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。     

引起机会性感染的常见病原体分析

机会性致病微生物在机体免疫功能正常时不能导致具有明显临床症状的感染性疾病, 但当机体微生态失调或免疫功能受损时, 可导致明显的临床感染性疾病, 甚至危及患者的生命。现代医疗技术的进步使先天性免疫功能缺陷者、肿瘤患者等免疫功能降低者生存期延长, 滥用抗生素致使正常微生态失调, 以及大量耐药变异菌株出现等诸多因素使得临床机会性感染逐渐增多。机会性感染多发生于免疫功能降低者, 可为耐药菌或多重耐药菌感染, 或为正常菌群致病; 临床表现复杂且不典型, 给治疗带来极大困难。了解常见机会性感染病原体及其特点对及时诊断和治疗机会性感染具有重要的临床意义。     

艾滋病机会性感染36例危险因素分析

目的分析艾滋病机会性感染者的相关危险因素。方法选择浦北县2007年1月~2013年12月有完整记录的730例艾滋病感染者,对36例出现机会性感染者的年龄、基础疾病、CD4水平、抗病毒治疗情况进行分析总结。结果 36例机会性感染者中,50岁以下11例,50岁以上25例;存在基础疾病21例;CD4+T淋巴细胞水平(简称CD4)200个/mm3 28例,200~350个/mm3 8例;完全未进行抗病毒治疗18例,无规范抗病毒治疗15例,规范抗病毒治疗3例。结论艾滋病机会性感染者与高龄、基础疾病、CD4水平及是否规范抗病毒治疗等因素有关。     

血液或无菌体液培养阳性标本中病原菌检测结果分析

目的：了解血培养（包括血液、无菌体液培养,下同）阳性标本中病原菌的分布及阳性报警时间,为临床及时明确病原菌和正确用药提供参考依据。方法：无菌条件下采集血培养标本注人相应的培养瓶,经仪器扫描后放入血培养仪进行检测,报警后及时进行菌种鉴定和药敏试验。结果：364例阳性报警标本中真阳性标本为176例,其中革兰阳性菌占61．7％,革兰阴性菌占35．0％,真菌占3．3％;188例为假阳性标本,其中革兰阳性菌占54％,革兰阴性菌占41．9％,真菌占4．0％;新生儿科的感染阳性率最高;不同种类病原菌的阳性报警时间多重叠;临床医生经验用药正确或根据药敏结果更换用药的百分比为78．2％。结论：本院引起血液、无菌体液感染的病原菌以革兰阳性细菌为主,病原菌种类较多,存在一定的污染;当新生儿有局部感染时要警惕脓毒血症;单独靠血培养仪报警时间来鉴定区分病原菌与污染菌不一定可靠,及时了解血培养结果及标准药敏结果可以辅助找出感染性疾病的病因,尽早正确合理的使用抗菌药物,从而优化抗菌治疗。     

血清IL-2、IL-16水平的变化和艾滋病患者机会性感染的关系探究

目的:研究血清IL-2、IL-16水平的变化和艾滋病患者机会性感染的关系。方法:选择2016年1月至2018年10月在我院接受治疗的艾滋病患者120例作为观察组,根据美国疾病预防控制中心及世界卫生组织标准将其分为三期,A期24例,B期41例,C期55例,其中96例为机会性感染者。同期选择20例在本院进行正常体检者作为对照组。观察组采用高效抗逆转录病毒疗法(HAART)治疗。检测和比较各期艾滋病患者与对照组、机会性感染组与非机会性感染组、艾滋病各期治疗前后血清白介素-2(IL-2)、白介素-16(IL-16)、CD4~+细胞、CD8~+细胞计数的差异。结果:观察组各期艾滋病患者血清IL-2、IL-16水平明显低于对照组,且C期患者血清IL-2、IL-16水平均显著低于A、B期患者(P0.05);观察组及各期患者CD4~+细胞计数均低于对照组,CD8~+细胞计数均高于对照组,且C期患者CD4~+细胞计数均显著低于A、B期患者,CD8~+细胞计数均高于A、B期患者(P0.05);机会性感染组患者血清IL-2、IL-16水平明显低于非机会性感染组(P0.05);治疗后,观察组各期患者血清IL-2、IL-16水平较治疗前明显显著升高,且A期患者血清IL-2、IL-16显著高于B、C期患者(P0.05)。结论:艾滋病机会性感染患者血清IL-2、IL-16水平均显著降低,通过监测血清IL-2、IL-16水平可积极防治机会性感染。     

