播散性隐球菌病1例及其实验研究

目的 播散性隐球菌病1例临床及实验研究.方法 患者男,72岁,红皮病1年2个月,口服醋酸泼尼松治疗,双下肢出现结节、溃烂6个月.皮损组织病理、皮损组织真菌培养、尿素酶试验、PCR扩增测序比对明确诊断,同时做胸部及脑部CT.结果 皮损组织病理显示为感染肉芽肿改变,可见大量圆形和椭圆形酵母细胞.皮损组织真菌培养可见酵母样菌落生长,菌株尿素酶试验阳性,ITS区测序比对鉴定为新生隐球菌grubii变种.血清隐球菌荚膜多糖抗原乳胶凝集试验阳性(++++).胸部CT显示左下肺后基底段空洞性病灶.依据临床及实验室检查确诊为由新生隐球菌grubii变种引起的 播散性隐球菌病.给予患者静滴氟康唑400 mg/d治疗2周,之后改口服300 mg/d治疗,3个月后结节性皮损全部消退,胸片显示左肺陈旧性病变,血清隐球菌荚膜多糖抗原乳胶凝集试验阳性(++).治疗15个月后,血清隐球菌荚膜多糖抗原乳胶凝集试验仍阳性(++).结论 对该病例的临床和实验室研究为临床明确诊断和治疗提供了依据,确定菌种需要进行分子生物学研究.     

肝肾移植术后患者隐球菌感染的临床特征分析

目的研究肝、肾移植术后患者隐球菌感染的临床特征。方法选取2010年1月到2015年7月来浙江大学医学院附属第一医院就诊的肝、肾移植术后并确诊为隐球菌感染的患者,对其临床特征进行回顾性分析。结果研究周期内有23例患者符合入组要求,其中肾移植术后21例、肝移植术后2例。对23例患者进行分析,发现单纯隐球菌肺炎6例(占26.0%)、单纯隐球菌性脑膜炎6例(占26.0%)、隐球菌性脑膜炎合并隐球菌肺炎8例(占34.7%)、隐球菌败血症2例(占8.6%),皮肤隐球菌感染1例(占4.3%)。所有隐球菌肺炎均经肺穿刺病理确诊,临床表现以发热,咳嗽咳痰,气急症状居多。胸部CT表现为结节、空洞、肿块、渗出等。所有隐球菌脑膜炎患者中9例经脑脊液培养出新生隐球菌、7例脑脊液墨汁染色见隐球菌,其中3例培养及涂片均为阳性。临床表现以头痛、发热、呕吐症状居多,1例并发癫痫,1例并发意识障碍。所有患者分别给予氟康唑、两性霉素B、氟胞嘧啶针、伏立康唑等抗真菌治疗,其中3例隐球菌脑膜炎患者予两性霉素B鞘内注射。经1~6个月治疗后,总体预后情况良好(好转22例,死亡1例)。结论肝、肾移植术后患者因免疫抑制剂的长期使用,隐球菌感染值得重视,其临床症状不典型,易误诊及漏诊,通过对其主要症状及影像学特点判断,结合肺穿刺活检、脑脊液检查、血培养等检查手段,可明显提高隐球菌感染的检出率,从而做到早诊断,早治疗,降低病死率。     

新型隐球菌合并鼻疽奴卡菌皮肤感染1例报道

<正>皮肤隐球菌感染在近年来逐渐受到重视,占隐球菌感染的10%~15%。长期使用糖皮质激素是皮肤隐球菌的主要病因之一[1]。但同时合并鼻疽奴卡菌感染少见。现报道1例新型隐球菌合并鼻疽奴卡菌皮肤感染的病例。经过氟康唑联合复方磺胺甲噁唑抗感染治疗,病情好转,出院后继续按医嘱巩固治疗。1资料与方法患者6个月前无明显诱因左足背起红肿结节,伴疼痛、低热38度,当地医院行脓肿切开引流术,真菌培养"阳性",口服伏立康唑治疗10d,红肿消     

