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內源性真菌性眼內炎二例

新生兒感染聚集性病例調查及流程改進實踐

目的通過新生兒疑似醫院感染聚集發病后控制過程回顧，探索有效的控制措施。 方法2013年3月22日-4月1日，通過對一起新生兒疑似醫院感染聚集發病事件的現場調查及病原學檢測，了解探討病因線索，提出有效控制措施，包括鼓勵報告，不一味責備，管理部門介入，病例調查，環境采樣，分組隔離，奶具由消毒供應中心處理，強化手衛生，強化環境消毒，改用小包裝無菌棉簽，病例討論等。 結果該新生兒室在短時間內連續發生4例口腔真菌感染患兒，其中2例口腔分泌物涂片見真菌孢子，臨床判斷為疑似醫院感染聚集性病例。經及時采取干預措施，疫情得到了有效改善，未造成不良后果。 結論在臨床中，醫院感染聚集病例受同源性檢測設備昂貴、時間長的限制，常不能及時確診，該起疑似醫院感染聚集病例的調查及處理對類似案例的處置可供借鑒。

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

狼瘡性腎炎合并肺部多重真菌感染一例

Analysis of risk factors for end-stage liver disease complicated with fungal esophagitis

Objective To investigate the risk factors for end-stage liver disease (ESLD) complicated with fungal esophagitis (FE). Methods The clinical data of ESLD patients who underwent gastroscopy during their hospitalization in the Second Affiliated Hospital of Chongqing Medical University between January 1, 2017 and December 31, 2023 were retrospectively analyzed. The ESLD patients with FE were selected as the study group, and the ESLD patients without FE during the same period were included as the control group by 1∶2 propensity score matching method. Multivariate logistic regression model was used to analyze the risk factors of ESLD complicated with FE. Results A total of 75 ESLD patients with FE and 150 ESLD patients without FE were enrolled. There was no significant difference in age, gender, decompensated cirrhosis, liver cancer, diabetes mellitus, or etiology of ESLD between the two groups (P>0.05). Multivariate logistic regression analysis showed that longer hospital stay [odds ratio (OR)=1.115, 95% confidence interval (CI) (1.069, 1.164)], with invasive procedures [OR=10.820, 95%CI (4.393, 26.647)], and higher total bilirubin [OR=1.015, 95%CI (1.005, 1.024)] were risk factors for ESLD complicated with FE (P<0.05). In the study group, 41 patients were treated with antifungal drugs, and 4 of them developed invasive fungal infection. Among the 34 patients who did not receive antifungal drugs, 10 developed invasive fungal infection. Conclusions ESLD patients with longer hospital stay, worse liver function, and invasive procedures are more likely to develop FE, and regular gastroscopy should be performed. Once FE is found, active antifungal treatment should be taken to reduce the occurrence of invasive fungal infection and improve the prognosis of patients.

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

摘要:目的: 探討我院呼吸內科病房老年肺部疾病患者并發真菌感染發病的相關因素,分析其易患因素、臨床特征和治療。 方法 : 采用回顧性調查方法對2002年1月至2008年6月收住內科的經微生物檢查證實49例繼發真菌感染的患者進行分析,并與同期無真菌感染的肺部疾病患者(對照組)比較。 結果 : 在呼吸內科病房中,老年患者院內肺部真菌感染發生率為378%,主要感染部位為泌尿系(218%),呼吸道(269%),消化道(409%)。慢性阻塞性肺疾病(498%)是繼發院內肺部真菌感染最常見的基礎疾病,其感染因素為長期使用廣譜抗生素(962%)和糖皮質激素(332%)、營養狀況不良(583%)出現低蛋白血癥及合并糖尿病、白細胞減少和侵襲性診療操作等。肺部真菌感染的臨床表現無特異性,確診需結合痰培養,組織病理學和臨床表現來確定,感染菌種以白色念珠菌為主,占626%。氟康唑治療有效率914%。研究組與同期無真菌感染的肺部疾病患者(對照組)比較:病死率分別為612%和082%,兩組治療無效的病例(惡化和死亡病例)比較差異有顯著性。 結論 : 院內真菌是呼吸系統疾病繼發感染的重要病原體,而白色假絲酵母菌是院內肺部真菌感染的主要致病菌,宿主免疫狀態、感染播散和疾病嚴重程度是影響預后的因素。該研究認為老年肺部疾病患者并發真菌感染的相關因素和影響預后的因素對其預防、診斷、治療、改進預后和生存質量有重要的臨床意義。除有效的抗真菌治療外,積極的綜合治療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.