艾滋病合并真菌感染研究概述

真菌感染是艾滋病患者最常见、比重最大的机会性感染,是最重要致死原因之一。常见的机会性真菌感染包括：念珠菌病、卡氏肺孢子菌病、隐球菌病、马尔尼菲蓝状菌感染、组织胞浆菌病、球孢子菌病。本文介绍了机体的CD4⁺T淋巴细胞与机会性真菌感染关系以及常见的真菌感染的流行病学、发病机制、临床表现、诊断、治疗、预防等方面研究进展。提高临床医生对这类真菌感染系统全面的认识,有助于做到早期诊断、早期治疗,合理选择抗真菌药物,从而提高患者生存质量,延长生存时间。     

229例血培养阳性结果分析

目的研究血液感染的微生物种类分布及病因。方法5 m l血标本在优快双相血培养瓶内于恒温(35±1)℃培养箱孵育,分离阳性标本菌落,采用“第2代15 e系统”进行细菌鉴定,并做药敏试验。结果2 310例血培养标本共分离出229株细菌,其中革兰阴性菌198株占86.46%,革兰阳性菌27株占11.79%,真菌4株占1.74%,阳性率从高到低为甲副伤寒菌、大肠埃希菌、洋葱假单胞菌、产碱杆菌属、金黄色葡萄球菌,分别是55.89%、6.55%、5.24%、3.93%、2.62%。沙门菌占65.06%,分离自感染内科及门、急诊科,大肠埃希菌主要见于感染内科及内分泌科,常见菌阳性标本在孵育<24、24~48、48~76、≥76 h的阳性率依次为5.29%、46.47%、85.88%、99.40%。结论血液感染病原菌在沿海地区以沙门菌属尤其以甲副伤寒菌为主,其次为非发酵菌和葡萄球菌。快速血培养技术仍是血液感染病原学诊断的必要手段。     

艾滋病合并肺部感染12例临床分析

目的:探讨艾滋病(AIDS)合并肺部感染的临床特点、实验室检查及影像学特征。方法:回顾性分析我院2008年1月-2012年4月期间确诊的12例AIDS合并有肺部感染患者的病例资料。结果:发病以男性为主(11例),临床症状以发热、咳嗽、胸闷等为主,实验室检查血沉明显增快、中性粒细胞升高,2例合并有梅毒螺旋体感染,5例合并有乙肝病毒感染,1例合并丙肝病毒感染,氏肺孢子虫肺炎发生率41.67%(5/12);影像学检查主要表现为双肺弥漫性病变,肺门部位为主的毛玻璃样改变。结论:AIDS合并肺部感染患者早期不易诊断,应进一步提高对AIDS的临床症状及影像学认识提高对AIDS的早期诊断率,如存在高危因素者应及时进行艾滋病病毒抗体检测以明确诊断。     

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…     

双向瓶1589份血培养结果分析

目的:了解双向瓶血培养细菌的分类情况.方法:用法国生物梅里埃公司生产的双向血培养瓶(Hemoline),对临床1 589份血液标本进行检测,阳性者用法国生物梅里埃公司生产的API系统进行鉴定.结果:分离出265株细菌共42种,阳性率为16.68%,较传统培养方法高.菌种涉及范围广,其中革兰阳性菌占56.98%,革兰阴性菌占31.70%,真菌占11.32%.结论:用Hemoline双向血培养瓶进行血培养提高了细菌检出的阳性率,增加了检出细菌的种类.     

The circulatory system: blood procurement, AIDS, and the social body in China

The market for blood thrived in China for more than a decade, preying on rural villagers desperate for cash. Profit motives and unhygienic collection created an AIDS epidemic, where now up to 80 percent of adults in some villages are HIV infected. Today, illegal blood banks continue to operate in some areas. Moreover, better screening and blood testing do little to address the underlying cultural reluctance to give blood. This article examines what is at stake for blood donors in the circulation of blood through both the physical and the social bodies in China today. I argue that public health and social policy solutions require consideration of the symbolic meanings of blood and the body, kin relations, and gift exchange. China's HIV-contaminated blood procurement crisis demands a critical reexamination of the hidden processes embedded in a "circulatory system" that has inseparably bound the "gift of life" and a "commodity of death".     

