。因此,有发热、咳嗽、淋巴结肿大、淋巴细胞数减少、双肺部阴影的患者要考虑艾滋病合并马尔尼菲青霉病感染的可能。     

2006年顺德区艾滋病防制工作回顾

目的了解佛山市顺德区HIV流行情况，评价已采取的预防控制措施，为今后开展防治工作提供策略和依据。方法对2006年顺德区哨点和常规HIV监测资料进行综合分析。结果2006年顺德区共发现HIV感染者84例，感染人数有逐年上升趋势。HIV感染者主要以青壮年男性和外省籍人员居多。主要传播途径为经血传播，静脉注射吸毒传播31例（占36．90％）；性接触传播29例（占34．52％），其中异性性接触传播25例（占29．76％），同性性接触传播4例（占4．76％）。结论顺德区目前正处于艾滋病流行初期，建议加大综合防治措施，认真落实“四免一关怀”政策，才能控制疾病的传播和蔓延。     

成人原发型肺结核的X线胸片表现探讨

目的：对成人原发型肺结核的X线胸片表现进行探讨。方法选取从2011年5月~2014年5月诊治的36例原发型肺结核患者,分析其X线胸片表现。结果本组患者中,4例为原发综合征肺结核,X线以边界模糊云絮状影为主要表现。胸内淋巴结结核8例,在初诊时X线表现为椭圆形或者是圆形结节状影,纵隔同内缘相连接,外缘呈现为分叶状或者是半圆形突出,边界较为清晰。7例采取胸部CT平扫,在左上肺可以发现胸膜粘连与纤维条索影。结论通过对胸部X线表现与肺结核临床表现可以看出,不同类型肺结核的X线表现有其一定的独特性。部分肺结核患者临床X线表现处于正常水平,因此大多数肺结核诊断主要是参照X线表现与临床表现进行确诊。在不同时间要注意动态观察,这对于鉴别诊断有着重要的作用。     

艾滋病疑病症患者心理卫生状况分析

目的:探讨艾滋病疑病症患者的心理状卫生状况。方法:①详细记录72例患者个人资料及对艾滋病的了解情况;②选用90项症状清单(SCL-90)对艾滋病疑病症患者进行测试;③以心理咨询、心理治疗为主,药物治疗为辅的原则进行治疗,观察治疗前后症状的变化。结果:艾滋病疑病症患者以中学以上学历为主(占94.4%),本人、性伴侣有高危性行为70例(97.2%),艾滋病知识主要通过网络信息获得39例(54.2%);临床表现复杂,以疑艾滋病、有艾滋病相似症状为主诉;躯体化、强迫症状、人际敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性等因子均明显高于常模,治疗后38例(52.8%)患者症状完全缓解,恢复正常工作。结论:艾滋病疑病症患者心理健康状况明显异常,积极的心理干预是防治的有效手段。     

艾滋病合并肺结核患者临床分析

目的提高对人类免疫缺陷病毒感染/艾滋病（HIV/AIDS）合并肺结核的认识.方法分析了12例AIDS合并肺结核患者有关资料.结果 12例AIDS合并肺结核者X线胸片显示病灶超过4个肺野9例,出现空洞6例,痰抗酸菌涂片阳性3例,9个月短化方案（2HRZE/7HR）治疗肺结核,5例完成疗程,停药观察1～2年半,病灶稳定,生活质量良好.死亡4例.结论肺结核合并HIV/AIDS时胸片病灶广泛,痰抗酸菌涂片阳性率较低,9个月短化方案抗结核治疗有效.     

广东和云南部分地区艾滋病患者中隐孢子虫感染的调查分析

目的 了解艾滋病患者中隐孢子虫的感染状况.方法 收集广东和云南省部分地区艾滋病患者的粪便,采用改良的抗酸染色法和免疫荧光染色法检测隐孢子虫卵囊;并同时检测患者的CD4细胞计数.结果 212例艾滋病患者粪便标本中9例标本为阳性,感染率为4.25%.广东和云南的艾滋病患者隐孢子虫感染率分别为4.00%(5/126)和4.65%(4/86),两地之间差异无统计学意义(P＞0.05);稀便与软便中的隐孢子虫卵囊检出率分别为12.00%(3/25)和3.21%(6/187),其差异无统计学意义(校正χ2=2.31,P＞0.05);男性与女性艾滋病患者隐孢子虫感染率分别为5.07%(7/138)和2.70%(2/74),其差异无统计学意义(校正χ2=0.21,P＞0.05);50～59岁组隐孢子虫感染率高于30～39岁组的感染率(校正χ2=7.15,P＜0.01);接受抗病毒治疗组与未接受治疗组艾滋病患者隐孢子虫感染率分别为1.12%(2/179)和21.21%(7/33),两者差异有统计学意义(校正χ2=18.54,P=0.0000);艾滋病晚期,尤其是CD4细胞计数少于100个/μl的患者其发病率明显提高.结论 我国南方艾滋病患者中存在着隐孢子虫感染,但发病率明显低于国外报道;艾滋病患者的便形、性别及所处地区不能预示隐孢子虫感染率;抗病毒治疗能降低隐孢子虫病感染率,艾滋病患者的隐孢子虫感染多发生在疾病的终末期.     