肺隐球菌病1例

报道1例肺隐球菌病。患者男性,35岁,体检发现右肺下叶阴影1个月余。胸腔镜下行右肺下叶切除术,组织病理可见多量大小不一的酵母细胞,PAS、黏蛋白卡红、阿申兰、免疫组化染色均阳性,血清隐球菌荚膜多糖抗原乳胶凝集试验阳性（＋＋）。术后给予口服氟康唑400mg／a治疗3个月,停药2个月后化验血清隐球菌荚膜多糖抗原乳胶凝集试验阴性。     

以皮下结节为首发表现的播散性隐球菌感染1例

报道1例系统性红斑狼疮合并干燥综合征患者出现以皮下结节为首发表现播散性隐球菌感染。患者,女,50岁,以双下肢皮下结节、头痛为主要症状,血培养、脑脊液培养出新生隐球菌,皮肤活检病理可见大量均一、透亮的小圆形菌体真菌孢子浸润,PAS(+)、六胺银(+)。诊断为播散性隐球菌感染。先后使用两性霉素B、氟康唑、两性霉素B脂质体、氟胞嘧啶治疗1个月后症状好转。     

隐球菌性腹膜炎合并结核性胸膜炎1例并文献复习CSCD

报道1例隐球菌性腹膜炎合并结核性胸膜炎病例的诊疗情况,并结合国内外相关报道进行文献回顾分析。患者,男,72岁,表现为腹胀伴轻咳,腹水培养确诊为隐球菌感染,予氟康唑(400 mg 1次/天)治疗4个月后,出现胸腔积液,经胸膜活检病理诊断结核性胸膜炎,加用抗结核治疗,胸腹水吸收。腹腔隐球菌感染较为少见,确诊主要依靠病原学检测,隐球菌荚膜抗原检测、腹水等临床标本的NGS检测可能是提高诊疗效率的办法之一。     

肾移植术后隐球菌性脑膜炎的临床分析

目的 分析肾移植术后隐球菌性脑膜炎的临床特点,以期提高临床医生的诊治水平.方法 回顾性分析肾移植术后隐球菌性脑膜炎的临床表现、实验室检查和治疗预后.结果 4例患者中,男2例,女2例,全部为首次同种异体肾移植.所有患者均有发热和头痛症状,多表现为轻度头痛和低热.3例患者隐球菌涂片和培养均为阳性.所有患者分别给予两性霉素B脂质体、伏立康唑、5-氟胞嘧啶等抗真菌治疗,其中1例合并两性霉素B鞘内注射.经2～4个月治疗后,4例隐球菌涂片转阴,临床症状消失,均在我院随访,至今未复发.结论 肾移植术后隐球菌性脑膜炎首发症状隐匿,临床表现不典型,极易误诊漏诊.早期明确诊断、多科室协作、规范足量治疗是提高此病救治成功的关键.     

肾移植术后隐球菌性脑膜炎合并肺炎1例并文献复习

目的 探讨肾移植术后隐球菌性脑膜炎合并肺炎的诊断及治疗.方法 对1例肾移植术后隐球菌性脑膜炎合并肺炎患者的临床及实验室检查特点进行分析,并结合文献复习进行讨论.结果 给予患者两性霉素B脂质体联合伏立康唑诱导、伏立康唑维持治疗后头痛、咳嗽等症状消失,影像学检查示肺部病灶吸收.治疗过程中未发生急性排斥.结论 肾移植术后隐球菌性脑膜炎并发肺炎患者的临床表现缺乏特异性,脑脊液墨汁染色和隐球菌抗原乳胶凝集试验是诊断的主要手段.及时诊断和有效抗真菌治疗可改善患者的预后.治疗过程中免疫抑制药物需作相应调整.     

