艾滋病合并侵袭性真菌感染35例临床分析

目的 分析艾滋病(AIDS)合并侵袭性真菌感染的发生情况及临床特点,为其诊治提供参考。方法 回顾性分析85例AIDS患者的临床资料,总结侵袭性真菌感染的发病情况及临床特点。结果 85例AIDS患者继发侵袭性真菌感染35例,感染率为41．2％,感染部位以消化道为主,占44．4％,致病菌以白念珠菌(白假丝酵母)为主,占57．4％,侵袭性真菌感染病例主要发生于CD4~+T淋巴细胞计数＜100个/μl的患者,占71．8％。35例患者中27例治愈,8例死亡。结论 侵袭性真菌感染是AIDS患者主要的机会性感染之一,其发生与CD4~+T淋巴细胞计数密切相关,临床上以消化道真菌感染多见,侵袭性真菌感染的病死率高。     

艾滋病患者侵袭性真菌感染的治疗

艾滋病患者由于严重免疫缺陷而易于并发各种机会感染和肿瘤。高效抗反转录病毒联合治疗(HAART)的出现明显改善了艾滋病患者的预后,提高了患者生存质量,随着HAART在临床的广泛使用,艾滋病患者出现各种机会感染包括侵袭性真菌感染的概率大大降低。然而,由于我国艾滋病患者明确诊断时大多处于疾病晚期,机体免疫功能极低;部分患者尽管接受了HAART,但是由于依从性、病毒耐药性等原因导致患者未能出现良好的应答反应,患者的免疫功能仍未能得到     

糖皮质激素与侵袭性真菌感染

糖皮质激素(激素)是诱发真菌感染、特别是机会性真菌感染重要的因素,可通过抑制免疫反应的多个环节而影响真菌感染的发生与进程.内源性激素相关的疾病如Chushing综合征的患者,以及医源性皮质激素使用的患者均可成为真菌感染的易患人群.正确理解糖皮质激素免疫抑制作用和真菌感染发生的相互关系,可以提高对相关真菌感染的认识并针对性开展防治策略,改善激素应用条件下发生真菌感染的预后.     

艾滋病与机会性致病原虫感染

艾滋病（ＡＩＤＳ）是当前世界上严重威胁人类健康的最疑难病症,危及ＡＩＤＳ病人生命的机会性致病原虫感染,已引起高度重视。卡氏肺孢子虫可引起子卡氏肺孢子虫肺炎,是ＡＩＤＳ病人最危险机会性感染病原体之一,刚地弓形虫主要成弓形虫脑病,是导致ＡＩＤＳ病人死亡的重要原因之一,隐孢子虫和贾第虫可引起严重腹泻,患者可因体质消耗而死亡,对这４种原虫感染做出早期诊断,及时治疗,是减少ＡＩＤＳ病人死亡率的重要措施之一。     

伊曲康唑预防艾滋病患者真菌感染有效性的Meta分析

目的 对艾滋病患者预防性应用伊曲康唑的有效性进行Meta分析,为临床合理使用伊曲康唑预防艾滋病患者真菌感染提供依据.方法 制定检索策略,检索Cochrane图书馆临床对照试验数据库、PubMed、EMbase、EBSCO、万方和清华同方数据库,时间从1981年1月～ 2013年7月,收集有关对艾滋病患者预防性应用伊曲康唑的随机对照临床研究.应用Stata 10.0软件进行Meta分析,采用异质性检验（齐性检验）,统计合并效应量,得出合并后的RR值及其95％ CI值.结果 共3篇文献符合纳入标准进入Meta分析.结果显示,预防性应用伊曲康唑可以明显降低艾滋病患者的总体真菌感染率,RR =0.54 （95％ CI：0.44 ～0.67）,P＜0.05;而侵袭性真菌感染率差异无统计学意义,RR =0.38（95％ CI：0.13～1.10）,P＞0.05;病死率差异无统计学意义,RR =1.14 （95％ CI：0.79～1.65）,P＞0.05.结论 艾滋病患者预防性应用伊曲康唑可以明显降低总体真菌感染率,目前对侵袭性真菌感染并未显示有预防效果.对于艾滋病患者是否预防性应用伊曲康唑,需要仔细评估,要根据不同疾病阶段的真菌感染率制定不同的预防策略.     

