课件：肺部真菌的诊治.pptVIP

曲霉菌培养阳性患者的基础疾病 % Perfect JR, et al. Clinical Infectious Diseases 2001; 33:1824–33 侵袭性曲霉菌病危险因素 高危 (%) 同种异体BMT 25/39 (64) 白细胞减少 39/61 (64) 血液系统恶性 53/106 (50) 中危 (%) 自体BMT 4/14 (28) 营养不良 27/99 (27) 皮质激素 78/381 (20) HIV 26/138 (19) 实体器官移植 21/124 (17) 糖尿病 17/151 (11) 基础肺部疾病 45/477 (9) 实体器官肿瘤 10/126 (8) 低危 (%) 囊性纤维化 1/127 (0.7) 结缔组织疾病 0/28 (0) BMT, bone marrow transplant. Number to the left of the virgule, no. of cases of IA; number to the right of the virgule, no. of cases in which an Aspergillus species was isolated. Perfect JR, et al. Clinical Infectious Diseases 2001; 33:1824–33 器官移植后感染的常见顺序 常见院 内感染 HSV Onset of CMV 0 1 2 3 5 4 6 Onset of hepatitis B or C Fishman JA, et al. NEJM. 1998, 338:1741-1751 EBV, VZV, influenza, RSV, adenovirus 细菌 病毒 Wound,catheter-related infections, pneumonia 真菌 Nocardia Listeria, tuberculosis Pneumocystis Aspergillus Cryptococcus Candida 移植后月数 不常见或机会性感染 社区获得性或持续感染 寄生虫 曲霉菌病的治疗 Practice Guidelines for Diseases Caused by Aspergillus. Clinical Infectious Diseases 2000;30:696–709 Australian Guidelines for use of antifungal agents in the treatment of invasive Candida and mould infections (2003). .au 制霉菌素 两性霉素B (1958) 灰黄霉素 5-FC 咪康唑 酮康唑 氟康唑 伊曲康唑 L-AmB ABCD ABLC 特比萘芬 伏立康唑 Posacon XMP 粪壳菌素 Caspofungin Micafun Ravucon Anidulafungin # of drugs 抗真菌药物的50多年历程 抗侵袭性真菌药物分类 多烯类 两性霉素B的各种剂型 拟核苷类 氟胞嘧啶(flucytosine) 棘球白素 Caspofungin卡泊芬净 Micafungin米卡芬净 Anidulafungin阿尼芬净 吡咯类 Ketoconazole酮康唑 Itraconazole伊曲康唑 Fluconazole氟康唑 Vericonazole伏立康唑 Posaconazole泊沙康唑 Ravuconazole雷夫康唑 二性霉素 二性霉素-B脱氧胆酸 (DAMB) 二性霉素-B脂质体 AMB colloidal dispersion, ABCD AMB lipid complex, ABLC Liposomal AMB, LAMB 吡咯类抗侵袭性真菌药 Ketoconazole Itraconazole Fluconazole Vericonazole Posaconazole Ravuconazole 咪唑 三唑类 “二代三唑” 棘球白素(棘白霉素) Caspofungin Micafungin Anidulafungin They have potent and broad-spectrum, potentially fungicidal in vitro activity against C. species and cause severe structural damage to the hyphal elements of Aspergillus spp. 抗真菌药物治疗靶位 细胞膜 真菌主要利用麦角固醇而非胆固醇 多烯类抗真菌药 吡咯类抗