HIV/AIDS患者机会性感染与CD4+ T淋巴细胞间的关联性

目的 研究人免疫缺陷病毒（HIV）感染者及艾滋病（AIDS）患者发生机会性感染的概率与自身CD4+ T淋巴细胞之间的关系,为HIV患者机会性感染的防治提供参考。方法 以2016年6月至2017年6月我院400例HIV患者为研究对象,回顾性分析不同CD4+T淋巴细胞计数HIV患者发生机会性感染的情况。结果 400例HIV患者发生机会性感染178例,总感染率为44.5%。CD4+T淋巴细胞计数≤50个/μL的患者机会性感染发生率（86.67%）最高,与其他各组比较差异有统计学意义（P<0.05）。随着CD4+ T淋巴细胞计数的减少,HIV患者机会性感染率升高。178例机会性感染者中,单一感染82例,2部位感染52例,3部位感染28例,4部位以上感染16例。感染病原体检测显示,细菌感染84例（47.19%）,结核杆菌感染36例（20.22%）,病毒感染30例（16.85%,包括巨细胞病毒感染18例、单纯疱疹病毒感染12例）,真菌感染77例（43.25%,包括假丝酵母感染35例,肺孢子菌感染20例,马尔尼菲青霉菌感染12例,新型隐球菌感染10例）,未明确病原体性质34例（19.10%）,复合感染多见。结论 CD4+ T淋巴细胞水平与HIV患者继发机会性感染的概率关系密切。HIV患者CD4+ T淋巴细胞水平的监测对其继发机会性感染的防控具有重要临床意义。     

Entamoeba histolytica and/or Entamoeba dispar: infection frequency in HIV+/AIDS patients in Mexico city

The objective of this work was to evaluate the frequency of Entamoeba histolytica/Entamoeba dispar intestinal infection in HIV+/AIDS subjects and their HIV- close relatives or sexual partners. Enteric parasites were investigated in stool samples by microscopic examination and E. histolytica and E. dispar were identified by PCR. We found by microscopic analysis in HIV+/AIDS group that the E. histolytica/E. dispar complex was present in 5.9% of the members, while in the HIV- group was 2.9%. With PCR we found that the E. histolytica prevalence was 25.3% in the HIV+/AIDS group and 18.5% in the HIV-group. The difference in the results obtained with the microscopic and PCR is due to the different sensibility of the procedures. Besides, we found patients who were infected with E. histolytica in both groups were asymptomatic cyst passers. Our results suggest that E. histolytica strains prevalent in the studied community appear to be of low pathogenic potential.     

Cytomegalovirus encephalitis: neuropathological comparison of the guinea pig model with the opportunistic infection in AIDS

The AIDS epidemic has transformed the importance of cytomegalovirus (CMV) as a pathogen for the adult human central nervous system (CNS). At autopsy, about 25 percent of AIDS cases have cytopathologic evidence of CNS infection by CMV. Since almost nothing is known of the host CNS-viral interactions, we have developed a laboratory model of CMV infection of the brain in the guinea pig. In the present paper, we review the syndromes of CMV infection of the human CNS and compare the neuropathological findings of the opportunistic CMV brain infection in AIDS with the model. Destructive meningoencephalitis, perivascular infiltrates, and subependymal inflammation are found in both, but the glial nodule is the most characteristic feature of each. Thus, we demonstrate that the model faithfully reflects the histopathology of the human disease. Furthermore, since we have found that CNS infection is achieved following systemic infection in the guinea pig, the model recapitulates the sequence of infection in humans.     