艾滋病合并多部位真菌感染1例

报道1例艾滋病并发由红色毛癣菌引起的双侧乳房周围及阴囊、股部皮肤的体、股癣患者,男,41岁,双侧乳房周围及阴囊、双侧股部皮肤出现境界清楚的红斑,真菌学检查为:红色毛癣菌。外涂阿莫罗芬乳膏治愈。患者在1个月前血液化验检查确诊为艾滋病。     

探讨深部真菌感染的机理

为了解肺部真菌感染的情况,我们共收集Ｘ光片发现（除肺结核外）可疑片状阴影３５例,留取支气管灌洗液２７例和胸腔穿刺液８例的标本进行研究。其试验情况如下：１材料与方法１１材料３５例均为我院住院肺结核患者,病程３年,年龄１９－６９岁,其中已确诊肺结核浸润...     

我国临床新现的条件致病真菌感染

机会性真菌的感染近年不断增多,出现的新菌种也随之增多。尤其是近年不断出现少见的机会性真菌感染,包括酵母和酵母样真菌、暗色孢科的腐生菌、地域性流行的少见双相真菌感染及一些罕见真菌感染等。由于此类真菌引起的感染难于诊断并且难鉴定到属,流行病学较难解释,且一些菌对抗真菌药物治疗抵抗,故所引起的感染危害更大。应引起真菌工作者的高度重视。     

268例艾滋病合并机会性感染患者血液、体液培养结果分析

人类免疫缺陷病毒(human immunodeficiencyvirus,HIV)感染人体后造成机体免疫系统功能进行性下降,表现出各种机会性感染和/或肿瘤,称之为“获得性免疫缺陷综合征(acquired immunodefi-ciency syndrome,AIDS)”。本文总结分析了两年来268例AIDS合并机会性感染患者血液、体液等样     

艾滋病合并播散型隐球菌感染1例

1临床资料患者,男性,51岁。因反复腹泻伴消瘦7个月,间歇性发热、头痛3周,于2004年3月6日收治入院。患者2003年8月起无诱因出现腹泻,稀水样便5~6次/d,伴进行性消瘦,外院直肠镜检查示慢性结肠炎,给予得舒特、培菲康等药治疗效果不佳。2004年1月,因阵发性腹部绞痛,腹部CT、MRI检查未见明显异常,予头孢拉啶、左旋氧氟沙星静滴2周,腹痛渐缓解。同年2月底出现胸部不适,肺部CT示右上肺占位,纵隔淋巴结肿大,右侧胸腔积液,未治疗。继之出现发热伴头痛,体温波动于38.5℃左右,并出现颈部淋巴结肿大,经淋巴结活检确诊为隐球菌性淋巴结炎(见图1),脑脊…     

Common protozoans as an uncommon cause of respiratory ailments in HIV-associated immunodeficiency

Opportunistic infections (OIs) are the leading cause of mortality and morbidity among HIV-positive subjects. The breadth of reports of the rare occurrence of OIs in HIV/AIDS has been increasing over the years and more recent studies have outlined the changing trends in the emergence of newer pathogens. Recent reports of the association of certain protozoans that normally do not infect sites other than their normal sites of localization have generated huge interest among scientists. The complete depression of the immune system, followed by the onset of OIs, especially due to protozoans, i.e. toxoplasmosis, isosporiasis, leishmaniasis, cyclosporosis, microsporidiosis and cryptosporidiosis, is not uncommon in AIDS. The immunologic and pathologic basis behind the susceptibility of immunodepressed individuals to these 'non-site-specific parasites' is likely to have a huge impact on HIV disease progression. Certain possible shortcomings in the immunologic armory of immunodeficient subjects, their failure to contain the establishment of these 'uncommon' agents in the human host and their significance in HIV disease progression are discussed.     

