系统性真菌感染诊断与治疗王静.pptVIP

系统性真菌感染诊断与治疗 郑大一附院 王静 感染性疾病特征 有病原体（病毒、细菌、支原体、真菌···） 有流行病学特征（传染源、传播途径、易感人群、免疫力） 临床规律（潜伏期、典型临床经过等） 治疗选择（重视病原治疗） 预防措施（疫苗、药物预防） 真菌感染的类型 浅部真菌病(表皮、甲板、毛发、粘膜) 皮下组织真菌病(真皮、皮下组织和骨) 系统性真菌病(内脏感染、全身播散) 问 题 现代诊疗措施的发展，诱发真菌感染因素增多 涉及感染的真菌广泛,发病率逐年增加 临床过程错综复杂, 认识和诊断手段落后 药物治疗效果不甚理想，毒副反应很难避免 主要内容 流行病学现状 深部真菌感染的影像学表现 实验诊断的方法 预防及治疗的策略 流行病学 常见深部真菌感染病原体 念珠菌属（Candida) 曲霉属（Aspergillus) 隐球菌属（Cryptococcosis) 毛霉属（Mucorales) 念珠菌属（Candida) 白念珠菌（C.albicans) 热带念珠菌（C.troicalis) 近平滑念珠菌（C.parapsilosis) 光滑念珠菌（C.glabrata) 克柔念珠菌（C.krusei) 曲霉属（Aspergillus) 烟曲霉（A.fumigatus) 黄曲霉（A.flavus) 构巢曲霉（A.nidulans) 黑曲霉（A.niger) 土曲霉（A.terreus) Opportunistic Systemic Fungal Infection Rose from 2.0 to 3.8 infections per 1000 discharges from US Hospitals between 1980 and 1990(J Infect Dis,1993;167:1247). An increase from 0.9 to 6.6 nosocomial fungal infections per 1000 discharges in one Taiwanese hospital between 1981 and 1993 (Infect Control Hosp,1997;18:369). 医院病房中分离出来的医院感染致病菌 各科检出念珠菌的发生率(1000人) ICU中分离出来的医院致病菌 Frequency of Systemic Fungal Infection(I) 20%-50% of patients died from haematologial malignancies have evidence of invasive fungal infections at autopsy Mortality was 73% for bone marrow recipients with Candida infections and 84% for those with Aspergillus The death rate was even higher in patients with mixed Aspergillus and Candida tissue infections Frequency of Systemic Fungal Infection(II) Fungal infections occur in 5% to 45% of all solid organ transplant patients 60%-90% of individuals with progressive HIV disease develop at least one fungal infection during the course of the disease Fungi, including Candida and Aspergillus, were isolated in 20% of individuals with chronic granulomatous disease(CGD) 高危人群 血液系统疾病(血液系统肿瘤、肿瘤化疗） 实体器官移植（肝移植、心脏移植等） 各种屏障破坏（烧伤、各种插管、抗生素应用等） 有严重的基础疾病（心、肝、肾、肺脏器功能障碍，糖尿病，艾滋病等） 老年/婴幼儿等特殊人群 流行病学Ι 念珠菌属 It is most nosocomial fungal infections, ranking as the fourth most frequent cause of nosocomial bloodstreams C.albicans is the most frequently isolated species, causing between 48% a