Pulmonary cytology in patients with the acquired immunodeficiency syndrome (AIDS)

Over a 2-yr period, 1982-1984, 181 pulmonary cytology specimens were obtained from 45 patients clinically suspected of having AIDS in an attempt to identify the various organisms and the cytologic atypias present in pulmonary cells. Cytologic correlations with autopsy findings were available for 28 of these cases (62%). Specimens were collected from sputum, bronchial washes and brushes, bronchoalveolar lavages, and pleural fluid. Of the 181 specimens, 121 (67%) were of diagnostic value. Depending on the cytologic technique, Pneumocystis carinii, cytomegalovirus, herpesvirus, and Candida were detected with varying frequency. The bronchial epithelial and glandular cell atypias, ranging from mild inflammatory reactive changes to marked cellular atypia, were noted most often in specimens from patients with pulmonary infections who were concurrently receiving oxygen therapy and/or chemotherapy for Kaposi's sarcoma or central nervous system lymphoma. An awareness of the wide range of AIDS-associated pulmonary cell atypias is required to rule out a diagnosis of malignancy.     

Disseminated crytococcosis with extensive cutaneous involvement in AIDS

Cutaneous infections is observed in 15% of patients with disseminated cryptococcosis with AIDS. We present here a case of a 34 years old female with AIDS. She presented with multiple skin coloured umbilicated over face, neck, trunk and limbs, which mimicked molluscum contagiosum and kaposi sarcoma. The tissue from cutaneous lesions was collected by excision biopsy and processed by standard mycological methods. Cryptococcus neoformans was isolated and identified. Cerebrospinal fluid (CSF) also yielded the growth of C. neoformans . Cryptococcal antigen was detected with a titre of 1024 by Latex agglutination, is serum and CSF. Her serum was reactive for HIVI and 2 antibodies. The CD4 lymphocytes count was 80/cmm. The HIV viral load was 2,48,084 copies/mL. She was treated with amphotericin B injectable and oral fluconazole. She responded well and lesions regressed.     

用流式细胞仪检测HIV感染者和AIDS患者的T细胞亚群

目的用流式细胞仪（ｆｌｏｗｃｙｔｏｍｅｔｅｒ,ＦＣＭ）检测周围血中ＣＤ４＋、ＣＤ８＋淋巴细胞,结合临床情况对ＨＩＶ感染者和ＡＩＤＳ患者的免疫状况进行评价。方法将抗凝全血进行白细胞分类计数,用双色荧光标记的单克隆抗体染色,经溶血和固定后,用ＦＣＭ计数,从而得出ＣＤ４＋、ＣＤ８＋淋巴细胞数。结果ＨＩＶ感染者和ＡＩＤＳ患者的ＣＤ４＋淋巴细胞数都比正常人低,特别是ＡＩＤＳ患者,他们的ＣＤ４＋淋巴细胞数都低于２００个／ｍｍ３,临床表现也很差。结论ＦＣＭ检测结果与临床评价高度一致,而且ＦＣＭ比一般人工计数法更准确、方便、迅速,同时也证明ＦＣＭ是监测ＨＩＶ感染者和ＡＩＤＳ患者的免疫状况的最佳方法。     

Neuropathology of the Central Nervous System in Acquired Immune Deficiency Syndrome (AIDS) in Japan

The neuropathologiesl features of the central nervous system in IS autopsy cases of Japanese male with AIDS were reported. Nine patients had various histological changes including a variety of opportunistic infections in six patients (40%), primary malignant lymphoma of the brain in two (13%), AIDS encephalopathy in four (27%) and vacuolar myelopathy in one (7%). Usually, these pathological changes were present concomitantly. AIDS encephalopathy was characterized by infiltration of mono and multinucleated cells and myelin pallor with astrogliosis located predominantly in the cerebral white matter and subcortical gray matter. Furthermore, unevenly distributed neuronal loss of the cerebral cortex was apparent in one case. Diffuse astrocytosis of the gray matter out of proportion to neuronal loss was also an outstanding finding in another case. The present study suggested that not only the white matter changes but also gray matter alterations might be the morphological substrates of AIDS encephalopathy.     

