Renal Aspergilloma--A Case Illustrating the Problems of Medical Therapy

The second documented case of renal aspergilloma due to Aspergillusflavus is presented. The merits of the medical therapy thatfailed are discussed. Pathological examination showed a nidusof aspergillus around suture material persisting from a pyelolithotomyoperation 2 years before in India. We argue that this was thereason for the failure of the medical therapy. This is the firstcase of its kind reported.     

人类免疫缺陷病毒暴露前预防的应用与挑战

抗病毒治疗不仅将HIV感染从一个致死性疾病转变为一种可以治疗的慢性疾病，同时减少了HIV在人群间的传播，近年来“治疗即是预防”的观念已被人们所认可。随着研究的深入，人们发现HIV暴露前预防（PrEP）能有效减少HIV在高危人群间的传播。临床试验显示PrEP是安全的，可以有效预防HIV感染。目前，欧美国家及WHO指南均推荐对男男性行为者、感染HIV高风险的异性性行为者、HIV单阳伴侣中的HIV阴性者以及静脉吸毒者等高危人群进行PrEP。推荐使用的药物和方法是每日口服替诺福韦和恩曲他滨合剂，部分人群也可使用替诺福韦。PrEP应结合其他预防措施如安全套使用、静脉吸毒的处理以及抗病毒治疗来进一步降低HIV感染的风险。目前，PrEP面临的主要挑战是伦理学、药物可及性、服药依从性以及使用率等问题，应该针对高危人群大力推行PrEP，让更多的人群受益减少HIV感染。     

新型隐球菌脑膜炎38例

目的分析新型隐球菌脑膜炎（隐脑）的临床特点和疗效。方法对38例隐脑进行回顾性分析，所有患者均经病原学检查确诊。结果36例隐脑呈慢性或亚急性起病，初次脑脊液涂片确诊24例，经反复脑脊液涂片及培养确诊14例。38例中有8例未用药，其中2例自动出院，其余6例均死亡。30例行抗真菌治疗，治愈11例，好转7例，转院治疗8例，未愈出院2例，死亡2例。其中两性霉素B联合5-氟胞嘧啶治疗9例，6例治愈，3例好转。结论隐脑常易误诊、漏诊，反复行脑脊液涂片以及同时行真菌培养可提高诊断率。两性霉素B联合5-氟胞嘧啶治疗效果较好。     

Molecular typing and in vitro resistance of Cryptococcus neoformans clinical isolates obtained in Germany between 2011 and 2017

Cryptococcosis is a fungal infection of the central nervous system predominantly caused by Cryptococcus neoformans in immunocompromised patients. In several countries worldwide, up to 50% of isolates show in vitro resistance to clinically used antifungals including fluconazole. No prospective data on susceptibility to antifungal drugs are available for Germany. In this study, we characterised all C. neoformans isolates collected from individual patients’ samples at the German reference laboratory for cryptococcosis 2011 and 2017 (n = 133) by multi-locus sequence typing and phenotypic drug susceptibility testing. We identified serotype A/genotype VNI isolates belonging to clonal complexes previously described from Europe, Africa, Asia and South America as the most prevalent agents of cryptococcosis in Germany. Overall, we observed minimal inhibitory concentrations (MICs) above the epidemiological cut-offs (ECVs) in 1.6% of isolates regarding fluconazole and 2.3% of isolates regarding 5-flucytosine. Here, two C. neoformans var. grubii isolates displayed decreased drug susceptibility to fluconazole, one of them additionally to 5-flucytosine. We also found 5-flucytosine MICs above the ECV for two C. neoformans var. neoformans isolates. We identified a novel mutation in the ERG11 gene which might be associated with the elevated fluconazole MIC in one of the isolates. The clinical importance of the detected in vitro resistance is documented by patient histories showing relapsed infection or primary fatal disease. Of note, sertraline demonstrated antifungal activity comparable to previous reports. Systematic collection of susceptibility data in combination with molecular typing of C. neoformans is important to comprehensively assess the spread of isolates and to understand their drug resistance patterns.     

氟胞嘧啶注射液稳定性预测

氟胞嘧啶为5-氟-4-氨基-2(1 H)-嘧啶酮(简称5-FC),系近年来发展起来的新型抗真菌药。Florey曾介绍薄层—紫外分光光度法测定氟胞嘧啶的含量,研究其制剂的稳定性,但其原文未见公开发表。本文报告应用反相离子对色谱法测定注射液中氟胞嘧啶的含量,并按照化学动力学方法预测氟胞嘧啶注射液的稳定性。     

Cladophialophora bantiana brain abscess in an immunocompetent patient

Cladophialophora bantiana is a dematiaceous mold with a predilection for causing central nervous system infection, particularly in normal hosts. A case involving a 79-year-old immunocompetent woman who presented with left-sided weakness and a ring-enhancing brain lesion is reported. She underwent surgical excision, which revealed a brain abscess due to C bantiana. The patient was treated with liposomal amphotericin B for several weeks, then switched to voriconazole and flucytosine, but eventually succumbed to the infection. Therapy is not standardized for this rare mycosis, and mortality remains high, even in immunocompetent patients. Additional studies to understand the pathogenesis of this infection and to improve outcomes are needed.     

Cryptococcosis in AIDS patients: observations concerning CNS involvement

Summary The clinical course and response to therapy of seven patients with cryptococcosis and AIDS were reviewed. One patient was still in the primary stage of cryptococcosis in AIDS, i.e. the stage that is characterized by the sole cultural detection of Cryptococcus neoformans in the respiratory tract. The other six patients were in the secondary stage, where C. neoformans can be detected from the cerebrospinal fluid (CSF), blood, urine, faeces and other body sites. The main presenting features (headache, fever, nausea) were due to central nervous system involvement, although meningism and mental changes were rarely present, and CSF changes were very subtle. Treatment with amphotericin B and flucytosine was very effective, there being no more growth of fungi in cultures in most cases. Adverse reactions to the drugs used occurred frequently and consisted mainly of anaemia, hepatosis and fever. Diagnosis in the primary stage of cryptococcosis may improve the prognosis.     

对1例隐球菌性脑膜炎患者的药学监护

1例60a女性患者,因间断发热、头痛2月余入院。腰穿脑脊液涂片墨汁染色找到隐球菌,诊断隐球菌性脑膜炎。参照隐球菌性脑膜炎治疗指南,采用两性霉素B联合氟胞嘧啶进行抗真菌治疗,并对两性霉素B的剂量调整及不良反应进行监测。在应用两性霉素B过程中,患者出现低血钾及心电图异常,立即停药,根据每日血钾监测情况,积极给予静脉滴注氯化钾和口服枸橼酸钾对症治疗;同时对患者高颅压进行监护。患者接受抗真菌药物治疗2个多月后,症状较前改善。