艾滋病合并咽喉马尔尼菲青霉菌病的研究

目的研究艾滋病(AIDS)患者合并咽喉马尔尼菲青霉菌病(Penicilliosis marneffei,PSM)的咽喉表现和诊疗方法。方法收集2002年5月~2007年3月,经真菌学、血清学和组织病理学证实的5例AIDS合并咽喉PSM患者。应用抗逆转录病毒药物治疗AIDS,用两性霉素B联合氟康唑静滴治疗PSM。结果咽痛、声嘶及粘膜溃疡是AIDS合并PSM的咽喉部症状体征。5例病变组织病理学检查发现细胞内PM菌体。真菌培养分离出双相性马尔尼菲青霉菌(Penicillium marneffei,PM)。经抗真菌治疗,2例体温下降,咽喉疼痛减轻,声嘶改善,扁桃体炎症消退,溃疡面缩小,全身症状减轻。最终4例机会性感染死亡,1例仍在随访中。结论AIDS合并咽喉PSM是根据病史、临床表现和实验检查三方面作出诊断;HIV/AIDS用抗逆转录酶病毒治疗,PM用两性霉素B联合氟康唑静滴治疗。     

Analysis of the systemic immune response in HIV-1-infected patients suffering from opportunistic Candida infection

Infection by HIV-1 is a major risk factor predisposing for fungal infection. However, few studies have addressed the immunological status of HIV-1 patients suffering fungal infections. This study examines the status of polymorphonuclear phagocytes (PMN) and T cells in HIV-1-infected patients suffering from mucosal Candida infections. These patients had a more immature population of blood PMN, as detected by lower CD18 expression, than HIV asymptomatics or healthy controls. They also had a selective defect in T cell activation in response to phytohemagglutinin (PHA), but not to stimulation through the T cell receptor by anti-CD3 crosslinking, when compared to HIV-1 asymptomatic patients. This was shown by a decrease in cellular proliferation and cell surface expression of CD69, CD25 and CD71 activation antigens. There was also a severe impairment of IL-2 production upon activation by PHA. IL-10, and TNF secretion was also reduced, whereas IFN-gamma and IL-5 production was not affected. No correlation with viral load, CD4 or CD8 T cell number or clinical stage was found. In conclusion, our results indicate that Candida-infected HIV patients have a selective defect, independent of viral load, CD4 or clinical status, involving some aspects of T cell activation, IL-2 production being severely impaired.     

Biological properties of opportunistic enterobacteria isolated from the blood of patients

The comparative study of the signs of pathogenicity in enterobacteria (119 strains) isolated from the blood of 145 patients with the clinical symptoms of sepsis and from the feces of healthy persons (560 strains from 220 persons) has demonstrated that the same species of opportunistic microorganisms may essentially differ in the formation of DNase, RNase, as well as in their capacity for the positive reaction with Congo red. The possibility of using the above-mentioned signs of pathogenicity for diagnostic purposes as additional signs for the differentiation of virulent cultures of opportunistic enterobacteria from avirulent ones is suggested.     

深圳地区新生儿血培养病原菌分布及耐药性分析

目的了解深圳地区新生儿败血症病原菌分布及其常见病原菌的耐药情况,为临床合理选择抗生素提供依据.方法用Bact/Alert全自动血培养系统进行血培养,VITEK-32全自动微生物鉴定仪对2003～2005年深圳市儿童医院794例新生儿血培养阳性标本进行细菌鉴定和药敏试验.结果794例新生儿血培养标本共检出细菌177株,总阳性率为22.29%,其中革兰阳性菌134株,占75.71%,革兰阳性菌以凝固酶阴性葡萄球菌为主,占阳性菌的85.07%,占总分离率的64.41%.革兰阴性菌43株,占24.92%,革兰阴性菌以肺炎克雷伯菌居多,占阴性菌的41.03%,占总分离率的9.04%.革兰阳性菌对抗生素耐药率最高的为青霉素,其次为头孢唑啉、苯唑西林、红霉素和氨苄西林/舒巴坦.在常见的革兰阴性菌中大肠埃希菌和肺炎克雷伯菌的产ESBLs均在50%左右,这些菌株对亚胺培南、头孢替坦、环丙沙星、左旋氧氟沙星表现了较低的耐药率.结论凝固酶阴性葡萄球菌是该地区新生儿败血症最常见的病原菌,其次为肺炎克雷伯菌.对常用抗菌药物有不同程度的耐药.了解该地区病原菌的流行分布和抗生素的耐药情况对临床合理选用抗生素具有重要意义.