Search

Clinical characteristics of patients with Coronavirus Disease 2019-associated pulmonary mucormycosis

ObjectiveTo analyze the clinical characteristics, prognosis and predisposing factors of coronavirus disease 2019 (COVID-19) associated pulmonary mucormycosis (CAPM), so as to improve people's understanding of the disease.MethodsFrom from September 1, 2021 to July 31, 2024, 11 patients with CAPM who were hospitalized in Beijing Chaoyang Hospital affiliated to Capital Medical University were retrospectively collected, and 22 patients with non-CAPM were included after matching according to the ratio of 1:2. The clinical manifestations, laboratory examinations, imaging features, tracheoscopy, treatment and prognosis of the two groups were analyzed. ResultsThe average age of patients in CAPM group was 59.5 ± 10.6 years, with 81.8% of males; diabetes mellitus (90.9%) was the most common complication. In CAPM group, the median time after the occurrence of mucor after COVID-19 was 13.0 (10.0, 24.0) days. The utilization rate of glucocorticoids in the CAPM group was 63.6% (7/11), which was significantly higher than that in non-CAPM group [13.6% (3/22)], and the difference between the groups was statistically significant (P=0.006). The C-reactive protein level in CAPM group was significantly higher at 93.90 (75.00, 129.00) mg/L than that in non-CAPM group at 26.10 (4.83, 114.03) mg/L, with a statistically significant difference (P=0.040). The CD4+T lymphocyte counts and B lymphocyte counts in CAPM group were 223.00 (66.75, 336.75)/µL and 32.00 (21.75, 55.25)/µL, respectively, which were significantly lower than those in the non-CAPM group 394.00 (206.00, 610.00)/µL and 112.50 (56.00, 159.25)/µL, with statistical differences between the groups (P=0.040, P=0.040). In terms of imaging, the main imaging findings were the involvement of multiple lobes in both groups. 63.6% (7/11) of patients with pulmonary aspergillosis in CAPM group were significantly higher than those(4/22, 18.2%) in non-CAPM group (P=0.017). The incidence of dyspnea in CAPM group was significantly higher than that in non-CAPM group (90.9% vs. 50.0%, 0.027%).ConclusionThe proportion of glucocorticoid use and the proportion of pulmonary aspergillosis in CAPM group are significantly higher, and they are in a more serious state of immunosuppression. Once combined with pulmonary aspergillus , the mortality rate is higher.

类风湿关节炎合并毛霉菌肺部感染一例

侵袭性肺曲霉菌感染诊治进展

随着社会老龄化, 抗肿瘤药物、免疫抑制剂和器官移植等治疗的广泛开展, 在危重患者中广谱抗生素药物的长期应用, 与之伴随的是真菌感染发生的逐年增多, 其中侵袭性曲霉菌感染因其感染隐匿, 难以诊治和高死亡率等特点被临床医生所重视。按我国医院感染监控网分析, 医院真菌感染率从1993 ～1996 年的13. 9% 上升至1998 ～1999 年的17. 1% 、1999 ～2000 年的24. 4% 。侵袭曲霉菌病特别是肺部曲霉菌感染多发生在有严重基础疾病的患者,预后差, 病死率达50% ～100% [ 1 ] 。本文回顾相关研究文献中关于侵袭性肺曲霉菌诊治进展, 高危人群, 目前诊断检测技术的临床价值, 抗曲霉菌药物特点和治疗现状。

Infection Rate of Acquired Immune Deficiency Syndrome Disease Combined with Penicillium Marneffei Laboratory Test Results and Analysis of Susceptibility