Malignant Lymphomas in Japanese AIDS Patients

Seven non-Hodgkin's malignant lymphomas (MLs) were found in 25 Japanese AIDS (acquired immune deficiency syndrome) patients who died at two hospitals in Tokyo. All of these MLs originated from extranodal organs including the brain (three cases), skin (two cases) liver and adrenal gland. B cell markers were demonstrated in all of them. Epstein-Barr virus (EBV) capsid antigen (EBVCA) was demonstrated in 5/7, nuclear antigen (EBNA) in 2/2, the W fragment of EBV DNA by in situ hybridization in 5/7 and the same fragment by PCR in 6/7, indicating high association of these MLs with EBV. The adult T cell leukemia/lymphoma (ATL), endemic in south-west Japan and known to have a high association with HTLV-I, was not found in this series. The incidence of ML among the present AIDS cases is higher than in any other autopsy reports from western countries, although statistical analysis did not show this to be significant in comparison to some of these reports at a level of p<0.05. In spite of apparent higher incidence, the histopathologic and immunophenotypic characteristics of AIDS-associated MLs in Japan are in accordance with those in western countries. Acta Pathol Jpn 41: 744-750, 1991.     

Immune complexes in the acquired immunodeficiency syndrome (AIDS): Relationship to disease manifestation,risk group,and immunologic defect

Immune complex assays (and other immunologic tests) were performed on sera from 162 patients with the acquired immunodeficiency syndrome (AIDS) and 275 AIDS-related subjects. Immune complexes were detected in 89% of AIDS patients and 93% of homosexual men with lymphadenopathy. Immune complex levels in AIDS patients were not associated with a particular risk group or with types of opportunistic infection or malignancy; however, they correlated with other laboratory features of the immune defect (depression in T helper cells and T helper/suppressor-cell ratio, and IgG levels). Immune complexes were also detected in a lesser proportion of risk-group controls (homosexual men, hemophiliacs, Haitians). In risk-group controls, immune complex levels were associated with certain features reflecting sexual practice, blood product exposure, or infection, but these features did not account for the higher levels found in AIDS patients. In appropriate situations, immune complex assays may be of value as screening tests or, possibly, as prognostic indicators for AIDS or AIDS-related syndromes.     

Lymphocyte status of lymph node and blood in acquired immunodeficiency syndrome (AIDS) and AIDS-related complex disease

Blood lymphocytes and lymph nodes from three patients with acquired immunodeficiency syndrome (AIDS) and two cases with AIDS-related complex (ARC) were studied during the course of the disease. The lymph node histomor-phology could be grossly categorized into three stages: follicle hyperplasia, follicle degeneration and the depleted stage. In the first stage, follicles show large and sometimes irregular-sized germinal centres and narrow B-cell mantles. Dendritic reticulum cells in the germinal centres reveal disruption of their fine dendritic processes; often indentations are visible, filled with small B- and T-lymphocytes of follicle mantle and paracortical origin. These lesions may be the first signs of follicle degeneration, in which only hyalinized remnants of follicle centres are found. The changes in the paracortex are less prominent than those in the follicles. The disturbance in the numerical balance of T-cell subsets of helper–inducer and suppressor–cytotoxic phenotypes is less than that found in the blood. In some cases the paracortex reveals a high density of T6-positive elements resembling interdigitating cells, suggestive of continuous antigen exposure. We found follicle hyperplasia in ARC, follicle degeneration in one case of ARC and in full-blown AIDS, while the depleted stage was found in lymph nodes at autopsy of AIDS patients. Lymph node changes do not completely correlate with the changes in the blood lymphocyte pool. Investigations on lymph nodes may be of value in the assessment of the prognosis of the disease.     

Prevalence and Its Predictors of Extrapulmonary Involvement in Patients with Pulmonary Tuberculosis

Extrapulmonary organ involvement in human immunodefiaency virus (HIV)-infected patients with pulmonary tuberculosis (TB) is reported to be 26%, however, the clinical predictors of extrapulmonary involvement in pulmonary TB patients has not been reported yet. We tried to determine the clinical predictors of presence of extrapulmonary involvement in patients with pulmonary TB. Cross-sectional study was performed including all adult patients with culture-proven pulmonary TB diagnosed between January 1, 2004 and July 30, 2006, at a tertiary referral hospital in South Korea. The presence of extra-pulmonary TB involvement was diagnosed based on bacteriological, pathological, or clinical evidence. Among 320 patients with a culture-proven pulmonary TB, 40 had extrapulmonary involvement. Patients with bilateral lung involvement were more likely to have extrapulmonary involvement, with an adjusted odds ratio (OR) of 4.21 (95% confidence interval [CI], 1.82-9.72), while patients older than 60 yr (adjusted OR, 0.27; 95% CI, 0.08-0.89), patients with cavitary lesions (adjusted OR, 0.37; 95% CI, 0.16-0.84), and with higher levels of serum albumin (adjusted OR, 0.45; 95% CI, 0.25-0.78) had less frequent involvement. Clinicians should be aware of the possibility of extrapulmonary involvement in TB patients with bilateral lung involvement without cavity formation or lower levels of serum albumin.