Ph阳性急性淋巴细胞白血病合并肺、脑曲霉菌病

为了探讨Ph染色体阳性急性淋巴细胞白血病合并侵袭性曲霉菌病的临床特点和治疗措施,对1例Ph＋ALL患者进行了血常规、骨髓像、胸片、头颅CT扫描和细胞遗传学等检查,并先后给予DVCP、善唯达及格列卫联合诱导化疗.患者在骨髓抑制期发生侵袭性肺、脑曲霉菌感染,给予伊曲康唑、两性霉素等抗真菌治疗,进行了开颅病灶引流术.经过上述综合治疗,患者获得缓解,肺、脑曲霉菌感染临床治愈.结论：Ph＋ALL是一种常规方案化疗效果差的特殊亚型,格列卫联合化疗是其较好的治疗方案.由于临床真菌检出率低,早期经验性选用抗真菌药物如伊曲康唑,并结合手术切除病灶是治疗肺、脑曲霉菌的较好方法.     

PCR检测痰曲霉菌在慢性阻塞性肺疾病合并侵袭性肺曲霉菌病中的诊断价值

目的：探讨荧光定量PCR检测痰曲霉菌在慢性阻塞性肺疾病（COPD）患者侵袭性肺曲霉菌病（invasive pulmonary aspergillosis, IPA）中的诊断价值。 方法：采用前瞻性观察性研究，入组2015年4月至2017年3月因COPD急性加重入住复旦大学附属中山医院的49例患者。收集患者常规痰液真菌培养后剩余的痰液，采用荧光定量PCR检测曲霉菌。同时分析患者的一般资料，包括临床症状、影像学资料、实验室检查结果。 结果：49例患者中18例诊断为IPA，多见于全身应用糖皮质激素及广谱抗生素的患者。该病确诊较困难，多依赖临床诊断，荧光定量PCR检测痰液中曲霉菌在COPD患者合并IPA诊断中的敏感性和特异性分别为72.2%、87.1%。 结论：COPD患者发生IPA并不少见，荧光定量PCR检测痰中曲霉菌对其具有早期诊断价值。     

伊曲康唑和氟康唑在预防肺移植术后曲霉菌感染的疗效比较

目的探讨预防肺移植术后曲霉菌感染的药物疗效。方法 2003年7月～2010年4月,为38例患者实行肺移植手术,应用伊曲康唑,氟康唑在预防肺移植术后曲霉菌感染的临床效果和在卫生经济学方面来比较和评价。结果应用伊曲康唑比应用氟康唑在预防肺移植术后曲霉菌感染的发生率明显降低(P=0.002)。并且可以减少肺移植术后患者并发曲霉感染的风险,降低相应的治疗费用,有效的节约社会医疗资源。结论应用伊曲康唑和二性霉素B雾化在对肺移植术后的早期曲霉菌感染的预防和治疗中是相对有效的。     

The impact of invasive fungal diseases on survival after lung transplantation

Arthurs SK, Eid AJ, Deziel PJ, Marshall WF, Cassivi SD, Walker RC, Razonable RR. The impact of invasive fungal diseases on survival after lung transplantation.
Clin Transplant 2010: 24: 341–348. © 2009 John Wiley & Sons A/S. Abstract: Background: Recipients of lung transplants are at high risk of infectious complications. We investigated the epidemiology of infections after lung transplantation and determined their impact on survival. Methods: We retrospectively reviewed the medical records of patients who underwent lung transplantation at Mayo Clinic (Rochester) during 1990–2005. Survival analyses were performed using Kaplan–Meier estimation and Cox proportional hazard modeling. Results: Sixty‐nine lung transplants were performed during the 16‐yr study period. The mean (±SD) patient age was 50.5 ± 9.7 yr; 45% were male. During the mean (±SD) follow‐up period of 1188 (±1288) d, the cumulative percentage of patients with infections were: bacteria (52%), cytomegalovirus (CMV) (49%), other viruses (32%), fungi (19%), mycobacteria (7%), and Pneumocystis jiroveci (1%). The median survival time after lung transplantation was 5.02 yr. Kaplan–Meier estimation of one‐, three‐, and five‐yr survival was 80%, 61%, and 50%, respectively. Overall, 37 (54%) patients died due to graft rejection and failure (35%), invasive fungal diseases (16%), post‐transplant lymphoproliferative disorder and other malignancies (14%), cardiovascular diseases (5%), CMV disease (3%), bacterial infection (3%), or other causes (24%). Survival analysis using Kaplan–Meier estimation showed that invasive fungal disease (Aspergillus sp., n = 9, Candida sp., n = 2, Alternaria sp., n = 1, Rhizopus sp., n = 1, and/or Mucor sp., n = 1) was significantly associated with mortality (p = 0.0104). After adjusting for age and graft rejection, invasive fungal disease remains a significant predictor of mortality (p = 0.0262). Conclusion: Invasive fungal disease is significantly associated with all‐cause mortality after lung transplantation. An aggressive antifungal preventive strategy may lead to improved survival after lung transplantation.     