AIDS合并马尔尼菲青霉病36例分析

目的探讨艾滋病合并马尔尼菲青霉病的临床表现,治疗与转归。方法回顾分析本院2008年8月～2009年8月收治的艾滋病合并马尔尼菲青霉36例。结果 36例艾滋病合并马尔尼菲青霉病平均年龄35.8岁。马尔尼菲青霉感染临床表现呈现非特异性,其中发热86.11%,贫血94.44%,GGT升高69.44%,AST升高63.89%,淋巴结肿大88.89%,脾大63.89%,低蛋白血症83.33%,咳嗽36.11%,皮损30.56%(其中典型改变仅5例,占13.89%),CD4+50cells/mm388.89%,骨髓培养(27/27)及皮损活检培养(2/2)阳性率100%,血液培养阳性率69.44%(25/36)。36例经抗真菌治疗,其中29例给予HAART治疗,28例治愈,7例好转,1例死亡。结论马尔尼菲青霉是艾滋病常见的机会性感染,早发现,早治疗,长程敏感抗真菌药物联合治疗可提高治愈率,减少复发。     

Paracoccidioidomycosis in a patient with acquired immunodeficiency syndrome

The authors report a case of paracoccidioidomycosis and other opportunistic diseases in a patient with acquired immunodeficiency syndrome.     

镰刀菌所致皮肤感染的文献回顾

镰刀菌主要为植物致病菌,但也可引起严重人类感染。镰刀菌病临床表现形式多样,本文主要综述相关的皮肤感染,分为局限性皮肤感染及播散性感染,诊断多较困难。由于该属真菌对抗真菌药物存在天然耐药,播散性镰刀菌病死亡率可达80%-90%。本文对Medline和中文文献数据库中的相关文献进行了系统查阅和分析,综合归纳了镰刀菌所致皮肤感染的致病种、地域分布、危险因子、临床表现形式、药物敏感性及其诊疗方案等,该综述对全面了解镰刀菌病的特征及对临床医师对本病的诊断具有重要的意义。     

Characterization of Encephalitozoon (Septata) intestinalis Isolates Cultured from Nasal Mucosa and Bronchoalveolar Lavage Fluids of Two AIDS Patients

ABSTRACT. Microsporidia are obligate intracellular protozoan parasites that can cause opportunistic infections in AIDS patients. Species from five genera of microsporidia are presently known to infect man. One species, Septata intestinalis originally was detected in stool specimens of individuals with chronic diarrhea and subsequently was found to disseminate to the kidneys, lungs, and nasal sinuses. This organism has since been reclassified as Encephalitozoon and in this study, we report the culture of Encephalitozoon intestinalis from a bronchoalveolar lavage specimen and a nasal mucus aspirate of two AIDS patients living in the USA. The bronchoalveolar and nasal microsporidian isolates grew in several continuous cell lines including RK-13, MDCK, HT-29, Caco-2, Vero, and 1047. Transmission electron microscopy of the clinical and cell culture specimens revealed that the new isolates appeared to be E. intestinalis based on morphology and growth of organisms in septated membrane-bound parasitophorous vacuoles. The new E. intestinalis isolates were characterized and compared with the first isolated E. intestinalis that was cultured from stool to confirm their identity and to determine if there existed any minor differences, as seen in the closely related Encephalitozoon cuniculi strains. By the methods of sodium dodecyl sulfate-polyacrylamide gel electrophoresis staining for proteins and carbohydrates, Western blot immunodetection, and polymerase chain reaction-based methods with restriction endonuclease digestion, double-stranded DNA heteroduplex mobility shift analysis, and DNA sequencing of the ribosomal DNA intergenic spacer region, the new isolates were identical to each other and to the reference isolate of E. intestinalis. In addition, with any of these methods, the E. intestinalis organisms could be distinguished from the three E. cuniculi strains, Encephalitozoon hellem, and Vittaforma corneae, which is important for diagnostics, therapeutic strategies, and epidemiology.