艾滋病合并卡氏肺孢菌性肺炎临床探讨

目的 探讨艾滋病患者中卡氏肺孢菌性肺炎的临床特征、诊断方法及治疗预防措施.方法 对36例艾滋病患者合并卡氏肺孢菌性肺炎病例资料进行回顾性描述和分析.结果 艾滋病患者CD4+T淋巴细胞低于200/μL时,易发生卡氏肺孢菌性肺炎机会感染.36例患者临床表现为发热、咳嗽、气促、低氧血症、呼吸衰竭,7例找到肺孢子菌包囊,确诊PCP,其余29例为临床诊断.通过复方磺胺甲恶唑联合卡泊芬净并辅以糖皮质激素治疗,取得较好疗效,9例痊愈,27例症状明显好转,无死亡病例.结论 艾滋病患者若出现快速进展的低氧血症伴CD4+T淋巴细胞低于200/μL及乳酸脱氢酶升高者应警惕卡氏肺孢菌性肺炎,早期诊断、早期应用以复方磺胺甲恶唑联合卡泊芬净为基础的综合治疗是提高生存率的关键.     

Complex radiological diagnosis of pulmonary thromboembolism

Three hundred and twelve patients (210 males and 102 females) aged 47 to 69 years who had suspected pulmonary thromboembolism (PTE) were examined. All the patients received hospital treatment in the clinics of I.M. Sechenov Moscow Medical Academy for different diseases, such as coronary heart disease, chronic venous insufficiency, hypertensive disease, and postoperative condition. PTE was ascertained in 209 patients. The examination used a "Hi Speed CT/i" spiral computer tomograph (General Electric) and an "Aquilion" computer tomograph (Toshiba), a "Millennium" gamma-chamber, and a "Sequoia" high-resolution ultrasound apparatus (Acuson). An algorithm of examination of patients with suspected PTE has been developed.     

Asymptomatic infection of Legionella pneumophila in four cases with pulmonary diseases

In view of the wide-spread existence of legionellae in cooling-tower and other environmental water, asymptomatic infection of this organism could occur. In order to verify the possibility of colonization of legionellae at lower respiratory tract of patients with various pulmonary diseases, a total of 22,036 sputum samples from in- and out-patients at National Sanyoso Hospital were examined during a five-year period from September, 1984 to August, 1989. Four (0.073%) out of 5,502 cases were culture-positive for L. pneumophila. L. pneumophila strains were isolated from expectorated, subsequently washed sputum samples of two male and two female patients with respiratory tract diseases. The identification of the isolates was genetically confirmed by the fluorometric microplate DNA-DNA hybridization method. The serogroup (SG) and viable counts of L. pneumophila per ml of sputum of each patient were as follows: 73 y/o female K.H., SG-6, 10(3) CFU; 75 y/o male H.J., SG-5, 10(4) CFU; 61 y/o female M.S., SG-5, 10(5) CFU; and 77 y/o male M.G., not-agglutinable against SG-1-6 antisera, 10(4) CFU. None of the four patients was clinically suspected of legionellosis and antibody titer of paired sera remained 1:64 or lower than 1:32. From these findings, we concluded that L. pneumophila can cause, though quite rarely, asymptomatic infection in human respiratory tract. None of the environmental samples obtained from in- and out-side of the Hospital was culture-positive for legionellae. Thus, the source of infection has remained unknown.     

Epidemiologic examination of focuses of community-acquired pneumonia caused by Legionella

Main directions of epidemiologic examination of community-acquired pneumonia focus caused by Legionella accounting for features of epidemic process of this infection are discussed. Typical questionnaires, suggested list of documents, characteristics of laboratory tests are presented. Importance of epidemiologic examination of disease focuses as a basis for adequate sanitary and antiepidemic (prophylactic) measures for suppression of outbreaks of Legionella infection are underlined.     

Plasma antithrombin III activity in patients with pulmonary thromboembolism]

A decreased plasma antithrombin III activity has been noted in 12 out of 20 patients. In 2 patients it was most probably congenital defect, whereas in the remaining 10 patients--acquired. The observed disorders in the activity of antithrombin III with particular reference to anticoagulant therapy have been discussed.     

Legionella micdadei species nova: Classification of a third species ofLegionella associated with human pneumonia

Deoxyribonucleic acid relatedness studies were used to characterize threeLegionella-like organisms; TATLOCK, HEBA, and the Pittsburgh pneumonia agent. The results showed that these three strains belong in the same species, which is distinct from the previously described speciesLegionella pneumophila andL. bozemanii. Legionella micdadei species nova is proposed for this new species. The type strain ofL. micdadei is TATLOCK (ATCC 33218).     

Occurrence of the Legionella species in the respiratory samples of patients with pneumonia symptoms from Ahvaz,Iran; first detection of Legionella cherrii

Molecular Biology Reports - This study aimed to investigate the occurrence of Legionella species in the respiratory samples of patients with pneumonia symptoms from Ahvaz, Iran by culture and the...     

慢性阻塞性肺疾病急性加重期合并侵袭性肺曲霉菌病23例临床分析

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)合并侵袭性肺曲霉菌病(IPA)的危险因素及临床特点。方法回顾分析2008年5月至2010年6月浙江大学医学院附属第一医院收治的慢性阻塞性肺疾病急性加重期合并侵袭性肺曲霉菌病患者的临床资料。结果 23例患者中,确诊7例,临床诊断16例。平均年龄(68.3±4.32)岁。其中22例使用广谱抗生素和15例长期使用激素,12例1年内住院>3次,11例年龄>70岁。病灶出现在双上肺占52.1%,双肺多发占21.7%,双下肺占13.0%,位于右中叶和左舌叶共占13.0%;其中5例(21.7%)出现晕征,4例(17.3%)出现"新月"征。结论使用广谱抗生素、长期激素治疗、频繁住院等是慢性阻塞性肺疾病合并肺曲霉菌的危险因素,患者临床表现缺乏特异性,胸部CT表现有一定特征性,结合患者有危险因素及实验室检查,有助于早期诊断和早期治疗,改善患者预后。