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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)合并馬爾尼菲青霉病(PSM)的感染率，以及常規實驗室檢查結果和5種抗真菌藥物對馬爾尼菲青霉菌(PM)的體外抗菌活性。 方法 2006年1月-2009年11月間確診AIDS患者326例，從其血液、骨髓培養出65株PM，檢測該65例患者的血常規、肝功能和腎功能，并對20株酵母相PM進行體外藥敏進行分析。 結果 AIDS合并PSM的感染率為19.94%；外周血常規：WBClt;4.0×109/L者48例，HBlt;100 g/L者51例，PLTlt;100×109/L者46例。肝功能檢查：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。腎功能檢查：BUNgt;7.2 mmol/L者9例，Crgt;150 μmol/L者4例。20株酵母相PM對5-氟胞嘧啶(5FC)、兩性霉素B(AMB)、氟康唑(FCA)、伊曲康唑(ITR)、伏立康唑(VRC)的敏感率分別為75%、90%、80%、90%、90%。 結論 AIDS合并PSM感染率較高；患者感染后外周血WBC、HB、PLT通常低于正常人，肝功能多表現異常，腎功能的改變較少；對PM的治療以AMB、ITR、VRC為首選。

侵襲性肺曲霉菌感染診治進展

隨著社會老齡化, 抗腫瘤藥物、免疫抑制劑和器官移植等治療的廣泛開展, 在危重患者中廣譜抗生素藥物的長期應用, 與之伴隨的是真菌感染發生的逐年增多, 其中侵襲性曲霉菌感染因其感染隱匿, 難以診治和高死亡率等特點被臨床醫生所重視。按我國醫院感染監控網分析, 醫院真菌感染率從1993 ～1996 年的13. 9% 上升至1998 ～1999 年的17. 1% 、1999 ～2000 年的24. 4% 。侵襲曲霉菌病特別是肺部曲霉菌感染多發生在有嚴重基礎疾病的患者,預后差, 病死率達50% ～100% [ 1 ] 。本文回顧相關研究文獻中關于侵襲性肺曲霉菌診治進展, 高危人群, 目前診斷檢測技術的臨床價值, 抗曲霉菌藥物特點和治療現狀。

The Interpretation of Diagnosis and Treatment Guidelines of Aspergillosis from Infectious Diseases Society of America in 2008

聯合檢測半乳甘露聚糖和（1→3）-β-D葡聚糖在診治侵襲性曲霉菌感染中的研究進展

近年隨著廣譜抗生素和免疫抑制劑的使用，侵襲性真菌感染（invasive fungal disease，IFD）的發病率逐年上升。其中侵襲性曲霉病（invasive aspergillosis，IA）在IFD中比例逐年增高。侵襲性曲霉菌感染在血液科和重癥加強治療病房（ICU）最為常見，其次為呼吸內科、感染科和免疫科，IA為免疫功能低下患者致死率高的主要原因，造血干細胞移植（HSCT）患者中IA的發病率為2%~26%，在血液病和造血干細胞移植患者中IA死亡率高達70.0%~90.0%。造成死亡率高的主要原因是在病程早期不能對IA進行可靠診斷，往往使患者延誤治療而死亡。因此，選擇正確、合適的早期診斷方法對疾病的預后具有決定性意義。傳統的診斷方法如影像學、真菌直接鏡檢、培養及組織病理學檢查的敏感性不高，檢出率低，難以用于早期診斷。因此，新的診斷方法對IA的治療至關重要。血清學診斷方法是應用免疫和生化方法檢測血清或其他體液中的真菌細胞壁和胞質成分，分為抗原和抗體檢查兩類。但由于IFD多繼發于嚴重免疫受損患者，往往缺乏可檢測到的抗體，或者抗體的產生變化較大，因此以檢測真菌抗原為主。目前半乳甘露聚糖（GM）和（1→3）-β-D葡聚糖（BG）成為真菌檢查中非常重要的兩個抗原。

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.

