资源描述
单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,ppt课件,*,肺隐球菌感染,的影像学改变,1,ppt课件,肺隐球菌感染的影像学改变1ppt课件,1,肺部真菌感染,/,真菌病,影像学特征是什么?,2,ppt课件,2ppt课件,2,精品资料,精品资料,3,你怎么称呼老师?,如果老师最后没有总结一节课的重点的难点,你是否会认为老师的教学方法需要改进?,你所经历的课堂,是讲座式还是讨论式?,教师的教鞭,“不怕太阳晒,也不怕那风雨狂,只怕先生骂我笨,没有学问无颜见爹娘 ”,“太阳当空照,花儿对我笑,小鸟说早早早”,肺隐球菌感染的影像学改变-课件,4,Specific pulmonary infiltrates on CT scan,halo sign,air crescent sign,cavity,nodules,5,ppt课件,Specific pulmonary infiltrates,5,思考:肺,细菌,感染影像学特征?,不同细菌引起的肺部感染表现,肺炎链球菌,肺炎克雷伯菌,铜绿假单胞菌,金黄色葡萄球菌,厌氧菌,军团菌,结核分枝杆菌,6,ppt课件,思考:肺细菌感染影像学特征?不同细菌引起的肺部感染表现6pp,6,肺,真菌,感染影像学特征,随着真菌病例的积累,需要分析不同真菌感染的影像学特点,肺曲霉病,肺隐球菌病,肺念珠菌病,肺孢子菌病,肺毛霉菌病,7,ppt课件,肺真菌感染影像学特征随着真菌病例的积累,需要分析不同真菌感染,7,肺隐球菌感染,罕见病还是常见病吗,?,8,ppt课件,8ppt课件,8,2024/8/14,Dr.HU Bijie,9,Fungal Species Identified From 140 Patients With Pulmonary Fungal Infections,Aspergillus,曲霉,80,Cryptococcus,隐球菌,30,A fumigatus,12,C,neoformans,30,A flavus,9,Mycelium sterila,3,A niger,2,Penicillium marneffei,2,A terreus,1,Coccidioides immitis,1,Candida,念珠菌,20,Mucor spp,1,C albicans,9,Rhizopus spp,1,C tropicalis,4,Histoplasma capsulatum,1,C glabrata,4,Rhodotorula glutinis,1,C parapsilosis,2,Chen KY, Ko SH, Hsueh PR, et al.Pulmonary Fungal Infection. Chest 2001;120:177-184,9,ppt课件,2023/8/25Dr.HU Bijie9Fungal Sp,9,10,ppt课件,10ppt课件,10,肺隐球菌感染发病率,在中国有地区差别吗?,南京军区福州总医院,2003.3-2010.2,,,38,例,广州呼吸病研究所,1995 to 2010,,,78,例,上海肺科医院,,2001-2009,,,76,例,上海中山医院,100,例,11,ppt课件,肺隐球菌感染发病率在中国有地区差别吗?南京军区福州总医院2,11,肺隐球菌感染,胸部CT的特征性表现?,12,ppt课件,肺隐球菌感染12ppt课件,12,2024/8/14,Dr.HU Bijie,13,13,ppt课件,2023/8/25Dr.HU Bijie1313ppt课件,13,【,病例,】,右肺多发结节,男,,43,岁 ,体检发现右肺多发小结节。无咳嗽、咳痰、咯血、胸痛、发热盗汗。,2006.11.13,入院,2006.11.8,经皮肺穿刺:病理报告无殊,培养:新型隐球菌,4cfu,。,2006.11.17,支气管镜:,TBLB,(右上叶)支气管壁及肺泡组织,其间见炎症细胞浸润伴多核巨细胞反应,未见凝固性坏死,真菌感染可能。,PAS(-),六胺银,(-),抗酸,(-),。,隐球菌乳胶凝集试验:,11.17,及,11.21,两次(),滴度均,1:320,14,ppt课件,【病例】右肺多发结节男,43岁 ,体检发现右肺多发小结节。,14,2024/8/14,Dr.HU Bijie,15,男,,61,岁,,5,月前鼻咽癌行放化疗;,1,周前检查发现双肺阴影。偶有干咳,无咯血、胸痛。胸部,CT,示双肺多发片状、类结节状阴影。,支气管镜,TBLB,病理:慢性炎症。,CT,引导下经皮肺穿刺病理:,炎性病变。,2,次隐球菌乳胶定性试验:阳性;,2,次乳胶凝集定量试验:滴度(,1,:,80,),15,ppt课件,2023/8/25Dr.HU Bijie15男,61岁,5月,15,肺隐球菌感染,女,,73,岁,发热,20,天,,2010-7-14,入院。,T38.2,,稍咳无痰。多种抗菌药物治疗无效,血清隐球菌乳胶凝集试验:,1:1280,G,试验:(,-,),病理(,B,超引导经皮肺活检):肉芽肿性病变,多核巨细胞内见孢子样物,倾向新型隐球菌感染,16,ppt课件,肺隐球菌感染女,73岁,发热20天,2010-7-14入院。,16,肺隐球菌感染,男性,,28,岁,,2,周前出现发热,,T39.0,,伴咳嗽,咳黄脓痰,痰中带少许鲜红色血丝。