重庆某医院近5年新生隐球菌感染患者临床资料及药物敏感性分析CSCD

目的了解重庆地区新生隐球菌感染的类型、治疗、预后和菌株耐药性情况。方法回顾性分析我院近5年新生隐球菌感染病例的临床资料以及6种抗真菌药物的敏感性。结果我院新生隐球菌感染共47例,感染类型以隐球菌性脑膜脑炎为主(72.3%),78.7%的患者为男性,且大部分患者无HIV感染;此外,有17.1%的患者患有隐球菌肺炎。37例患者进行血清和/或脑脊液隐球菌荚膜多糖抗原检测,其阳性率均为100%。所有菌株对伊曲康唑和伏立康唑均为野生型,90%以上的菌株对5-氟胞嘧啶和泊沙康唑为野生型,对氟康唑为野生型的菌株占85.1%,但对两性霉素B为野生型的菌株仅有53.2%。经药物治疗后预后良好者占78.0%,但未进行治疗的患者中仅有16.7%预后良好。结论及时检测隐球菌荚膜多糖抗原有助于提高隐球菌感染诊断的阳性率,新生隐球菌培养阳性后及时进行药物敏感性试验非常重要,根据药敏结果尽早给予联合抗隐球菌治疗对改善患者预后意义重大。     

1982至2020年中国肾移植受者合并隐球菌病的系统分析

隐球菌病是威胁肾移植患者生命的严重感染性疾病,本文旨在报道我国肾移植患者合并隐球菌病（cryptococcosis in kidney transplant patients,C-KT）的情况。通过对208例患者的资料进行分析,发现隐球菌病平均发病时间为肾移植后(5.48±4.09)年,就诊时间为发病后(27.28±30.69)d,入院后确诊时间为(31.6±44.0)d。本研究中C-KT患者误诊率为23.1%,误诊患者占所有死亡患者的37.5%。此病可侵袭全身各个系统,最常见于中枢神经系统（脑）、呼吸系统（肺）和皮肤等。临床特征除发热、头痛、呕吐外,还常见为恶心、咳嗽、胸闷气短,结节、红斑、脓肿溃疡伴或不伴皮肤疼痛、触痛。诊断方法主要是墨汁染色、乳胶凝集素试验等,检出标本主要为脑脊液,血液,肺泡灌洗液,肺、皮肤病例活检组织等。首选治疗药物为两性霉素B脂质体、氟康唑、5-氟尿嘧啶和伏立康唑等,临床中有氟康唑耐药病例的报道。C-KT患者的总死亡率为15.8%。本文对全面了解肾移植患者合并隐球菌病的特征及对本病的诊断与治疗具有重要的意义。     

儿童激素耐药型肾病综合征合并星形诺卡菌脑脓肿1例

本文报道1例激素耐药型肾病综合征儿童合并星形诺卡菌(Nocardia asteroides,N.asteroides)脑脓肿。患儿,男性,8岁,临床诊断为原发性肾病综合征(激素耐药型),病理诊断为局灶节段性肾小球硬化症(经典型)。肾穿后第4天患儿出现持续高热、抽搐,时有头痛,抗感染、抗凝治疗效果不佳。复查颅脑磁共振成像(magnetic resonance imaging,MRI)提示多发脑脓肿。头颅脓肿液经穿刺后培养显示为星形诺卡菌感染。予以多种抗生素联合糖皮质激素等治疗2个月,患儿体温正常,头痛缓解,脑脓肿范围明显缩小。因此,肾病综合征患儿在应用激素及免疫抑制剂治疗过程中如出现化脓性炎症,常规抗生素疗效差,应积极寻找病原,高度警惕诺卡菌病及其他机会性感染的可能。     

Cytopathologic and genetic diagnosis of pulmonary amebiasis: a case report

BACKGROUND: Amebiasis is a parasitic infection with Entamoeba histolytica. Pulmonary amebiasis is rare since the infection is commonly manifested as amebic colitis or liver abscess. Most pleuropulmonary amebiasis is seen in patients with amebic liver abscesses. A pulmonary amebic lesion without either a liver abscess or amebic colitis is extremely rare. Thus, reported cases of sputum cytologic diagnosis of a pulmonary amebic lesion from a patient without a liver abscess are also very rare. CASE: A 53-year-old man presented with a dry cough and mild fever. Chest radiography revealed an abnormal solitary mass lesion in the right upper lung field. The clinical diagnosis was a bacterial lung abscess. Sputum cytologic examination demonstrated many trophozoites of E. histolytica. Following sputum cytodiagnosis, serologic tests revealed a slightly high but almost normal titer of IgG antibodies to E. histolytica, indicating the possible presence of the pathogen. Polymerase chain reaction (PCR) using E. histolytica-specific primers for DNA extracted from the sputum sample revealed specific DNA product. CONCLUSION: Pulmonary amebiasis without either a liver abscess or amebic colitis must be distinguished from bacterial abscesses and neoplastic disease. A sputum cytologic examination combined with PCR for DNA extracted from a sputum sample is a good approach to the diagnosis of a pulmonary amebic abscess.     