Interferon Therapy for Mycosis Fungoides: A Systematic Review

【摘要】　目的　采用系統評價方法，評估干擾素（IFN）治療蕈樣霉菌病（MF）的療效及安全性。　方法　計算機檢索截止2010年5月的Cochrane協作網系統評價方法，納入所有比較IFN與其他方法治療MF的隨機對照試驗及臨床對照試驗進行質量評價，采用RevMan 5.0.24軟件進行Meta分析。　結果　共納入6篇符合標準的已發表文獻，包括142例受試者。Meta分析結果顯示: IFN-α單獨使用對MF的療效優于安慰劑組[OR=69.36，95%CI（3.71～1 296.64）]及地精丹方劑[OR=35.53，95%CI（1.78～710.56）]；而IFN-α與胸腺肽[OR=15.11，95%CI（0.71～322.61）]及IFN-α+阿維A酯[OR=3.10，95%CI（0.79～12.12）]的臨床療效差異無統計學意義；IFN-γ聯合窄譜中波紫外線（NB-UVB）治療與單用NB-UVB的臨床療效差異無統計學意義[OR=15.00，95%CI （0.46～485.32）]。90%的患者出現輕度“流感樣癥狀” 的不良反應，多可緩解及消退。　結論　IFN是目前治療MF的一線用藥，療效確切且大部分患者耐受性較好。【Abstract】　Objective　To evaluate the clinical efficacy and side effects of interferon (IFN) in the treatment of mycosis fungoides (MF) with the method of systematic review. 　Methods　According to the Cochrane reviewer’s handbook, all the clinical controlled trials involving mycosis fungoides being treated with interferon were retrieved. The Cochrane Collaboration’s software RevMan 5.0.24 was used for meta-analysis.　Results　Only six papers including 142 patients met the inclusion criteria. Meta-analyses indicated the results as follows: IFN-α monotherapy was more effective than placebo [OR=69.36,95% CI (3.71-1 296.64)] and a traditional Chinese medicine (Di-jing-dan) [OR=35.53,95% CI (1.78-710.56)], but no significant difference was found between INF-α and thymic peptide [OR=15.11, 95% CI (0.71-322.61)], and between IFN-α monotherapy and IFN-α combined with etretinate therapy [OR=3.10, 95% CI (0.79-12.12)]; and there was no significant difference between the efficacy of IFN-γ combined narrowband ultraviolet B (NB-UVB) therapy and that of single NB-UVB therapy [OR=15.00, 95% CI (0.46-485.32)]; Influenza-like side effects occurred to 90% of all the patients, which were usually slight and easy to release.　Conclusion　Although there are some mild side effects, interferon is safe to treat MF.

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.

Disseminated Penicillium Marneffei Infection in Immunocompetent Patients: One Case Report and Literature Review

Objective To summarize the characteristics of disseminated Penicillium marneffei infection.Methods The clinical, imageological and bacteriological characteristics were summarized by reviewing one case of disseminated Penicillium marneffei infection in an immunocompetent patient diagnosed in our hospital and the related literatures. Results The patient was a 32-year-old Guangdong male, whose main clinical features were fever, cough, and the abscess of pulmonary, tracheomucosa and subcutaneous. Routine blood examination showed leukocytosis. Other laboratory examination revealed multiple lesions of heart, liver, and kidney. Multiple masses histopathology revealed inflammation, but the culture from the purulent exudates were negative and standard antibiotic therapy was useless. Bronchoscope revealed gray nodus on airway mucosa. Under the direction of bacteriologist, final diagnosis of Penicillium marneffei infection was obtained by the fungal culture from the purulent exudates and the deep sputum. Conclusions Penicillium marneffei can infect immunocompetent patients. Disseminated Penicillium marneffei infection should be considered when patients presented with multiple organ lesions and multiple subcutaneous pyogenic masses which can not explained by connective tissue disease or common pyogenic infection, and with epidemiology of southeast life history.

Completely Video-assisted Thoracopic Surgery for Pulmonary Aspergilloma: A Case Control Study

ObjectiveTo discuss the possibility and safety of video-assisted thoracoscope surgery for pulmonary aspergilloma. MethodsWe retrospectively analyzed the clinical data of 39 patients with pulmonary aspergilloma in Beijing Chaoyang Hospital between June 2009 and May 2014. The patients were divided into two groups according to their operation method including a conventional thoracotomy surgery group (open group, n=11) and a video-assisted thoracoscope pneumonectomy group (VATS group, n=28). There were 8 male patients and 3 female patients with age of 29-64 (50.7±9.7) years in the open group. There were 13 male patients and 15 female patients with age of 20-75 (55.4±15.3) years in the VATS group. We compared clinical effectiveness between the two groups. ResultsThe operations of all patients were performed successfully. There were statistical differences between the two groups in the average length of operative time (P=0.001), the loss of intraoperative blood (P=0.005), and the score of pain (P=0.001). There was no statistical difference in lead flow of postoperative chest (P>0.05) and the time of hospitalization (P>0.05). ConclusionVideo-assisted thoracoscope surgery in the treatment of pulmonary aspergilloma could be feasible, safe, and effective based on our study. It is worth of clinical application and popularization．

侵襲性肺遲緩曲霉病一例報道

目的 通過本病例及綜述以提升對侵襲性肺遲緩曲霉病早期病原學診斷的重視，并為治療方案提供參考依據。方法 回顧我科診治的1例COVID-19感染后繼發的侵襲性肺遲緩曲霉病患者的臨床資料，復習既往文獻總結分析肺遲緩曲霉病的臨床表現、診斷及治療用藥方案。結果 患者79歲，老年男性，咳嗽、咳痰伴呼吸困難4月余。胸部CT提示：雙肺數個結節灶，部分結節內空洞形成；散在實變影。G實驗、GM結果陰性。氣管鏡肺泡灌洗液送檢mNGS查見遲緩曲霉菌。給予伏立康唑治療后效不佳，且繼發肝功能異常，調整為艾沙康唑治療后臨床癥狀及肺部影像學征象好轉。復習文獻，共有12例個案報道，其中8例存在免疫抑制狀態，4例合并慢性阻塞性肺病，6例為器官移植術后。臨床選藥以伏立康唑和兩性霉素B居多，雖經治療仍有66.7%（8例）患者在確診后7周內死亡。結論 本例為國內外首次使用艾沙康唑成功治療侵襲性肺遲緩曲霉病的報告。侵襲性肺遲緩曲霉病屬于罕見病，免疫抑制狀態是其高危因素。該病進展迅速，具有高度耐藥性，預后差，病死率高，早期病原學診斷尤為關鍵。