Low Dose MSCT Diagnosis of Pulmonary Fungal Infection

Objective To explore the diagnosis value of the low dose multi-slice spiral computed tomography (MSCT) imaging in pulmonary fungal infection in order to improve its diagnosis level. Methods CT manifestations of 106 cases of pulmonary fungal infection confirmed by operation, pathology, mycetes cultivation and follow-ups of clinical therapy were retrospectively analyzed. All cases underwent low dose MSCT examinations including CARE dose 4D and sinogram affirmed iterative reconstruction technology, and 6 cases underwent contrast-enhanced CT scanning. Results Among the basic MSCT findings of pulmonary fungal infection, they showed patch-nodular type in 54 cases, solid variant in 38 cases, and tumor type in 14 cases. In all cases, 91 cases displayed as mulifocality, 83 cases as polymorphism and 78 cases as polytropy. Among the 106 cases with comparative distinctive MSCT manifestations, bud of branch sign were showed in 39 cases, halo sign in 32 cases, wedge shape consolidation in 19 cases, ice needle sign in 15 cases, crescentic sign in 11 cases, air ring sign in 6 cases, and contra-halo sign in 4 cases. The nodules in the cavities were not enhanced in enhanced scan in 5 cases. Conclusions There are some distinctive MSCT findings in patients with pulmonary fungal infection. Pulmonary fungal infection can be diagnosed with typical MSCT findings in close combination with the clinical information.

真菌性眼內炎的診斷和治療進展

真菌性眼內炎因其潛伏期長、癥狀輕、進展慢、臨床表現不典型易誤診，導致治療延誤，造成嚴重視功能損害。但早期診斷及抗真菌藥物的選擇均較困難。近年來，新型抗真菌藥物的研發和眼部給藥途徑的拓寬成為關注的焦點。兩性霉素B、伏立康唑、氟康唑等抗真菌藥物已廣泛應用于臨床治療，且不同類型抗真菌藥物聯合應用已取得良好的治療效果。現就真菌性眼內炎的早期診斷技術、抗真菌藥物種類、眼部給藥途徑、玻璃體腔注射抗真菌藥物聯合玻璃體切割手術治療等方面進行綜述。

In vitro Antifungal Spectrum and Activity of 1% Naftifine-0.25% Ketoconazole Cream Compared with 2% Ketoconazole Cream and 1% Terbinafine Cream

Objective　To research the anti-fungal spectrum and activity of the cream containing 1% naftifine-0.25% ketoconazole compared with other two creams that contain of 2% ketoconazole and of 1% terbinafine, respectively. Methods　The agar diffusion method was used to judge drug sensitivity. Twenty-nine isolates of pathogenic fungi belonging to 11 species from clinic and three species of Malassezia standard stains were enrolled into the experiment. Organism suspension of each species was spread on the surface of the plate of the optimal media containing 2% agar. Then wells were made in the plate and three types of cream were put in each well respectively. After seven-day incubation, the diameter of the inhibition zone around the well full of each cream was observed and recorded. Results　The inhibition zone around the well full of 1% naftifine-0.25% ketoconazole cream for all experiment isolates (Dermatophytes, Candida spp., Sporothrix schenkii, Fonsecaea pedrosoi, Fusarium graminearum, Malassezia furfur, M. globosa and M. sympodialis) was observed, with the mean diameter of 45.46mm. Similarly, the mean diameter of inhibition zone of 2% ketoconazole cream for all experiment isolates was 23.92mm. About 1% terbinafine cream, the mean diameter was 29.81mm but there was no inhibition zone observed around Candida krusei and Candida albicans mycelial-form. There were significant significances for mean diameters of the inhibition zone when comparing 1% naftifine-0.25% ketoconazole cream with 2% ketoconazole cream (P=0.000) and with 1% terbinafine cream (P=0.000). Conclusion　The anti-fungal spectrum of 1% naftifine-0.25% ketoconazole cream is wider than that of 1% terbinafine cream. The antifungal activity of 1% naftifine-0.25% ketoconazole cream is ber than that of 2% ketoconazole cream and 1% terbinafine cream.

無哮喘的變應性支氣管肺曲霉病一例

目的 報道并分析1例變應性支氣管肺曲霉病（allergic bronchopulmonary aspergillosis，ABPA）的臨床特點、診斷及治療方法。方法 結合文獻資料分析我科2019年診治的1例ABPA的病例。結果 該患者診斷明確，治療稍有曲折。ABPA常發生于肺部有基礎疾病者，尤其是支氣管哮喘或囊性纖維化者。臨床表現主要是咳嗽、咳痰、喘息、胸悶；實驗室檢查血清總IgE水平和曲霉特異性IgE水平上升，以及嗜酸性粒細胞數增加；胸部影像學表現為反復的肺部游走性浸潤影和中心性支氣管擴張等。治療包括糖皮質激素和抗真菌治療，對于不能耐受糖皮質激素的患者，抗IgE抗體治療有益。結論 臨床上ABPA容易誤診、誤治，特別是無哮喘病史時，其診斷更加困難。因此早期診斷和正確治療可以減少ABPA造成的肺損傷，改善患者的預后。