肺毛霉病

探讨肺毛霉病的临床表现，诊断和治疗方法。方法 本组２例采用纤维支气管镜，开胸探查和痰检查，经病理或真菌培养确诊。结果 随着广谱抗生素，抗肿瘤药物，皮质和器官移植的广泛应用。发病率有增高趋势。病死率极高，国外报道为８０％，局限于肺部者为６５％，播散型高达９６％。     

10例肺隐球菌病的临床分析

摘要：目的 总结分析10例原发性肺隐球菌病患者的临床特点,提高对肺隐球菌病的诊治水平。方法 分析广东省佛山市第四人民医院2006-2010年间10例原发性肺隐球菌病患者的临床、影像学表现、实验室检查、病理及确诊方法、疗效等。 结果 （1）10例原发性肺隐球菌病,有基础疾病者5例,有临床症状者8例,主要表现为咳嗽、发热、咯血,影像学表现不典型,呈多样性,7例经皮肺穿刺病理检查确诊,3例经手术病理确诊。（2）治疗采用氟康唑治疗。3例行手术切除后口服氟康唑,另7例均行氟康唑治疗,治愈7例,好转2例,疗程6～12个月不等。结论 原发性肺隐球菌病临床和影像学表现不典型,呈多样性,应积极行肺活检以明确诊断,肺隐球菌病单用氟康唑抗真菌治疗效果良好。     

原发性肺隐球菌病10例临床分析

目的总结分析10例原发性肺隐球菌病患者的临床特点。方法分析我院10例原发性肺隐球菌病患者的临床、影像学表现、实验室检查、病理及确诊方法、疗效等。结果①10例原发性肺隐球菌病,男6例,女4例,有基础疾病者2例,有临床症状者8例,主要表现为胸痛、咳嗽、咳痰、痰中带血、发热,影像学表现为结节肿块型1例,肺炎型4例,混合病变型5例,全部病例均经病理确诊。②治疗采用手术切除病灶和(或)氟康唑治疗。1例行手术切除后口服氟康唑,另9例均行氟康唑治疗,治愈6例,好转4例,有效率100%,疗程1～12月不等。结论原发性肺隐球菌病临床和影像学表现不典型,呈多样性,应积极行肺活检以协助诊断,肺隐球菌病单用氟康唑抗真菌治疗效果良好。     

肺毛霉病三例临床分析

目的探讨肺毛霉病的临床表现、诊断和治疗方法。方法报道2006年我院收治的、经纤维支气管镜检查和组织病理确诊且具有完整资料的3例肺毛霉感染病例并结合国内外文献进行复习。结果3例均为农民，女2例，男1例，年龄42～48岁。例1和例2为糖尿病酮症酸中毒患者，例1在确诊次日因大咯血死亡；例2应用大剂量两性霉素B（总剂量2g）治愈；例3为肺鳞癌右上叶切除术后伴支气管狭窄，通过应用大剂量两性霉素B（总剂量1．5g）和支气管镜介入治疗成功治愈；例2和例3随诊0．5～1年均无复发。结论肺毛霉病患者痰培养阳性率极低，病死率很高。对临床可疑病例应及时行纤维支气管镜检查，并经组织病理学确诊；治疗的关键在于早期诊断、控制基础病、应用大剂量的两性霉素B和及时的外科手术。     

老年人肺部曲菌球病17例诊断和治疗

报道老年人肺曲菌球病１７例，其原发病为肺结核１４例，肺囊肿、肺癌、肺脓肿各１例。临床表现反复咯血１４例，占８２．４％。本组１５例延误诊断，误诊率８８．２％。１３例行肺切除术，１例术后死于呼吸衰竭，１２例痊愈出院，随访１～３．５年无复发；４例应用抗霉菌药物，３例症状减轻，１例无变化。因此，对老年人肺部曲菌球病进行手术治疗应持积极态度。     

结核性阑尾炎的诊断与治疗

目的探讨结核性阑尾炎的诊断和治疗方法。方法对１９６８～１９９７年收治的４６５２例阑尾炎中，经病理确诊的１２例（占０２６％）结核性阑尾炎作回顾性分析。结果本组病例的平均发病年龄为３５岁，女性多见，男女比为１∶２，多为继发（７例）。１２例中增殖型７例，溃疡型３例，混合型２例。术前均误诊，术中确诊２例。１２例均手术治疗，单纯阑尾切除７例，盲肠部分切除２例，右半结肠切除１例，合并回盲部淋巴结切除２例，术后抗结核治疗９例。１２例均顺利痊愈，无并发症。结论结核性阑尾炎发病率低，临床表现无特异性，术前确诊困难，要注意术中观察并重视病理检查。应早期手术和术后抗结核治疗，防止并发症产生。     