Ribotyping to compare Fusobacterium necrophorum isolates from bovine liver abscesses, ruminal walls, and ruminal contents.

Restriction fragment length polymorphism analysis of rRNA genes was employed to genetically compare Fusobacterium necrophorum subsp. necrophorum and F. necrophorum subsp. funduliforme isolates from multiple abscesses of the same liver and isolates from liver abscesses, the ruminal wall, and ruminal contents from the same animal. Four livers with multiple abscesses and samples of ruminal contents, ruminal walls, and liver abscesses were collected from 11 cattle at slaughter. F. necrophorum was isolated from all liver abscesses, nine ruminal walls, and six ruminal content samples. Chromosomal DNA of the isolates was extracted and single or double digested with restriction endonucleases (EcoRI, EcoRV, SalI, and HaeIII); then restriction fragments were hybridized with a digoxigenin-labeled cDNA probe transcribed from a mixture of 16S and 23S rRNAs from Escherichia coli. EcoRI alone or in combination with EcoRV yielded the most discriminating ribopatterns for comparison. Within the subspecies multiple isolates from the same liver were indistinguishable based on the ribopattern obtained with EcoRI. The hybridization patterns of liver abscess isolates were concordant with those of the corresponding isolates from ruminal walls in eight of nine sets of samples. None of the six ruminal content isolates matched either the liver abscess isolates or the ruminal wall isolates. The genetic similarity between the isolates from liver abscesses and ruminal walls supports the hypothesis that F. necrophorum isolates of liver abscesses originate from the rumen.     

Successful antimicrobial therapy of hepatic,intra-abdominal and intrapelvic abscesses.

Antimicrobial therapy without surgical drainage or therapeutic aspiration was effective in the management of four patients with deep abscesses ranging in diameter from 1.3 to 10.0 cm. Two of the patients had multiple hepatic abscesses, one had hepatic, intra-abdominal and intrapelvic abscesses, and one had an intrapelvic abscess alone. Anaerobic bacteria were isolated from the blood or abscesses in all four patients, and an aerobic-anaerobic infection was present in one patient. The patients were treated with metronidazole, alone or in combination with other antibiotics, for 3 to 6 weeks. Therefore, in selected patients with deep abscesses, a therapeutic trial of antimicrobial agents instead of surgery may be justified.     

Pathology of aural abscesses in free-living Eastern box turtles (Terrapene carolina carolina)

Aural abscess or abscess of the middle ear is common in free-living Eastern box turtles (Terrapene carolina carolina) of Virginia (USA) and elsewhere. Although its etiology remains unknown, hypovitaminosis A has been suggested on the basis of similar lesions occurring in captive chelonians fed diets that are deficient in vitamin A. This hypothesis was supported by significantly greater body burdens of organochlorine compounds (reported disruptors of vitamin A metabolism) and a nonsignificant trend toward lower serum and hepatic vitamin A levels in free-living box turtles with this lesion. The tympanic epithelium was evaluated in 27 box turtles (10 with aural abscesses and 17 without). Lesions of the tympanic epithelium of box turtles with aural abscesses included hyperplasia, squamous metaplasia, hyperemia, cellular sloughing, granulomatous inflammation, and bacterial infection. These changes were more severe in turtles with aural abscesses than in those without and were more severe in tympanic cavities that had an abscess compared to those without when the lesion was unilateral. Organs from 21 box turtles (10 with aural abscesses and 11 without) from the study population were examined for microscopic lesions, and minimal histopathologic changes were found, none of which were similar to those found in the tympanic epithelium. Histopathologic changes in box turtles with aural abscesses were consistent with a syndrome that may involve hypovitaminosis A.     

