肺隱球菌病的診斷和治療_《中國呼吸與危重監護雜志》

作者：

盛華 , 瞿介明

復旦大學附屬華東醫院呼吸科（上海 200040）;

關鍵詞：

肺隱球菌病診斷治療

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肺隱球菌病（PC）是一種由隱球菌感染引起的急性或亞急性肺部真菌病。好發于免疫功能低下者。在HIV感染者中，PC的發生率為5%~10%。非HIV感染者，PC發病的危險因素包括：結節病、關節炎、Crohn’s病、結締組織病、腎小球腎炎、糖尿病、腫瘤、實體器官移植受者、接受抗腫瘤壞死因子α治療、接受激素治療或免疫抑制劑治療等。約15%的PC患者沒有基礎疾病，屬于免疫功能健全者。有研究發現免疫功能健全的PC發病與患者吸煙史、既往激素治療史和曾有腫瘤史相關[1]，這可能與這類患者存在自然免疫缺陷有關[2]。患者沒有任何肺原發病癥和肺結構異常而形成PC感染稱為原發性隱球菌型肺炎，約50%是發生在免疫功能健全的患者中，大多數患者肺為單一受累器官。

引用本文： 盛華,瞿介明. 肺隱球菌病的診斷和治療. 中國呼吸與危重監護雜志, 2010, 9(1): 107-109. doi: 復制

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2.	Marroni M,Pericolini E,Cenci E,et al.Functional defect of natural immune system in an apparent immunocompetent patient with pulmonary cryptococcosis.J Infect,2007,54:e5-8.
3.	Warnock DW.Trends in the epidemiology of invasive fungal infections.Nippon Ishinkin Gakkai Zasshi,2007,48:1-12.
4.	Chen J,Varma A,Diaz MR,et al.Cryptococcus neoformans strains and infection in apparently immunocompetent patients,China.Emerg Infect Dis,2008,14:755-762.
5.	Khawcharoenporn T,Apisarnthanarak A,Mundy LM.Non-neoformans cryptococcal infections: a systematic review.Infection,2007,35:51-58.
6.	Bernicker EH,Atmar RL,Schaffner DL,et al.Unanticipated diagnoses found at autopsy in an urban public teaching hospital.Am J Med Sci,1996,311:215-220.
7.	Mitchell DH,Sorrell TC.Pancoast’s syndrome due to pulmonary infection with Cryptococcus neoformans variety gattii.Clin Infect Dis,1992,14:1142-1144.
8.	Lehmann PF,Morgan RJ,Freimer EH.Infection with Cryptococcus neoformans var.gattii leading to a pulmonary cryptococcoma and meningitis.J Infect,1984,9:301-306.
9.	Vilchez RA,Linden P,Lacomis J,et al.Acute respiratory failure associated with pulmonary cryptococcosis in non-aids patients.Chest,2001,119:1865-1869.
10.	Nadrous HF,Antonios VS,Terrell CL,et al.Pulmonary cryptococcosis in nonimmunocompromised patients.Chest,2003,124:2143-2147.
11.	Lortholary O,Nunez H,Brauner MW,et al.Pulmonary cryptococcosis.Semin Respir Crit Care Med,2004,25:145-157.
12.	Chang WC,Tzao C,Hsu HH,et al.Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients.Chest,2006,129:333-340.
13.	Yang CJ,Hwang JJ,Wang TH,et al.Clinical and radiographic presentations of pulmonary cryptococcosis in immunocompetent patients.Scand J Infect Dis,2006,38:788-793.
14.	Lindell RM,Hartman TE,Nadrous HF,et al.Pulmonary cryptococcosis: CT findings in immunocompetent patients.Radiology.2005,236:326-331.
15.	陳康. 原發性肺隱球菌病的光鏡和超微結構觀察.第三軍醫大學學報，2005,27:244-246.
16.	Baddley JW,Perfect JR,Oster RA,et al.Pulmonary cryptococcosis in patients without HIV infection: factors associated with disseminated disease.Eur J Clin Microbiol Infect Dis.2008,27:937-943.
17.	Jarvis JN,Dromer F,Harrison TS,et al.Managing cryptococcosis in the immunocompromised host.Curr Opin Infect Dis,2008,21:596-603.
18.	Saag MS,Graybill RJ,Larsen RA,et al.Practice guidelines for the management of cryptococcal disease.Infectious Diseases Society of America.Clin Infect Dis,2000,30:710-718.
19.	Aberg JA.Pulmonary cryptococcosis in normal hosts: treat or observe? Chest,2003,124:2049-2051.
20.	Thursky KA,Playford EG,Seymour JF,et al.Recommendations for the treatment of established fungal infections.Intern Med J,2008,38:496-520.