目的 探究艾滋病(AIDS)合并马尔尼菲青霉病(PSM)的感染率，以及常规实验室检查结果和5种抗真菌药物对马尔尼菲青霉菌(PM)的体外抗菌活性。 方法 2006年1月-2009年11月间确诊AIDS患者326例，从其血液、骨髓培养出65株PM，检测该65例患者的血常规、肝功能和肾功能，并对20株酵母相PM进行体外药敏进行分析。 结果 AIDS合并PSM的感染率为19.94%；外周血常规：WBClt;4.0×109/L者48例，HBlt;100 g/L者51例，PLTlt;100×109/L者46例。肝功能检查：ALTgt;40 U/L者49，ASTgt;40 U/L者51例，GGTgt;60 U/L者44例，ALPgt;150 U/L者36例，ALBlt;35 g/L者53例，A/G倒置者50例。肾功能检查：BUNgt;7.2 mmol/L者9例，Crgt;150 μmol/L者4例。20株酵母相PM对5-氟胞嘧啶(5FC)、两性霉素B(AMB)、氟康唑(FCA)、伊曲康唑(ITR)、伏立康唑(VRC)的敏感率分别为75%、90%、80%、90%、90%。 结论 AIDS合并PSM感染率较高；患者感染后外周血WBC、HB、PLT通常低于正常人，肝功能多表现异常，肾功能的改变较少；对PM的治疗以AMB、ITR、VRC为首选。

眶内霉菌感染一例并文献复习

【摘要】　目的　报道眶内霉菌感染一例。　方法　2011年3月4日收治1例眶内霉菌感染患者，结合文献分析其临床特点及诊治方法。　结果　患者为47岁女性，有霉菌性鼻窦炎病史，右眼肿胀、视物模糊。经抗真菌治疗，病情稳定出院；后多次复发入院，且出现肝肾功能损害。经抗真菌、保肝、保肾、对症治疗，病情稳定出院。　结论　眶内霉菌感染多系鼻窦炎扩散而来，易复发，疗程较长，治疗过程中应监测肝肾功能。

Clinicopathologic study on fungal necrcotizing retinochoroiditis

Objective To investigate the clinical manifestation and histopathologic changes of the fungal necrotizing retinochoroiditis. Methods Collecting 7 cases of fungal retinochoroiditis with severe immunodepression and loss of visual acuity.Seven removed eyeballs were stained with HE,PAS and silver methenamine,and observed by light microscopy,and in addition,2 of them examined by electron microscopy.Also fungal cultures of blood and affected tissues were performed. Results The chief clinical macnifestation included ciliary injection of conjunctiva,opaque aqueous fluid and vitreous and diffuse hemorrhage and greyt white opacity with retinal detachment in severe cases.Pathologic changes included hemorrhage in the retina,chorioretinal tissue necrosis,hyphae in the blood vessels,affected tissue and vitreous.Fungal culture of blood was positive in three cases.Culture of affected tissues was positive in all cases. Conclusions Eedogenous fungal infection of choroid and retina may be due to the severe immunodepression of the sufferers and usually causes chorioretinal tissue destruction and blind. (Chin J Ocul Fundus Dis, 1999, 15: 235-237)

Role of aspergillus infection in bronchiectasis and its diagnosis and treatment

Bronchiectasis is a heterogeneous disease characterized by abnormal expansion of the bronchi, manifested by cough, sputum, and recurring lung infections. As one of the common fungi of lung infection, aspergillus can not only appear as the outcome of the disease in bronchiectasis, but also as an inducement to participate in the disease progression, and ultimately complicate the course of bronchiectasis. This article describes the susceptibility factors and pathogenic mechanisms of aspergillus in bronchiectasis, and further introduces the diagnosis and treatment status of bronchiectasis combined with aspergillus infection, aiming to clarify the effect of aspergillus infection on bronchiectasis and provide new thinking directions for its clinical diagnosis and treatment.

