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真菌性眼内炎的诊断和治疗进展

真菌性眼内炎因其潜伏期长、症状轻、进展慢、临床表现不典型易误诊，导致治疗延误，造成严重视功能损害。但早期诊断及抗真菌药物的选择均较困难。近年来，新型抗真菌药物的研发和眼部给药途径的拓宽成为关注的焦点。两性霉素B、伏立康唑、氟康唑等抗真菌药物已广泛应用于临床治疗，且不同类型抗真菌药物联合应用已取得良好的治疗效果。现就真菌性眼内炎的早期诊断技术、抗真菌药物种类、眼部给药途径、玻璃体腔注射抗真菌药物联合玻璃体切割手术治疗等方面进行综述。

Clinical Research on Correlation Factors of Concurrent Fungal Infections in Old Patients with Pulmonary Diseases: 49 Case Reports

摘要:目的: 探讨我院呼吸内科病房老年肺部疾病患者并发真菌感染发病的相关因素,分析其易患因素、临床特征和治疗。 方法 : 采用回顾性调查方法对2002年1月至2008年6月收住内科的经微生物检查证实49例继发真菌感染的患者进行分析,并与同期无真菌感染的肺部疾病患者(对照组)比较。 结果 : 在呼吸内科病房中,老年患者院内肺部真菌感染发生率为378%,主要感染部位为泌尿系(218%),呼吸道(269%),消化道(409%)。慢性阻塞性肺疾病(498%)是继发院内肺部真菌感染最常见的基础疾病,其感染因素为长期使用广谱抗生素(962%)和糖皮质激素(332%)、营养状况不良(583%)出现低蛋白血症及合并糖尿病、白细胞减少和侵袭性诊疗操作等。肺部真菌感染的临床表现无特异性,确诊需结合痰培养,组织病理学和临床表现来确定,感染菌种以白色念珠菌为主,占626%。氟康唑治疗有效率914%。研究组与同期无真菌感染的肺部疾病患者(对照组)比较:病死率分别为612%和082%,两组治疗无效的病例(恶化和死亡病例)比较差异有显著性。 结论 : 院内真菌是呼吸系统疾病继发感染的重要病原体,而白色假丝酵母菌是院内肺部真菌感染的主要致病菌,宿主免疫状态、感染播散和疾病严重程度是影响预后的因素。该研究认为老年肺部疾病患者并发真菌感染的相关因素和影响预后的因素对其预防、诊断、治疗、改进预后和生存质量有重要的临床意义。除有效的抗真菌治疗外,积极的综合治疗有助于提高真菌感染的治愈率。Abstract: Objective: To study the susceptible factors,clinical features and treatments of nosocomial pulmonary fungal infection in the ward of respiratory department.〖WTHZ〗Methods : The chart files of 49 patients with nosocomial pulmonary fungal infection admitted from January 2002 to June 2008 in the ward of Respiratory Department were reviewed. Results : The incidence rate of nosocomial pulmonary fungal infection was 378%.COPD(498%)was the main predisposing disease,and candidiasis(626%) was the most common pathogen. The main susceptible factors associated with nosocomial pulmonary fungal infection are longterm use of broadspectrum antibiotics(962%),hypoalbuminemia(583%),longterm use of adrenocortical steroid(332%),and diabetes mellitus.There is no specific clinical feature.Fluconazole(914%)is more efficient in the treatment.〖WTHZ〗Conclusion : Nosocomial pulmonary fungis are important pathogenin the secondary infection in respiratory disease.The most common pathogen is candida albicans.Combined therapy as well as treating fungus infection are important measures to increase the cure rate of nosocomial pulmonary fungal infection.