糖尿病合并毛霉菌病二例报道

回顾分析2例经病理检查确诊肺型、鼻脑型毛霉菌合并糖尿病患者的临床特征。其中,1例为糖尿病合并肺型毛霉菌患者,表现为胸痛、咯血,右上肺肿块穿刺活检示形态符合毛霉菌,采用两性霉素B及手术治疗治愈。1例为糖尿病合并鼻脑型毛霉菌病患者,表现为头痛、鼻腔内黑色干酪样物,最后偏瘫、死亡,鼻腔肿物病理检查见毛霉菌团块及菌孢,经手术及氟康唑治疗无效后死亡。毛霉菌病罕见且易继发于糖尿病等免疫力低下疾病,病情进展迅速,需尽快诊断及治疗。     

82例老年人肺部念珠菌感染的临床分析

目的对我院１９８０年１月至１９９５年５月收治的８２例老年人肺部念珠菌感染病例进行分析，探讨其临床特点。方法３％过氧化氢溶液漱口后采取痰标本，连续３次以上痰真菌培养为同一种菌，并结合临床确诊。６３例应用氟康唑治疗的患者中，４２例口服，第１天３００ｍｇ，第２天改为１５０ｍｇ，每天１次；另２１例患者第１天４００ｍｇ静滴，第２天改为２００ｍｇ静滴，每天１次。连续１～２周后改口服１５０ｍｇ，每天１次。疗程３～４周。应用其它抗真菌药物治疗者包括酮康唑１４例，两性霉素Ｂ１例，５－ＦＣ１例。结果６３例应用氟康唑治疗患者，病死率９．５２％。应用其它抗真菌药物者，治愈９例，死亡７例。氟康唑治疗组１２例出现轻度胃肠道反应，其它抗真菌药物组中８例出现轻、中度胃肠道反应。结论老年人肺部念珠菌感染的治疗，除停用抗生素、改善营养状况外，应早期适当应用抗真菌药物     

2型糖尿病合并孤立性气管毛霉病两例报道并文献复习

毛霉病是一种罕见且致命的疾病。本文报道2例2型糖尿病合并孤立性气管毛霉病患者的诊疗经过，患者表现为呼吸困难，胸部CT检查提示气管软组织增生伴管腔狭窄，经支气管镜获取病变组织并行病理检查证实为毛霉病。行硬质支气管镜治疗及全身抗真菌治疗后患者病情好转，随访期间病情稳定。孤立性气管毛霉病因缺乏特异性影像学及临床表现，易造成漏诊及误诊，从而延误治疗。病理检查对毛霉病的早期诊断必不可少，且确诊后行内镜介入治疗联合全身抗真菌治疗可改善患者预后。     

肺曲霉菌病21例临床分析

肺曲霉菌病在临床上并不罕见。近年来，有关的文献报道逐渐增多。由于此病大多继发于一些肺部的疾病，在临床表现方面，与基础肺部疾病互相混淆，易造成误诊或漏诊，因此临床医师应引起注意。本文对我院近２０年来，经手术及纤维支气管镜检查与病理确诊的２１例肺曲霉菌病进行临床统计分析，现报告如下。１　临床资料１－１　本组病例共２１例，男１７例，女４例。年龄２１～６０岁。经手术切除肺叶病理检查确诊的病例为１６例。经纤维支气管镜活检病理报告确诊的病例为５例。１－２　本组２１全病例均有咳嗽、咳痰病史，其中２０例有咯血的…     

A case report of pulmonary nocardiosis successfully treated with a combination of sulfamethoxazole-trimethoprim (ST) and sparfloxacin]

We encountered a case of pulmonary nocardiosis that responded dramatically to combined ST and sparfloxacin treatment. A 55-year-old woman presented with fever, cough and yellowish sputum. She had been under treatment with oral prednisolone (15 mg per day) since July 1997 after a diagnosis of Evans syndrome. A high fever of 39.8 degrees C was noted on January 30, 1998. The patient was hospitalized for bloody sputum, bilateral hypochondriac pain and evidence of infiltrative opacities in the left lower lobe on chest radiography. Bacterial pneumonia was suspected, and she was treated with piperacillin, but her clinical symptoms did not improve. Sputum culture and serologic examination failed to lead to a definitive diagnosis. Nocardia farcinica was isolated by culturing tissue obtained by CT-guided transcutaneous pulmonary biopsy, leading to a diagnosis of pulmonary nocardiosis. The results of an MIC test for antimicrobial agents led to treatment with a combination of ST and sparfloxacin, and the clinical symptoms improved. These clinical observations suggest that, when pneumonia is diagnosed in patients who have been receiving oral steroids for a prolonged period, pulmonary nocardiosis should be considered in the differential diagnosis to enable selection of appropriate antimicrobial agents.     