In vivo regulation of granulocyte protluction in acute inflammation

In order to study in vivo the enhanced granulopoiesis that occurs during acute inflammation, 1-3 sterile metallic copper rods were inserted subcutaneously into mice either at the same place (one abscess) or at different sites (multiple abscesses). Diffusion chambers filled with bone marrow cells were implanted intraperitoneally for 3 days. When a single abscess was created, the granulocytic content of the diffusion chamber increased similarly whatever the number of inserted copper rods. However, there was a direct relationship between the number of abscesses and the number of granulocytic cells harvested from the diffusion chambers. In order to investigate the role of T-lymphocytes in the production of diffusible stimulating factors that act on diffusion chamber granulopoiesis, cyclosporin A (CyA) was given to the mice with implanted copper rods. CyA abrogated the induced enhancement of CFU-S, CFU-GM and mature granulocyte numbers inside the diffusion chamber. The stimulatory effect of inflammation on diffusion chamber granulopoiesis was not observed in T-lymphocyte-deficient nude mice. These data suggest that in vivo stimulation of granulopoiesis is related to the level of inflammation, and that this effect requires the functional integrity of T-lymphocytes.     

Abcès rénal et périrénal chez l'enfant.

One child with a pure perinephric abscess and three with renal abscesses, one of which had perinephric extension, are described. All presented with a long course of subacute infection leading to localizing symptoms or signs in the flank. The diagnosis was confirmed by radiologic examination. All the abscesses were surgically drained at various intervals after diagnosis, while the patients were receiving antibiotic therapy. Salvage of renal function was possible in all cases. A rational approach to the diagnosis and management of such abscesses is emphasized.     

Comparison of the pathogenicity of three species of coagulase-negative Staphylococcus in a mouse model with and without a foreign body

Staphylococcus schleiferi, Staphylococcus lugdunensis, and Staphylococcus epidermidis produce a high incidence of abscesses in a mouse model with an implanted foreign body. We investigated the significance of the foreign body in this process. Fourteen strains of S. schleiferi, S. epidermidis, and S. lugdunensis were tested in our model. A preadhered foreign body was implanted into one mouse group, followed by injection of a test strain. Another group received injection without implant. Abscesses were assessed at 7 days; foreign bodies and infected tissues were cultured. The percent of samples that developed abscesses or were culture positive was compared for each strain. Nearly all mice infected with S. schleiferi developed abscesses and were culture positive. The foreign body made no difference in abscess formation for three of four S. schleiferi but increased the incidence of both organism recovery and abscess for three of five S. epidermidis. The foreign body enhanced abscess formation for four of five S. lugdunensis, with all five strains yielding significantly more culture recovery. Although the pathogenicity of nine strains was increased by the foreign body, five strains yielded high abscess and culture recovery rates that were not enhanced by its presence.     

Amebic abscess of the liver

In a review of the records in 50 cases of amebic abscess of the liver observed in the Canal Zone between 1920 and 1945 the following features were noted:Incidence was preponderantly in males and highest in persons between the ages of 20 and 40. None of the patients was under 21 years of age. There was a great variety of complaints at the time of admission to hospital. The most common was pain in the right upper quadrant of the abdomen. Demonstration of either elevated or fixed diaphragm by x-ray film and fluoroscopic examination was useful in diagnosis in a number of cases, but absence of such findings did not rule out abscess of the liver. In some cases there was history of previous dysentery with blood in the stools.One or another of three operative procedures was used for drainage of abscesses in 39 patients. Of the 39, six died; in five of the six, multiple abscesses were present. Emetine hydrochloride was given to all patients.     

AMEBIC ABSCESS OF THE LIVER

In a review of the records in 50 cases of amebic abscess of the liver observed in the Canal Zone between 1920 and 1945 the following features were noted:Incidence was preponderantly in males and highest in persons between the ages of 20 and 40. None of the patients was under 21 years of age.There was a great variety of complaints at the time of admission to hospital. The most common was pain in the right upper quadrant of the abdomen.Demonstration of either elevated or fixed diaphragm by x-ray film and fluoroscopic examination was useful in diagnosis in a number of cases, but absence of such findings did not rule out abscess of the liver.In some cases there was history of previous dysentery with blood in the stools.One or another of three operative procedures was used for drainage of abscesses in 39 patients. Of the 39, six died; in five of the six, multiple abscesses were present.Emetine hydrochloride was given to all patients.