肺真菌感染的诊断进展与治疗疗效.pptx

肺真菌病诊断与治疗进展
复旦大学附属中山医院
胡必杰
6/12/2022
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肺部真菌病临床上真的很常见吗？
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男性，51岁，咳嗽、发热1月（2008年9月24日）
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358-163.
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念珠菌肺炎Candida pneumonia
45岁，女，急性髓细胞性白血病acute myeloblastic leukemia，出现发热.
胸片示右上肺实变.
经皮肤细针穿刺活检标本specimen of percutaneous fine-needle biopsy分离到白色念珠菌 C albicans
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Pulmonary Fungal InfectionEmphasis on Microbiological Spectra, PatientOutcome, and Prognostic FactorsCHEST 2001; 120:177–184
入选标准：明显肺部病变合并如下一项：
活检标本病理组织中发现真菌
open thoracotomy
thoracoscopy
transbronchial lung biopsy
ultrasound-guided percutaneous needle biopsy；
上述标本涂片和培养分离到真菌；
胸水或血液中分离到真菌，无肺外感染征象。
肺隐球菌感染：经皮肺吸引物显微镜检查鉴定为隐球菌，或阳性隐球菌抗原，滴度>=1:8
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Diagnostic Methods for the 140 Patients With Pulmonary Fungal Infection
Pathologic
74 (53)
Thoracotomy or thoracoscopy
50 (36)
Percutaneous ultrasound-guided biopsy
9 (6)
Transbronchial lung biopsy
10 (7)
Necropsy
5 (4)
Microbiological
58 (41)
Thoracotomy or thoracoscopy
8 (6)
Percutaneous ultrasound-guided biopsy
26 (19)
Transbronchial lung biopsy
3 (2)
Pleural effusion
16 (11)
Blood
5 (4)
Microscopic Percutaneous ultrasound-guided aspiration
3 (2)
Serologic Percutaneous ultrasound-guided aspiration
5 (4)
Chen KY, Ko SH, Hsueh PR, et Fungal Infection. Chest 2001;120:177-184
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Fungal Species Identified From 140 Patients With Pulmonary Fungal Infections
Aspergillus 曲霉
80
Cryptococcus 隐球菌
30
A fumigatus
12
C neoformans
30
A flavus
9
Mycelium sterila
3
A niger
2
Penicillium marneffei
2
A terreus
1
Coccidioides immitis
1
Candida 念珠菌
20
Mucor spp
1
C albicans
9
Rhizopus spp
1
C tropicalis
4
Histoplasma capsulatum
1
C glabrata
4
Rhodotorula glutinis
1
C parapsilosis
2
Chen KY, Ko SH, Hsueh PR, et Fungal Infection. Chest 2001;120:177-184
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Patients and Mortality Rate With Different Patterns of Pulmonary Fungal Infections
No.
Mortality, No. (%)
Total
140
51 ()
Aspergillus