Wegener's granulomatosis in a woman with asymptomatic primary biliary cirrhosis

A 60-year-old woman was admitted to our hospital in June 1985, complaining of fever, cough and right lower chest pain, with a five-year history of asymptomatic primary biliary cirrhosis. Chest X-ray on admission showed an infiltrative shadow in the right lower lung field. She was first treated with various antibiotics unsuccessfully. Hemoptysis continued. Dyspnea and anemia appeared. Chest X-ray 17 days after admission showed multiple infiltrative shadows in the both lung fields. She was treated with steroid pulse therapy successfully. During prednisolone treatment decreasing nodular shadows with cavities appeared on chest X-ray. An open lung biopsy was performed in March 1986. The histologic findings showed a necrotizing vasculitis with granuloma and perivascular fibrosis. She was treated with prednisolone and prednisolone-azathioprine therapy unsuccessfully, but successfully with prednisolone-cyclophosphamide therapy. This case was a rare case of Wegener's granulomatosis with transition from fulminant type to granulomatous type. No similar case of Wegener's granulomatosis with asymptomatic primary biliary cirrhosis has been reported in the literature.     

Successful treatment of allergic bronchopulmonary aspergillosis with erythromycin and fluconazole]

A 30-year-old woman was admitted to our hospital because of productive cough, wheezing, and the disclosure of abnormal shadows on chest X-ray films. The patient was given a diagnosis of allergic bronchopulmonary aspergillosis (ABPA) based on eight findings: asthma, eosinophilia, elevated serum IgE concentrations, immediate skin reactivity to Aspergillus antigen, the presence of precipitating antibodies against Aspergillus antigen, lung infiltration, central bronchiectasis, and repeated culture of Aspergillus fumigatus in sputum. Because she refused steroids, we administered erythromycin. The volume of her sputum subsequently decreased, her symptoms were brought under control, and her serum IgE fell, but the lung infiltrates did not clear. Discontinuation of erythromycin resulted in exacerbation of the patient's asthmatic symptoms, with high fever, increased sputum volume and IgE levels, and worsening lung infiltrates. These symptoms responded well to oral prednisolone medication, but sputum culture was still positive for Aspergillus fumigatus. Following discontinuation of prednisolone, the patient was treated with erythromycin, to which oral fluconazole was added for 16 months. Subsequent sputum cultures were negative for Aspergillus fumigatus, and for 7 years thereafter the patient remained in remission. Erythromycin and anti-fungal drugs may be worth trying in cases of allergic bronchopulmonary aspergillosis.     

A case of rapidly deteriorated pulmonary aspergillosis with various clinical manifestations]

A 62-year-old man with chronic hepatitis was admitted to the hospital because of severe asthma, fever, and a chest radiograph abnormality. He had previously been treated unsuccessfully with several antibiotics in another hospital. The chest radiographs and CT films showed multiple infiltrations along the bronchi and in the peripheral regions of both lungs. Aspergillus fumigatus was detected in a sputum culture and the non-specific serum IgE was elevated. Allergic broncho-pulmonary aspergillosis (ABPA) was suspected and then steroids were administered. Although the asthma symptoms improved after the steroid therapy, lung infiltration deteriorated rapidly, affecting both lungs, and cavitations appeared. We concluded that invasive aspergillosis had developed from ABPA. Itraconazole and amphotericin B were administered, resulting in gradual improvements in the bilateral infiltration seen in the chest radiographs. The patient underwent open lung biopsy to rule out systemic vasculitis. The histological diagnosis was organizing pneumonia without vasculitis and without aspergillus or other organisms. The pathological findings resulted from the intensive anti-fungal therapy. There is a possibility that the temporal steroid therapy may have affected the conversion of ABPA to invasive aspergillosis.     