1. Jarvis JN,Harrison TS.Pulmonary cryptococcosis.Semin Respir Crit Care Med,2008,29:141-150.
2. Marroni M,Pericolini E,Cenci E,et al.Functional defect of natural immune system in an apparent immunocompetent patient with pulmonary cryptococcosis.J Infect,2007,54:e5-8.
3. Warnock DW.Trends in the epidemiology of invasive fungal infections.Nippon Ishinkin Gakkai Zasshi,2007,48:1-12.
4. Chen J,Varma A,Diaz MR,et al.Cryptococcus neoformans strains and infection in apparently immunocompetent patients,China.Emerg Infect Dis,2008,14:755-762.
5. Khawcharoenporn T,Apisarnthanarak A,Mundy LM.Non-neoformans cryptococcal infections: a systematic review.Infection,2007,35:51-58.
6. Bernicker EH,Atmar RL,Schaffner DL,et al.Unanticipated diagnoses found at autopsy in an urban public teaching hospital.Am J Med Sci,1996,311:215-220.
7. Mitchell DH,Sorrell TC.Pancoast’s syndrome due to pulmonary infection with Cryptococcus neoformans variety gattii.Clin Infect Dis,1992,14:1142-1144.
8. Lehmann PF,Morgan RJ,Freimer EH.Infection with Cryptococcus neoformans var.gattii leading to a pulmonary cryptococcoma and meningitis.J Infect,1984,9:301-306.
9. Vilchez RA,Linden P,Lacomis J,et al.Acute respiratory failure associated with pulmonary cryptococcosis in non-aids patients.Chest,2001,119:1865-1869.
10. Nadrous HF,Antonios VS,Terrell CL,et al.Pulmonary cryptococcosis in nonimmunocompromised patients.Chest,2003,124:2143-2147.
11. Lortholary O,Nunez H,Brauner MW,et al.Pulmonary cryptococcosis.Semin Respir Crit Care Med,2004,25:145-157.
12. Chang WC,Tzao C,Hsu HH,et al.Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients.Chest,2006,129:333-340.
13. Yang CJ,Hwang JJ,Wang TH,et al.Clinical and radiographic presentations of pulmonary cryptococcosis in immunocompetent patients.Scand J Infect Dis,2006,38:788-793.
14. Lindell RM,Hartman TE,Nadrous HF,et al.Pulmonary cryptococcosis: CT findings in immunocompetent patients.Radiology.2005,236:326-331.
15. 陳康. 原發性肺隱球菌病的光鏡和超微結構觀察.第三軍醫大學學報，2005,27:244-246.
16. Baddley JW,Perfect JR,Oster RA,et al.Pulmonary cryptococcosis in patients without HIV infection: factors associated with disseminated disease.Eur J Clin Microbiol Infect Dis.2008,27:937-943.
17. Jarvis JN,Dromer F,Harrison TS,et al.Managing cryptococcosis in the immunocompromised host.Curr Opin Infect Dis,2008,21:596-603.
18. Saag MS,Graybill RJ,Larsen RA,et al.Practice guidelines for the management of cryptococcal disease.Infectious Diseases Society of America.Clin Infect Dis,2000,30:710-718.
19. Aberg JA.Pulmonary cryptococcosis in normal hosts: treat or observe? Chest,2003,124:2049-2051.
20. Thursky KA,Playford EG,Seymour JF,et al.Recommendations for the treatment of established fungal infections.Intern Med J,2008,38:496-520.

《中國呼吸與危重監護雜志》

肺隱球菌病的診斷和治療

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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《中國呼吸與危重監護雜志》

肺隱球菌病的診斷和治療

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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