深部真菌感染诊断治疗进展课件.ppt

* Objective: The risk of developing invasive aspergillosis increases with increasing levels of immune deficiency. In contrast the risk of allergic aspergillosis is enhanced in individuals whose immune system is hyper-reactive. The two chest X-rays show examples of acute invasive and allergic pulmonary aspergillosis. Aspergilloma - This is a very different disease also caused by the Aspergillus mould where the fungus exploits an existing weakness. The fungus grows within a cavity of the lung, which was previously damaged during an illness such as tuberculosis or sarcoidosis. Any lung disease which causes cavities can leave a person open to developing an aspergilloma. The spores penetrate the cavity and germinate, forming a fungal ball within the cavity. The fungus secretes toxic and allergic products which may make the person feel ill. The picture shows the fungal ball (aspergilloma) which was removed from a lung and measures about 6cm diameter. * It is usually not easy to recognize the terrorist * So it is difficult to recognize them early * One needs instruments to discriminate between potential terrorists and normals persons – this is annoying enough but inevitable * Tools to diagnose loose on specificity with better sensitivity – not uncommon And then there is always the question whether we deal with a pathogen or bystander * * * Finally. the EORTC- IFICG and the MSG (NSAID) have developed a scheme to help integrate this information and assign a diagnosis with a reasonable degree of certainty. Hence. an empirical treatment strategy is essentially therapy initiated for possible invasive aspergillosis whereas pre-emptive therapy is employed to manage probable disease. * * * * * * * * * * * 由于念珠菌感染具有很高的死亡率，所以早期治疗侵袭性念珠菌感染可显著降低患者死亡率。 对自2001年1月至2004年12月的157例念珠菌血流感染患者进行的回顾性、队列研究，比较开始抗真菌治疗的时间与患者死亡率的关系，结果表明：自首次阳性血培养的血标本采集后开始计时，12小时内即给予抗真菌治疗，患者的死亡率仅为11.1%；12小时后才开始抗真菌治疗，患者的平均死亡率高达33.1%(P=0.169)。 参考文献： 4. Morrell M et al. Antimicrob Agents Chemother. 2005;49:3640-3645