内源性真菌性脉络膜视网膜炎治愈一例

报告1例内源性真菌性脉络膜视网膜炎病例.早期眼底改变为玻璃体后段呈团状纱网状混浊,夹杂灰白色雪片状渗出物,黄斑颞侧有一直径约1.5PD大小的灰白色团状病灶,表面微隆起.黄斑区水肿及小斑点状灰白色病灶,伴小片出血.玻璃体切割术治疗得以保存眼球和残存视力.术中取眼内容物培养证实为烟曲菌感染.该病例另一眼已丧失、追踪其病史记录也疑为真菌感染. （中华眼底病杂志，1993，9：237-238）

经纤维支气管镜诊断曲霉感染100例分析

目的探讨纤维支气管镜检查在肺曲霉感染诊断中的作用。 方法回顾性分析2012年至2014年我院100例曲霉感染患者的临床资料及纤维支气管镜(简称纤支镜)检查结果。 结果100例曲霉感染患者中, 男65例, 女35例, 年龄12~85岁, 30岁以下患者15例。62例合并基础疾病, 包括20例结核, 23例肿瘤, 6例慢性阻塞性肺疾病。36例患者经纤支镜病理检查确诊, 其中4例经纤支镜肺活检确诊, 无并发症发生; 64例患者纤支镜灌洗液或痰液曲霉培养阳性, 属于临床诊断。 结论纤支镜病理检查及灌洗液培养是诊断肺曲霉感染的有效手段, 若临床情况允许, 应尽早进行纤支镜检查明确诊断。

Clinical analysis of 47 cases of nosocomial pulmonary fungal infection in respiratory intensive care unit

Objective To analyze morbility，risk factors，etiology，treatment and outcome of nosocomial pulmonary fungal infections in respiratory intensive care unit（RICU）.Methods Forty-seven respiratory RICU patients with nosocomial pulmonary fungal infections between July 2000 and June 2005 were retrospectively analyzed.Results All of the 47 cases were clinically diagnosed as probable nosocomial pulmonary fungal infections，with the morbidity of 10.8% significantly higher than general wards（1.8%，Plt;0.005）.COPD and bacterial pneumonia were the major underlying diseases of respiratory system with a percent of 38.30% and 36.17%，respectively.Forty-one patients (87.2%) had risk factors for fungal infections.Compared with general wards，the proportion of Aspergillosis was higher in RICU without significant difference (Pgt;0.1)；the proportions of Candida glabrata and Candida tropicalis were higher too，but that of Candida krusei was relatively low.The effective rate of antifungal treatment was 79.1% and fluconazol was the most common used antifungal agents.The mortality of fungal infection in RICU was higher than that of general wards but without significant difference（Pgt;0.1）.Conclusion The morbidity of nosocomial pulmonary fungal infection in respiratory RICU is higher than that in general wards.The proportions of infection caused by Aspergilli and some Candida resistant to fluconazol is relatively high.Early and effective treatment is needed in these patients considering the poor prognosis.

The Interpretation of Guidelines for the Management of Candidiasis from Infectious Diseases Society of America 2009

The Interpretation of Diagnosis and Treatment Guideline of Invasive Fungal Disease in Patients with Hematological Diseases

内源真菌性眼内炎玻璃体注药治愈一例

Risk Factors of Positive Yield in Sputum Fungal Culture in Patients with Chronic Obstructive Pulmonary Disease

Objective To investigate the risk factors of positive yield in sputum fungal culture in patients with chronic obstructive pulmonary disease ( COPD) . Methods The patients with COPD who hospitalized in the respiratory departments of Shanghai First People’s Hospital, Zhongshan Hospital, and Huadong Hospital from January 2005 to December 2007 were analyzed retrospectively. Results The 78 patients were grouped according to the results of sputumfungal culture. There were no significant differences in sex, age, history of smoking, diabetes, atomization inhalation, and the accumulated doses of oral corticosteroids between the positive group and the negative group ( P gt; 0. 05) . However, the differences in species of antibiotics, duration of antibiotic therapy, and accumulated doses of intravenous corticosteroidswere significant ( P lt; 0. 01) . The logistic analysis showed that prolonged high-dose of corticosteroids and multiple broad-spectrum antibiotics were risk factors of the positive yield of sputum fungal culture ( P lt;0. 05) . Conclusion Prolonged high-dose of corticosteroids and multiple broad-spectrum antibiotics are riskfactors of fungal colonization in lower respiratory tract of COPD patients.

内源性真菌性眼内炎二例