柳州市2336名艾滋病自愿咨询检测者调查结果分析

目的全面了解接受艾滋病自愿咨询检测(VCT)人群目前构成现状及行为信息,为下一步有针对性地制定宣传教育对象与内容,为制定AIDS的防治决策和工作重点提供科学参考。方法主动到柳州市疾病预防控制中心(CDC)艾滋病防治中心进行HIV抗体检测的VCT者2336例,对所记录的人口与行为相关资料进行分析。结果VCT者主要是20~45岁青壮年,占80.99%。主要以女性为主,占55.44%,60.49%是因为有过婚外性行为而求询检测。已婚者,占总检测人数的55.52%。高中学历的占很大比例,占83.86%;自由职业和无业人员占79.92%。结论艾滋病的感染传播,今后将以性传播为主。加大对卖淫、嫖娼、同性恋、吸毒人员、文化水平较低的进城务工人员、家庭妇女等进行教育及扩大VCT面,是发现及预防HIV传播的重要手段。     

慢性呼吸道疾病并发社区获得性下呼吸道感染住院患者的病原菌调查

目的研究慢性呼吸道疾病并发社区获得性下呼吸道细菌感染住院患者的病原菌分布。方法回顾性分析2001～2005年在北京大学第三医院呼吸病房住院的212例社区获得性下呼吸道细菌感染患者的临床资料、痰培养及药敏结果，患者均具有慢性呼吸道基础疾病。结果临床分离病原菌229株，革兰阴性杆菌为主。慢性阻塞性肺疾病急性加重期患者感染的病原菌中革兰阴性杆菌占73．9％，铜绿假单胞菌和肺炎克雷伯菌最常见，分别为18．2％和13．6％；革兰阳性球菌占23-8％，其中金黄色葡萄球菌10．2％，肺炎链球菌9．1％。支气管扩张症患者感染革兰阴性杆菌占86．2％，前3位分别为铜绿假单胞菌（27．5％）、副流感嗜血杆菌（13．7％）和流感嗜血杆菌（11.8％）。Logistic回归分析发现：感染铜绿假单胞菌的危险因素为患有支气管扩张症（OR=5．590，95％CI 2．792～11．192）；感染鲍曼不动杆菌的危险因素为前1个月内使用制酸剂（OR=9．652，95％CI 2．636～35．339）和低蛋白血症（OR=2．679，95％CI 1．108～6．476）；感染肠杆菌科细菌（包括肺炎克雷伯菌、阴沟肠杆菌和大肠埃希菌）的危险因素为前1个月内使用抗菌药物（OR=4．236，95％CI 1．982～9．057），患有肾脏疾病（OR=4．305，95％CI 1．090-17．008）和糖尿病（OR=2．836，95％CI 1．339—6．009）。结论患有慢性呼吸道疾病患者并发社区获得性下呼吸道感染时的病原菌以革兰阴性杆菌为主，根据基础疾病、病情严重程度和用药史的不同而变化，对病原菌的正确判断有助于制定合理的经验性抗感染方案。     

社区获得性肺炎临床路径的初步探讨

目的评价肺炎严重度指数(PSI)评分系统在本地区临床应用结果,初步探讨社区获得性肺炎(CAP)临床路径的实施。方法选择符合CAP诊断患者327例,随机分为干预组(255例)和常规组(72例)。干预组应用PSI评分系统决策是否住院及严格按1999年中华医学会呼吸病分会制定的《社区获得性肺炎诊断和治疗指南(草案)》进行治疗。常规组按通常的实际经验处理CAP。对照分析两组住院率、住院时间及临床转归。结果干预组总死亡率5.49%,其中低危者占0.55%,高危者占17.6%,总有效率91.0%,其它不良结果3.53%,住院率32.2%,平均住院时间(6.70±1.22)天。常规组总死亡率5.56%,有效率90.3%,其它不良结果4.17%,住院率52.8%,平均住院时间(8.90±1.31)天。两组有效率比较差异无统计学意义(χ2=0.036,P>0.05),住院率比较差异有显著统计学意义(χ2=10.28,P<0.01),平均住院时间缩短2.20天。结论PSI评分系统能有效的用来评估CAP的死亡风险,有助于决策针对患者进一步的处理。对CAP应用PSI评分系统决策是否住院及严格按(草案)进行治疗作为临床路径中的重点环节能有效减少医疗资源使用,减少患者医疗支出,而不影响疾病转归。     

刺五加注射液联合左氧氟沙星治疗社区获得性肺炎30例观察

目的:观察刺五加注射液联合左氧氟沙星治疗社区获得性肺炎的疗效。方法:治疗组30例用刺五加注射液联合左氧氟沙星、对照组30例只用左氧氟沙星治疗,两组疗程均为10天。结果:治疗组和对照组总有效率分别为86．67％、63．33％,两组比较有显著性差异(P<0．05)。结论:刺五加注射液联合左氧氟沙星治疗社区获得性肺炎疗效显著。     

Lymphadenopathic Kaposi'S Sarcoma in a Pediatric PatienT with Acquired Immune Deficiency Syndrome

A six-year-old Hispanic female with acquired immune deficiency syndrome (AIDS) and multiple opportunistic infections was found to have disseminated lymphadenopathic Kaposi's sarcoma at autopsy. She was presumed to have been infected via maternal transmission, although both HIV antibody positive parents were asymptomatic. Kaposi's sarcoma is rarely reported in pediatric AIDS, and children may not have the typical aggressive cutaneous lesions found in adults with AIDS-associated Kaposi's sarcoma.     

