肺部真菌的诊治解决方案.ppt

解决常见真菌感染的建议方案 白念 氟康唑 曲霉菌 伏立康唑 伊曲康唑 二性霉素B 非白念 大剂量氟康唑 棘白霉素 伏立康唑(克柔) 白细胞减少患者真菌感染治疗策略 治疗 诊断 0 36 37 38 39 40 41 体温 Culture + Tissue + -7 0 7 14 21 28 35 42 49 56 63 -14 0.1 1 10 白细胞减少------ 白细胞计数 经验 可能 预防 无感染 目标 确诊 抢先治疗 疑似 侵袭性(尤其是肺)曲霉菌病的治疗(Practice Guidelines for Diseases Caused by Aspergillus in 2000 ) 尚无理想的治疗疗程，主要取决于临床治疗反应而非任何人为拟定的总剂量 疗程取决于 侵袭性曲霉菌病的程度 治疗的反应 基础疾病或免疫状态 恰当地疗程应包括 清除微小病灶 临床和放射学检查证实病灶吸收 培养阴性 基础状况改善 Stevens AD, et al. Clinical Infectious Diseases 2000;30:696–709 抗真菌感染的现在和将来展望 曲霉菌合并HIV 其他霉菌 其他霉菌合并爱滋病 1981 1986 1991 1996 率/10万人 0.0 0.2 0.6 0.4 念珠菌 念珠菌合并HIV 曲霉菌 引入氟康唑 引入新型抗真菌药 ？ 谢谢 ! * In patients at high risk for developing fungal infection, publications have supported that “halo” sign(s) are correlated with invasive aspergillosis. This has been confirmed in the Comparative Aspergillosis Study, where the majority of patients with a Data Review Committee-confirmed diagnosis of invasive aspergillosis presented with a halo or air crescent sign. High risk is referred to as HSCT in this instance. References: Herbrecht R, Denning DW, Patterson TF, et al., for the Invasive Fungal Infections Group of the European Organization for Research and Treatment of Cancer and the Global Aspergillus Study Group. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002;347:408-415. Rex JH, Walsh TJ, Anaissie EJ. Fungal infections in iatrogenically compromised hosts. Adv Intern Med. 1998;43:321-371. * Left. Bilateral aspergillomas in a 71-year-old man with residual tuberculosis. Chest computed tomographic (CT) scan (lung window) shows large cavities bilaterally in the upper lobes containing fungus balls of different sizes. Right. Aspergilloma with the air crescent sign in a 67-year-old woman with residual tuberculosis. Thinsection CT scan (mediastinal window) shows extensive scarring in the upper lobes. A large aspergilloma is seen in the left upper lobe, with a characteristic air crescent between the aspergilloma and the cavity wall