Effects of Aspergillus fumigatus spores on airway inflammation and airway responsiveness on asthmatic rat model

Objective To explore the effects of Aspergillus fumigatus（A. fumigatus） spores on airway inflammation and responsiveness in asthmatic rats.Methods Seventy male Wistar rats were randomly divided into Ⅰ and Ⅱ groups（n=35 in each group），then Group Ⅰ and Group Ⅱ were subdivided into a normal control group（n=5），an asthma group（n=10），a spores-treated control group（n=10），and a spores-treated asthma group（n=10）.The rats were sensitized to ovalbumin（OVA） and challenged with aerosol OVA to establish the asthma model.The effects of A. fumigatus spores on asthmatic rats before and after OVA aerosol challenging were investigated in Group Ⅰ and Group Ⅱ，respectively.The parameters associated with bronchial epithelial damage were observed by total protein concentration in BALF measured by BCA method.Total and differential cell counts in BALF were also counted.The airway resistance and airway responsiveness were calculated by transpulmonary pressure and gas flow rate.Results In Group Ⅰ，the total protein in BALF in the asthma group treated with A. fumigatus spores before OVA challenging（Group CA） was increased remarkably compared to the asthma group（Group A1）[（1.125±0.254）μg/mL vs（0.825±0.173）μg/mL，Plt;0.01].The nonspecific airway resistances induced by different concentration of acetylcholine in Group CA ［（0.997±0.196）cm H2O•mL-1•s-1，（1.123±0.142）cm H2O•mL-1•s-1，（1.130±0.197）cm H2O•mL-1•s-1］were increased significantly compared to Group A1 [（0.655±0.089）cm H2O•mL-1•s-1，（0.687±0.048）cm H2O•mL-1•s-1，（0.821±0.043）cm H2O•mL-1•s-1]（all Plt;0.05）.In Group Ⅱ，however，the above parameters in the asthma group treated with A. fumigatus spores after OVA challenging（Group AC） were not dramatically increased compared with the asthma group（Group A2）（all Pgt;0.05）.The differences in the total and differential cell counts in BALF in Group CA were not remarkable compared to other subgroups in Group Ⅰ（all Pgt;0.05）.But the BALF neutrophil count in Group AC was increased obviously compared to Group A2 ［（2.488±0.420）×106 vs （0.936±0.459）×106，Plt;0.05］.Conclusion These data indicate that exposure to A. fumigatus spores before challenging causes aggravated epithelial damage and increased airway resistance in an asthma rat model.

无哮喘的变应性支气管肺曲霉病一例

目的 报道并分析1例变应性支气管肺曲霉病（allergic bronchopulmonary aspergillosis，ABPA）的临床特点、诊断及治疗方法。方法 结合文献资料分析我科2019年诊治的1例ABPA的病例。结果 该患者诊断明确，治疗稍有曲折。ABPA常发生于肺部有基础疾病者，尤其是支气管哮喘或囊性纤维化者。临床表现主要是咳嗽、咳痰、喘息、胸闷；实验室检查血清总IgE水平和曲霉特异性IgE水平上升，以及嗜酸性粒细胞数增加；胸部影像学表现为反复的肺部游走性浸润影和中心性支气管扩张等。治疗包括糖皮质激素和抗真菌治疗，对于不能耐受糖皮质激素的患者，抗IgE抗体治疗有益。结论 临床上ABPA容易误诊、误治，特别是无哮喘病史时，其诊断更加困难。因此早期诊断和正确治疗可以减少ABPA造成的肺损伤，改善患者的预后。

未规范使用舒利迭致霉菌性食管炎一例临床分析

支气管哮喘是一种常见的慢性呼吸道疾病, 其本质是气道的慢性炎症。糖皮质激素是抗炎治疗的首选药物, 尤其是吸入性糖皮质激素( ICS) 加长效β2 受体激动剂( LABA) 联合治疗已被全球哮喘创议( GINA) 作为中重度哮喘的首选治疗方案。沙美特罗替卡松粉吸入剂( 舒利迭) 也已被广泛使用于哮喘患者的临床治疗中, 而且取得了非常良好的临床效果。但长期使用舒利迭, 部分患者会出现咽干、咽痒、声音嘶哑, 甚至口咽部真菌感染等并发症, 出现霉菌性食管炎的病例尚未见报道。