ECCMID 曲霉菌指南简介 慢性肺曲霉菌病感染【创意版】.ppt

慢性肺曲霉菌病-诊断标准 Chronic Pulmonary Aspergillosis – Diagnostic criteria 需要满足以下条件： 1.1 CT影像学表现为肺部真菌球 或 胸腔内空腔，或支气管扩张 Characteristic CT appearance of a fungus ball in a pulmonary or pleural cavity, or dilated bronchus, + 1.2 任何与曲霉菌感染相关的直接或间接的微生物证据 Any direct or indirect microbiological evidence of Aspergillus infection (see below). , 或： 2.1 影像学特征持续表现为慢性肺曲霉菌病（包括空腔，胸膜增厚，严重的纤维化或肉芽肿） Radiological features consistent with chronic pulmonary aspergillosis (including cavity(ies), pleural thickening, extensive fibrosis or nodule) + 2.2 患者的临床表现和影像学证据至少存在3个月以上时间[注意半侵袭性/慢性坏死性肺曲霉病的疾病疗程相对CPA较短，可逐渐演化成慢性肺曲霉病] Clinical or radiological evidence of at least 3 months disease (sometimes inferred) [Note shorter durations of disease may be seen in SIA/CNPA, which becomes CPA because of its chronicity], + 2.3 获得与曲霉菌感染相关的组织病理或微生物证据或免疫学证据（如：肺活检中组织病理发现曲霉样菌丝或经皮肺穿刺培养阳性；肺泡灌洗液抗原强阳性；IgG抗体阳性/曲霉沉淀素阳性）呼吸道分泌物培养或PCR方法检测曲霉样性 Histological or microbiological or immunologic evidence of Aspergillus infection (e.g.histological evidence of Aspergillus-like hyphae in lung biopsy or Aspergillus culture from a percutaneous cavity aspiration; strongly positive BAL antigen; positive IgG antibody/precipitins). Respiratory tract culture or PCR positive for Aspergillus is supportive. 排除： 对于特定地区或游历该地区患者需要排除组织胞浆菌，球孢子菌和副球孢子菌感染；以及排除肺放线菌病。排除活动性细菌感染，包括分枝杆菌感染伴或不伴恶性肿瘤。分枝杆菌感染可能与真菌感染相似 Exclusion of histoplasmosis, coccidioidomycosis and paracoccidiodomycosis in endemic areas or those with pertinent travel history; actinomycosis. Active bacterial infection, including mycobacterial infection and/or malignancy may occur concurrently. Mycobacterial infections or malignancy may mimic CPA. Present by David Denning ECCMID 10th May 2015 in Barcelona .新. * 慢性肺曲霉菌病-气道标本的诊断 Respiratory specimen diagnosis of CPA Present by David Denning ECCMID 10th May 2015 in Barcelona 患者人群 Population 目的 Intention 干预手段 Intervention SoR QoE 文献 Reference 备注 Comment 在非免疫抑制患者中伴有空腔/结节肺浸润 Cavitary or nodular pulmonary infiltrate in Non-immunocompromised patient