,2006-5-26,入院。,支气管镜检查:左下叶支气管开口呈外压性狭窄,下叶后基地段一亚段官腔狭窄、变形,粘膜光滑,未见新生物。,左下叶后基底段活检:镜下大量多核巨细胞,胞浆内见大量孢子,倾向新型隐球菌感染。,PAS,() 六胺银()。,隐球菌乳胶凝集试验:阳性;滴度,1,:,640,。,痰培养:新型隐球菌(),17,ppt课件,肺隐球菌感染男性,28岁, 2周前出现发热,T39.0,伴,17,72-year-old,,,underlying breast cancer.,A. at level of right inferior pulmonary vein shows subpleural consolidation and noduleB. Follow-up CT scan obtained five months after A and with four months of anti-fungal therapy demonstrates remaining lesions ofconsolidation (arrowhead) and nodule (arrow) in right lower lobe,.,18,ppt课件,72-year-old,underlying breast,18,肺隐球菌病影像学多样性,多发性结节,单个结节,结节可伴空洞形成,团块,/,实变型,斑片型,广泛微小结节,19,ppt课件,肺隐球菌病影像学多样性多发性结节19ppt课件,19,非获得性免疫缺陷综合征患者,肺隐球菌病,42,例影像学特征及诊断方法,中华内科杂志,2009,;,48,:,362-366,20,ppt课件,非获得性免疫缺陷综合征患者中华内科杂志2009;48:362,20,病理确诊的肺隐球菌病,38,例临床分析,南京军区福州总医院,2003,年,3,月至,2010,年,2,月,均社区获得,男,29,,女,9,,,21,70,岁(,4713,)。,伴基础疾病者,9,例。,CD4,细胞正常,20,例。,影像学表现,:,35,例病变靠近胸膜,以下肺部受累多见,其中左下肺,21,例,右下肺,23,例;单发结节影,11,例,多发结节影,16,例,多发斑片状影,3,例,肿块伴多发结节,5,例,弥漫性肺实质浸润影,3,例;,4,例,PET-CT,检查,病灶,均有较高,SUV,值,。,经皮肺穿刺活检确诊,33,例,开胸手术确诊,1,例,胸腔镜手术确诊,3,例,淋巴结活检确诊,1,例。,治愈,34,例,显效,3,例,死亡,1,例。,中华结核和呼吸杂志,2011,;,34,:,653-656,21,ppt课件,病理确诊的肺隐球菌病38例临床分析南京军区福州总医院2003,21,Retrospective analysis of 76 immunocompetent patients with primary pulmonary cryptococcosi,primary pulmonary cryptococcosis from 1995 to 2010 confirmed histologically among all patients.,Mean age = 42.5,,,55 (72%) were male,.,cough (47 pts, 62%),expectoration (29 pts, 38%),fever (16 pts, 21%),chest pain (15 pts, 20%),dyspnea (17 pts, 22%),emaciation (10 pts, 13%).,18 (24%) were asymptomatic,.,lower lung (60 pts, 78.9%),,,upper lung (25 pts, 32.9%).,More lesions (28 pts, 37%),were characterized by patchy consolidations.,Lung. 2012 Jun;190(3):339-46,22,ppt课件,Retrospective analysis of 76 i,22,目前对肺隐球菌病的病例总结,进行胸部,CT,表现分析,可能存在严重偏差!,23,ppt课件,目前对肺隐球菌病的病例总结,进行胸部CT表现分析,可能存在严,23,免疫功能,受损人群,肺隐球菌感染,胸部CT的特征是否不同?,24,ppt课件,免疫功能受损人群肺隐球菌感染胸部CT的特征是否不同?24pp,24,免疫功能正常与受损宿主,肺隐球菌病,临床特征,CHEST 2006; 129:333340,25,ppt课件,免疫功能正常与受损宿主肺隐球菌病临床特征CHEST 200,25,免疫功能正常与受损宿主,肺隐球菌病,胸部,CT,表现的比较,CHEST 2006; 129:333340,26,ppt课件,免疫功能正常与受损宿主肺隐球菌病胸部CT表现的比较CHES,26,免疫功能正常与受损宿主,肺隐球菌病,治疗随访的比较,CHEST 2006; 