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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.

Clinical Study of Treatment of NonInvasive Fungal Sinusitis via Nasal Endoscopy

摘要:目的:探讨鼻内镜术治疗非侵袭型真菌性鼻窦炎的疗效。方法:对76例行鼻内镜术治疗非侵袭型真菌性鼻窦炎的临床资料进行总结分析。结果:76例非侵袭型真菌性鼻窦炎均治愈,随访1～５年无复发。结论:鼻内镜术治疗非侵袭型真菌性鼻窦炎效果良好。

重症甲型H1N1流感肺炎合并侵袭性真菌感染的诊治体会

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.

真菌蛋白酶在变应性哮喘发病中的作用

近年来, 支气管哮喘的发病率在许多国家均呈上升趋势, 带来沉重的经济和社会负担 。许多研究表明, 室内真菌和变应性哮喘之间存在着密切关系, 给予对真菌存在免疫学致敏的哮喘患者抗真菌治疗能够改善症状, 提高生活质量。目前对于室内真菌引起变应性哮喘的详细机制还远未阐明, 本文主要论述真菌蛋白酶在变应性哮喘中的可能作用。

Research Progress of Feasibility of Dendritic Cell Antifungal Vaccines

Fungal infection is an important clinical problem for patients with immune deficiency or immunosuppression. With deadly fungus infection case increasing, the development of antifungal vaccine attracts the attention of researchers. Dendritic cell (DC) is the unique antigen presenting cell (APC) to trigger the antifungal immune reaction, and recent studies indicate that the targeted vaccination strategy based on DC have prospective antifungal potentials. In this paper, we review the antifungal immunity mechanism and recent development of the targeted DC antifungal strategy.

Discussion on the construction of fungal disease prevention and control system in China from the epidemic of Candida auris

Candida auris is an emerging multidrug-resistant fungus that has become a significant global public health threat due to its strong resistance to antifungal agents and its ability to spread within healthcare facilities. This paper reviews the global epidemiological trends of Candida auris and the current status of existing prevention and control systems, focusing specifically on pathogen epidemiological characteristics, domestic and international epidemic situations, current prevention and control frameworks, and the construction of prevention networks. In response to the challenges posed by the international spread of Candida auris , China’s fungal disease prevention system should advance towards a more systematic and scientific direction. By integrating resources from medical institutions, disease control agencies, and research institutes, and combining multidisciplinary knowledge and technologies, China should establish a multi-level coordinated prevention and control mechanism to improve its monitoring, prevention, and treatment systems. In the future, China’s fungal disease prevention and control system needs to further strengthen talent cultivation, improve surveillance networks, promote technological innovation, and build a comprehensive, multi-level modern prevention and control system.

内源性真菌性眼内炎二例

Infected endophthalmitis diagnosed by multiplex polymerase chain reaction

Objective To evaluate the rapid diagnosis of bacterial and (or) fungal endophthalmitis by multiplex polymerase chain reaction (MPCR). Methods MPCR was performed to detect the DNA segment of bacteria and (or) fungi from standard strains and 41 samples of intraocular fluid or vitreous from 38 patients (3 with double eyes and 35 with single), and the results were compared with the cultured bacteria and fungi. Results Five hours after detected by MPCR, bacteria and (or) fungi in 34 out of 41 samples (82.9%) from patients were detected，in cluding bacteria in 26，fungi in 6，and both bacteria and fungi in 2. The positive rate of MPCR was obviously higher than the cultured ones（χ2＝9.60, P＜0.05）. Conclusion With the advantages of rapidity, sensibility, and specificity, MPCR can make for the rapid and definitive diagnosis of bacterial and (or) fungal endophthalmitis. (Chin J Ocul Fundus Dis，2004，20：81-83)

氟康唑胶囊联合萘替芬酮康唑乳膏治疗甲真菌病临床疗效观察

【摘要】目的观察氟康唑胶囊联合萘替芬酮康唑乳膏治疗甲真菌病的临床效果。方法根据就诊先后顺序,将100例甲真菌病患者分为试验组和对照组,每组各50例。试验组患者年龄18～64岁,平均年龄41岁;病程8个月～6年。对照组患者年龄18～58岁,平均年龄27．9岁;病程3～31年。试验组患者口服氟康唑150 mg,1次/周,加外用萘替芬酮康唑乳膏,疗程24周。对照组患者口服伊曲康唑200 mg,1次/d,7 d/月,疗程24周。结果治疗后24周,试验组痊愈率为600％,有效率为900％;对照组痊愈率为620％,有效率为920％。两组痊愈率、有效率经统计学分析差异均无统计学意义(Pgt;005)。结论口服氟康唑联合外用萘替芬酮康唑乳膏,疗效最佳且费用较低,值得在临床中推广使用。