肺炎

文章对基层卫生人员必须掌握的肺炎的诊治等内容进行介绍.     

Malassezia Pneumonia

Malassezia species (formerly known as Pityrosporum) are part of normal human skin flora and have been associated with benign dermatologic conditions, such as seborrheic dermatitis and tinea versicolor. In rare cases, however, Malassezia has been associated with systemic disease in immunocompromised patients and infants in the neonatal intensive care unit. Malassezia species require long‐chain fatty acids for growth and therefore have a known predilection for individuals receiving lipid containing intravenous parenteral nutrition (PN). Systemic infections are characterized by prolonged fevers and illness but can include nonspecific signs and symptoms. We present the diagnosis and management of a rare case of an immunocompetent, nonneonatal, PN‐dependent child with Malassezia furfur pneumonia.     

隐球菌感染

1 病因 隐球菌造成的人体感染几乎均为新型隐球菌引起,其在自然界广泛存在,尤以饲鸽环境的鸽粪尘埃和腐败的水果更易污染,家畜亦为感染的传播者.肺部感染来源于吸入隐球菌孢子,肺感染后病人的新鲜痰标本涂片镜检隐球菌类似红、白细胞的形态.在1952年我院曾有1例隐球菌肺炎并脑膜炎,误诊为结核性,隔日以链霉素行蛛网膜下腔注入,并每周记录CSF常规1     

金黄色葡萄球菌肺炎

金黄色葡萄球菌肺炎 (简称金葡菌肺炎 )是金黄色葡萄球菌引起的急性化脓性肺部感染 ,占医院外获得性肺炎的 5 %以下 ,医院内获得性肺炎的 10 %～ 30 % ,其病情重 ,病死率高。金葡菌经常寄居于正常人的鼻前庭和皮肤等处 ,在寄居部位营共生生活。社区健康人群持续带菌率为 2 0 % ,间歇带菌率可达60 % ,医务人员的金葡菌携带率更高 ,经手在人 -人间传播。金葡菌肺炎可经吸入口咽部分泌物或血行途径引起肺炎。吸入口咽部分泌物获肺炎者常有肺部基础疾患 (ＣＯＰＤ、肺癌或肺囊性纤维化 ) ,慢性病 (糖尿病、肾功能衰竭 )或病毒感染后 ,流感流行期…     

军团菌肺炎

军团菌肺炎 (ｌｅｇｉｏｎｅｌｌａｐｎｅｕｍｏｐｈｉｌａｐｎｅｕｍｏｎｉａ)是军团菌引起的以肺炎为主要临床表现的急性感染性疾病。 1976年首次暴发流行于参加美国宾夕法尼亚州退伍军人军团会议的人员中而得名。至今共发现 4 3个菌种 (65个血清型 ) ,但临床只分离到 2 2个菌种 ,且 90 %是嗜肺军团菌 (Ｌ .ｐｎｅｕｍｏｐｈｉｌａ ,Ｌｐ)。欧美调查表明 :军团菌肺炎在社会获得性肺炎中占 8.0 %～ 12 5 % ,医院获得性肺炎中约占10 % ,可见是下呼吸道感染重要疾病。本病呈世界性分布 ,我国亦有本病存在。由于对本病认识和基层医院病原诊断…     

Pneumonia Syndromes in Children

Since etiologic diagnosis is the key to treatment, the many types of childhood pneumonia are discussed in terms of the organisms most likely to be involved in each; optimal regimens, including antibiotics when appropriate, are detailed.     

Management of Community-Acquired Pneumonia

Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality and is associated with the consumption of considerable health resources worldwide. Initial treatment of patients with CAP is often empirical. Growing concern about the increasing prevalence of atypical organisms is reflected in North American guidelines, which place considerable emphasis on the use of the macrolides.Azithromycin, the prototype azalide, is a macrolide derivative with a broad antimicrobial spectrum including enhanced activity against Haemophilus influenzae relative to erythromycin. Its distinctive pharmacokinetic profile is characterised by extensive and prolonged tissue distribution accompanied by low serum drug concentrations. An estimated tissue half-life of between 2 and 3 days enables the drug to be administered as a once daily, abbreviated regimen for the treatment of patients with CAP. This provides the drug with an advantage over other macrolides including erythromycin and clarithromycin, which require a longer treatment duration. However, the potential for prolonged subinhibitory tissue concentrations of azithromycin to promote the development of resistant microorganisms requires further evaluation.Clinical trials have demonstrated the efficacy of 3- to 5-day regimens of oral azithromycin (total dose 1.5g) in patients with CAP. These regimens were generally as effective as longer treatment durations with other commonly used antimicrobials including other macrolides and amoxicillin/clavulanic acid. Importantly, azithromycin is well tolerated and is associated with a lower incidence of gastrointestinal adverse events than erythromycin. Azithromycin is also associated with fewer pharmacokinetic drug interactions than erythromycin or clarithromycin.According to US prescribing information, orally administered azithromycin is not recommended for use (presumably as monotherapy) in patients with moderate to severe pneumonia, bacteraemia or significant underlying health problems, or in elderly or debilitated patients. A recently developed intravenous formulation of azithromycin may be of value in some of these patients but this requires confirmation.

Conclusion

Oral azithromycin is an attractive antimicrobial option in patients with mild CAP and has a role in both empirical therapy and pathogendirected treatment against atypical organisms. However, its usefulness, as for other macrolides, may be limited in regions with a high prevalence of macrolideresistant pneumococci. Particular benefits over erythromycin and some other macrolides include enhanced activity against Gram-negative pathogens, an improved tolerability profile, a once daily abbreviated treatment regimen (which may result in improved patient compliance) and few pharmacokinetic drug interactions. The development of an intravenous preparation may expand the use of azithromycin in patients with CAP requiring hospitalisation.