S1-HIV感染肺炎.pptVIP

Pneumonia in HIV, approached by specific diseases通过特定疾病考察HIV感染肺炎  Distribution of AIDS cases by five opportunistic infections in Thailand, (Data as of September 1984-March 2004)泰国按5种机会性感染分类的AIDS病例组成情况， （1984年9月-2004年3月数据） Mycobacterium Infection - Mycobacterium tuberculosis (M. TB) - Mycobacterium avium Complex (MAC) Fungal Infection - Pneumocystis jirovecii - Cryptococcus neoformans Bacterial Infection - Nocardia spp. - Rhodococcus equi - Miscellaneous Mycobacterium tuberculosis 结核分枝杆菌 (M. TB) Impact of TB on HIV leading AIDS-related OI enhance HIV replication might accelerate the natural progression of HIV infection drug interaction between RMP vs. ARV Impact of HIV on TB high rate of primary TB and reactivation increase incidence of extrapulmonary and disseminated TB increase incidence of paradoxical reaction might need longer treatment course more adverse drug reactions increase incidence of MDR-TB high mortality rate Clinical manifestations of active TBin early versus late HIV infection HIV感染早期和晚期活动性结核的临床表现 Radiographic Pictures of TB/HIV CD4 300 - patchy or nodular infiltration - location in apical or subapicoposterior segment of upper lobe or superior segment of lower lobe - dry, thick wall cavitation (~50%), air-fluid level is uncommon - lymphadenopathy is unusual - pleural effusion could be found Radiographic Pictures of TB/HIV CD4 200 - alveolar infiltration, diffuse interstitial infiltration, or mixed infiltration - location in any segments or lobes - common enlarged lymphadenopathy - common extrapulmonary involvement - normal CXR (14-20%) in advanced AIDS (CD450) Mycobacterium avium Complex鸟分枝杆菌综合症(MAC) MAC infection in Non-HIV Prior history of underlying lung pathology Middle-age to old man Typical radiographic pictures - upper lobe fibronodular lesion, associated with pleural thickening - cavitations tend to be higher than tuberculosis (60-90% vs. 50%) and more likely to be thin-wall, quite large - ple