Bacteraemia as Predictor of HIV Infection in African Children

ABSTRACT. In Rwanda, both HIV infection and bacteraemia represent major health problems among paediatric populations. We carried out a prospective study to determine if bacteraemia is a marker of HIV infection among ambulatory and hospitalized Rwandese children. All children presenting at the Department of Paediatrics of the Centre Hospitalier de Kigali and who had their blood cultured during a two-month period were eligible for the study. One hundred and thirty-five children were included in the study. A pathogen was isolated from 36 children (26.7 %): S. typhimurium (10 cases), S. enteritidis (6), S. typhi (4), Str. pneumoniae (9). H. influenzae (6) and S. aureus (1). No association was found between bacteraemia and HIV seropositivity when all the children were considered. However, among patients less than 2 years old, bacteraemic subjects were more frequently ( p ≤0.05) HIV seropositive (44 %) than those with negative blood cultures (19 %). Our study shows that in young children in Central Africa, the presence of bacteraemia may be an important marker of HIV seropositivity.     

Pulmonary Fibrosis with Megakaryocytoid Cell Infiltration and Chronic Myelogenous Leukemia

The relationship between fibrosis and megakaryocytic infiltration in the lungs of patients with Philadelphia-chromosome (Ph¹)-positive chronic myelogenous leukemia (CML) is the focus of this review. Ph¹-positive megakaryocytes are thought to reach and accumulate in the pulmonary vasculature through the marrow-blood barrier. In 21 autopsied patients with accelerated phase or blastic crisis of CML, megakaryocytic infiltration to the lungs was demonstrated in 10 patients, myelofibrosis in 12 patients and both in 5 patients. In 2 of the 10 patients with increased megakaryocytes in the lungs, relatively new fibrosis and alveolar damage in the acute phase were demonstrated with the simultaneous occurrence of myelofibrosis-“myelopulmonary fibrosis.” Leakage of mitogenic factors resulting from an abnormality in the packaging mechanism of alpha-granules in these cells termed acquired grey platelet syndrome could cause Fibrosis in the lungs as well as the bone marrow.     

An Outbreak of Echovirus 11 Meningitis in a Newborn Nursery

In the summer of 1981 an outbreak of echovirus 11 meningitis in a newborn nursery occurred in a general hospital near Tokyo. Ten newborn infants developed febrile illness in a period of 20 days. Nine babies out of ten were diagnosed as aseptic meningitis according to the CSF findings. Virus isolation was successful in 50% (3/6 cases) in the CSF, 80% (4/5 cases) in the stool and 20% (1/5 cases) in the throat swab. Echovirus 11 was proven to be the responsible agent. Clinical manifestations of aseptic meningitis were mild and nonspecific, except in one premature baby which had apnea and exanthema. Mean febrile period was 4.1 days. Pleocytosis of the CSF, dominant in polymorphonuclear cells, was observed in 6/9 cases. EEG about one month after onset revealed abnormal or borderline findings in 6/9 cases. In a community outbreak of echovirus. infection, newborn babies in nurseries are threatened with both horizontol and vertical transmission of virus.     

Successful treatment of acquired haemophilia with prednisolone therapy

Acquired hemophilia is a rare, life threatening coagulopathy in adults caused by the development of autoantibodies against to factor VIII. No general consensus exists on the best therapeutic approach. We report here a case that presented with extensive cutaneous and mucosal bleedings due to factor VIII inhibitors and treated successfully with steroid therapy alone but complicated with a life threatening thromboembolic attack during her follow up. In conclusion, corticosteroids are "cost effective therapy" associated with high inhibitor elimination rates and although recurrence of inhibitor in a patient with factor VIII inhibitor is an expected clinical situation thrombosis risk should also be considered.     

The peripheral nerve complications of human immunodeficiency virus (HIV) infection

Peripheral nerve complications occurring in patients with human immunodeficiency virus (HIV) infection are frequent and challenging. This review discusses these various complications according to the degree of advancement of HIV disease. Particular emphasis is placed upon emerging causes of neuropathy found in the context of HIV disease, such as infection with hepatitis C and human T-lymphotropic virus type I, as well as neuropathies related to antiretroviral medications.