A case of group G Streptococcus sepsis, chest wall abscess, and vertebral osteomyelitis mimicking a primary lung cancer with bone metastasis]

A 73-year-old woman who had been followed in our department of gynecology because of ovarian cancer since 2002, was admitted with liver dysfunction and complaining of back pain and light precordial chest pain. The chest radiograph on admission revealed a tumor in her left upper lung field, and chest CT revealed a tumor adjacent to the chest wall and mediastinum. FDG-positron emission tomography (PET) showed abnormal uptake in the tumor and Th6/7, and the subaortic lymph nodes. On the basis of these findings, primary lung cancer with bone metastasis was suspected. She had a high grade fever on admission, and blood cultures were positive for group G streptococcus. The treatment with intravenous penicillin was started. Percutaneous biopsy of the tumor in her left chest showed an abscess wall in the chest wall, but no evidence of malignancy. Transbronchial lung biopsy and CT-guided biopsy also showed no malignant cells. Since the tumor decreased in size and back pain improved gradually by only antibiotic treatment, a diagnosis of sepsis of group G streptococcus, chest wall abscess, and vertebral osteomyelitis was made. She was treated with intravenous penicillin for 4 weeks and oral amoxicillin for another 4 weeks. After 60 days of antibiotic treatment, the tumor vanished.     

A case of smoldering adult T-cell leukemia complicated by various pulmonary infections]

A 46-year-old man was admitted to Oita Medical College Hospital on October 16, 1987, because of cough and sputum. Chest X-ray and chest CT films showed diffuse reticulonodular shadow. The specimens obtained by transbronchial lung biopsy revealed cysts of pneumocystis carinii. Abnormal lymphocytes with lobulated nuclei were found 2-7% of peripheral leucocytes. The anti HTLV-I antibody was positive. According to these data, we diagnosed the patient as smoldering adult T cell leukemia with pneumocystis carinii pneumonia. The abnormal shadow on chest X-ray disappeared after SMX-TMP and pentamidine treatment. After about 1 year, he was again admitted for high fever. Chest X-ray showed infiltration with cavity in right upper lobe. Streptococcus pneumoniae was isolated from the sputum. The infiltration shadow on chest X-ray disappeared after antibiotics treatment. However, multiple nodular shadow appeared on the chest X-ray and ATL cell infiltration was found in the specimens of transbronchial lung biopsy. ATL cells in peripheral blood also increased and serum LDH and Calcium levels were markedly high. According to these data, we diagnosed the patient as having a ATL crisis. Although chemotherapy for ATL was started, the ATL, cell infiltration shadow on the chest X-ray enlarged, and bilateral diffuse patchy shadows was appeared on the chest X-ray. He died of respiratory failure on April 26, 1989. Cytomegalovirus pneumonia and ATL cell infiltration were revealed by necropsy.     

Bilateral pulmonary infiltrates in a patient with ulcerative colitis receiving mesalazine

A 36-year-old woman presented with a 2-month history of dry cough, bilateral pain in the upper chest, and low-grade fever. She had a 1-year history of ulcerative colitis (UC), which was treated with mesalazine. Cultures of sputum and bronchoalveolar lavage (BAL) fluid were negative. Chest radiograph and a computed tomography (CT) scan showed dense bilateral subpleural infiltrates in both upper lobes. A c-ANCA test was positive in a 1:1280 titer, and further specification showed antibodies against proteinase-3 antigen. Due to the possibility of mesalazine toxicity, this medication was stopped. Within 2 weeks, the patient's symptoms markedly improved, together with the chest roentgenogram.     

Lymphocytic interstitial pneumonitis associated with autoimmune hepatitis.

A 49-year-old woman was diagnosed as autoimmune hepatitis and started on steroids and azathioprine. Subsequently, she developed fever; chest radiograph showed lower lobe nodular opacities. Bronchoalveolar lavage and transbronchial lung biopsy confirmed the diagnosis of lymphocytic interstitial pneumonitis.     

Disseminated Mycobacterium kansasii infection with pulmonary alveolar proteinosis in a patient with chronic myelogenous leukemia

A 64-year-old woman with chronic myelogenous leukemia (CML) was admitted due to prolonged fever and lung infiltrates. An open lung biopsy was required to make the diagnosis of pulmonary alveolar proteinosis (PAP) and infection with Mycobacterium kansasii. She was treated successfully with combined antimycobacterial therapy for 14 months. However, the leukemia progressed and the patient developed recurrent bilateral lung infiltrates. Blood and bronchoalveolar fluid cultures yielded growth of Acinetobacter. She died shortly thereafter due to septic shock. The relationship between M. kansasii infection, PAP, and abnormal host defense in CML is discussed.