129:333340,27,ppt课件,免疫功能正常与受损宿主肺隐球菌病治疗随访的比较CHEST,27,胸部,CT,的随访比较,对,鉴别肺,隐球菌,病,的价值较大,28,ppt课件,胸部CT的随访比较,对鉴别肺隐球菌病的价值较大28ppt课件,28,病灶的变化速度,曲霉菌病:不定?,隐球菌病:通常较慢,念珠菌病:较快?,毛霉菌病:快速进展?,特殊细菌:奴卡菌、放线菌,结核病与非结核分枝杆菌,普通细菌:金葡菌、铜绿假单胞菌、厌氧菌,非感染性疾病:肿瘤、肺栓塞,29,ppt课件,病灶的变化速度曲霉菌病:不定?29ppt课件,29,Clinical analysis of 76 patients pathologically diagnosed with pulmonary cryptococcosis,Shanghai Pulmonary Hospital-2001-2009,males 54, females 22,41 immunocompetent (53.95%), 35/41 were asymptomatic.,Approximately,80% patients have histories suspicious of environmental fungal exposure,.,CT findings,:,predominantly peripheral findings (85.53%, 65/76) including nodular masses (55.26%, 42/76), pneumonic infiltrates (23.68%, 18/76) and mixed (21.05%, 16/76).,43.42% (33/76) were initially misdiagnosed, often as cancer by,false-positive 18F-FDG-PET (28/46 cases),.,51 patients received antifungal therapy, 25 patients were clinically observed without treatment.,Eur Respir J. 2012 Mar 9,PET/CT,:部分隐球菌感染病灶显示高,SUV,值!,30,ppt课件,Clinical analysis of 76 patien,30,肺,隐球菌,病,的其他病理类型?,31,ppt课件,肺隐球菌病的其他病理类型?31ppt课件,31,32,ppt课件,32ppt课件,32,33,ppt课件,33ppt课件,33,肺,隐球菌,病,的实验室诊断?,34,ppt课件,肺隐球菌病的实验室诊断?34ppt课件,34,2024/8/14,Dr.HU Bijie,35,Pulmonary Fungal InfectionEmphasis on Microbiological Spectra, PatientOutcome, and Prognostic Factors,CHEST 2001; 120:177184,入选标准:明显肺部病变合并如下一项:,活检标本病理组织中发现真菌,open thoracotomy,thoracoscopy,transbronchial lung biopsy,ultrasound-guided percutaneous needle biopsy,;,上述标本涂片和培养分离到真菌;,胸水或血液中分离到真菌,无肺外感染征象。,肺隐球菌感染:经皮肺吸引物显微镜检查鉴定为隐球菌,或阳性隐球菌抗原,滴度,=1:8,35,ppt课件,2023/8/25Dr.HU Bijie35Pulmonar,35,36,ppt课件,36ppt课件,36,隐球菌病,vs,结核病,:,T-Spot-+,37,ppt课件,隐球菌病 vs 结核病:T-Spot-+37ppt课件,37,2024/8/14,Dr.HU Bijie,38,Patients and Mortality Rate With Different Patterns of Pulmonary Fungal Infections,No.,Mortality, No. (%),Total,140,51 (36.4),Aspergillus spp,曲霉,80,32 (40.0),Aspergilloma,41,3 (7.3),Invasive aspergillosis,33,24 (72.7),Systemic,6,5 (83.3),Cryptococcus spp,隐球菌,30,2 (6.7),Cryptococcoma,23,0 (0),Pneumonia,5,0 (0),Systemic,2,2 (100),Candida spp,念珠菌,20,14 (70.0),Pneumonia,12,9 (75.0),Systemic,8,5 (62.5),Others,其他,10,3 (30.0),Mycetoma,4,0 (0),Pneumonia,4,2 (50.0),Systemic,2,1 (50.0),38,ppt课件,2023/8/25Dr.HU Bijie38Patients,38,肺,隐球菌,病,的治疗与预后:隐球菌对三唑类药物敏感性如何?,39,ppt课件,肺隐球菌病的治疗与预后:隐球菌对三唑类药物敏感性如何?39p,39,欢迎浏览和下载本课件,上海国际医院感染控制网上论坛,(我国最大的,医院感染控制,交流平台),Thank you!,40,ppt课件,欢迎浏览和下载本课件,40,
展开阅读全文