Epidemiology and outcome of invasive fungal infections in solid organ transplant recipients

D. Neofytos, J.A. Fishman, D. Horn, E. Anaissie, C.‐H. Chang, A. Olyaei, M. Pfaller, W.J. Steinbach, K.M. Webster, K.A. Marr. Epidemiology and outcome of invasive fungal infections in solid organ transplant recipients.
Transpl Infect Dis 2010: 12: 220–229. All rights reserved Abstract: Contemporary epidemiology and outcomes of invasive fungal infections (IFIs) in solid organ transplant (SOT) recipients are not well described. From March 2004 through September 2007, proven and probable IFIs were prospectively identified in 17 transplant centers in the United States. A total 429 adult SOT recipients with 515 IFIs were identified; 362 patients received a single and 67 patients received ≥2 organs. Most IFIs were caused by Candida species (59.0%), followed by Aspergillus species (24.8%), Cryptococcus species (7.0%), and other molds (5.8%). Invasive candidiasis (IC) was the most frequently observed IFI in all groups, except for lung recipients where invasive aspergillosis (IA) was the most common IFI (P<0.0001). Almost half of IC cases in liver, heart, and lung transplant recipients occurred during the first 100 days post transplant. Over half of IA cases in lung recipients occurred >1 year post transplant. Overall 12‐week mortality was 29.6%; liver recipients had the highest mortality (P=0.05). Organ damage, neutropenia, and administration of corticosteroids were predictors of death. These results extend our knowledge on the epidemiology of IFI in SOT recipients, emphasizing the occurrence of IC early after non‐lung transplant, and late complications with molds after lung transplant. Overall survival appears to have improved compared with historical reports.     

侵袭性肺曲霉病66例临床分析

目的 总结侵袭性肺曲霉病的临床特点,重视对侵袭性肺曲霉病的分级诊断,制定合理治疗方案.方法 对我院2010年1月—2010年3月66例临床诊断为侵袋性肺曲霉病患者的临床资料进行同顾性分析.结果 66例临床诊断为侵袭性肺曲霉病患者,在痰培养之前疑诊为侵袭性肺曲霉病者仅28例(42.4%).其中,64例(97.0%)患者有基础疾病,长期使用抗生素22例(33.3%),机械通气6例(9.1%).所有患者均出现不同程度的发热、咳嗽、咳痰、呼吸困难等症状,反复痰培养均提示曲霉生长.抗真菌方案有两性霉素B去氧胆酸盐(8例),伏立康唑(12例),卡泊芬净+伏立康唑(5例),卡泊芬净(7例),伊曲康唑(8例),米卡芬净(2例).其中,死亡12例(18.2%),自动出院27例(40.9%),治愈或好转27例(40.9%).结论 侵袭性肺曲霉病患者多数都有多种感染危险因素,诊断主要依据宿主危险因素、临床特征、影像学及微生物学特征,确诊有赖于组织学病理学检查及真菌培养.但按此要求,临床上势必造成多数患者失去治疗机会.因此,应当建立侵袭性肺曲霉病的分级诊断,据具体情况选择不同药物进行治疗.     

无免疫功能缺陷者侵袭性肺曲霉病3例并文献复习

目的 探讨无免疫功能缺陷者侵袭性肺曲霉病的诊断及治疗.方法 分析2008年1月至2008年12月在中国医科大学附属盛京医院呼吸内科住院的3例无免疫功能缺陷侵袭性肺曲霉病患者的病例资料,同时结合相关文献进行复习.结果 既往1例患糖尿病,1例怠慢性支气管炎,1例健康.临床共同特点是:病情进展快,发热,进行性呼吸困难,咯灰黄痰,双肺散在干湿罗音.CT表现呈多样性,双肺散在结节影、片影、实变影及多发空洞.洞内有絮状物是其特点,可见树芽征,纵隔多组淋巴结肿大.每例患者痰培养3次均提示烟曲霉茵生长.均用两性霉素B脂质体治疗显示有效,但1例发生急性肾功能不全,1例出现严重的恶心等副作用.结论 非免疫缺陷者或健康者也可发生侵袭性肺曲霉病.痰培养2次以上阳性者并结合临床可确定诊断.两性霉素B脂质体治疗侵袭性肺曲霉病有效,因其毒副作用,临床应用受到一定限制.     

侵袭性曲霉菌病诊断和治疗进展

近年来,侵袭性曲霉菌病(IA)发病率逐渐增高,IA的病死率高,对于IA的早期诊断及治疗显得极为重要。除了传统的组织病理学和影像学诊断方法外,新的诊断方法还有免疫学和分子生物学检测。抗真菌药物的不断研究更新,为临床上治疗IA提供了新的手段。     

20例侵袭性肺曲霉病临床分析

目的 探讨侵袭性肺曲霉病发病的高危因素、临床特点、影像学特征、治疗及预后因素.方法 回顾分析2008年1月至2012年6月在本院确诊肺曲霉病感染的20例临床资料.结果 20例侵袭性肺曲霉病患者中15例患者有免疫缺陷,5例既往体健.临床特点:发热14例(70％)、咳嗽12例(60％)、咳痰10例(50％)、气促8例(40％)、胸腔积液4例(20％)、胸痛4例(20％)、咯血12例(60％)等.影像学特征:结节影5例,团块影3例,磨玻璃浸润影2例,空洞4例及新月征3例,大片实变3例.治疗予抗真菌药物伏立康唑序贯疗法.预后为痊愈10例、显效5例、放弃2例、死亡3例.结论 侵袭性肺曲霉病临床特点、影像学特征不特异,诊断依赖病原学及病理检查.对有免疫缺陷的患者早诊断、采用伏立康唑治疗,可提高治愈率,无高危因素的患者预后良好.