真菌--胡亮钉讲稿

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1、军事医学科学院附属医院骨髓移植科全军造血干细胞移植中心胡亮钉侵袭性真菌感染(IFI)的预防和治疗3CAUSESOFDEATHAFTERUNRELATEDDONORTRANSPLANTS1994-1999SUM02_41.ppt%OFDEATHS100020406080PrimaryDiseaseGVHDIPnInfectionOrganFailureOther100%50%ChangeofTherapyat72hoursResponsetoInitialregimenNoresponseResponsetochangeofantibacterialdrugs7%18%Res

2、ponsetogranulocytetransfusionFurtherchangeoftherapyat4-6daysResponsetoantifungaltherapy5%50%25%Noresponse:died10%Neutrophilrecovery5%Responsetoantiviralagents(orsurgery)5%0246810+DayFeverNoresponsePersistentfeverduringfirst3-5daysoftreatment:noetiologyReassesspatientondays3-5Changeantibiot

3、icsAntifungaldrugwithorwithoutantibioticchangeIfprogressivediseaseifcriteriaforvancomycinaremetIffebriledays5-7andresolutionofneutropeniaisnotimminentMortalityDuetoInvasiveMycosesMcNeilMM,etal.ClinInfectDis2001;33:641-7UnitedStates,1980-1997NosocomialCandidemia:EpidemiologyPappasPGetal,Cli

4、nInfectDis2003;37:634-43N=1593InvasiveAspergillosisMortalityReviewofLiteratureafter1995Reviewof1941Patientsfrom50StudiesLinS-Jetal,ClinInfectDis2001;32:358-66PrimaryDiagnosisinPatientswithInvasiveAspergillosis(595patients)PattersonTF,etal.Medicine,2000;79:250-60EpidemiologyofInvasiveAsperg

5、illosisinHematopoieticStemCellTransplantationWaldA,etal.JInfectDis1997;175:1459-66DaysfromTransplanttoDiagnosisofInvasiveAspergillosisOnly31%neutropenic96%increasedincidence真菌感染存在的问题1真菌感染诊断？2那些是侵袭性真菌感染的高危因素？3实验室检查？4临床常见的真菌检测结果的判断？5怎样合理使用抗真菌药物？6抗真菌感染疗效评价？真菌感染的诊断1确诊（Proveninvasivefungalinfec

6、tions)2可能（Probableinvasivefungalinfections)3可疑（Possibleinvasivefungalinfections)真菌感染的高危因素低：自体BMTPBSC儿童急淋（卡肺除外）中低：粒缺100-500小于3W老年患者或导管中高：定植大于1个部位或1个部位多次急非淋或TBI异基因同胞间相合BMT高：粒缺小于100大于5W定植（热念）无关移植GVHD激素大于1mg/kg和粒缺小于100大于1W激素大于2mg/kg大于2W大剂量AraC、Fludarabine粒缺或器官移植患者肺部感染检查呼吸道症状和体症疾病状态粒缺/BMT肺X-ray

7、/CT器官移植DSBAL肺X-rayFLneedle/biopsyDSBALCAresectionFLCTbiopsy实验室检查霉菌：痰涂片、BAL、活检物镜检呼吸道分泌物和活检物培养GM检测（FDA）ß-1，3-D-glucanPCR实验室检查念珠菌：体液和组织活检血和体液培养呼吸道分泌物培养PCRß-1，3-D-glucanprecipitinCandidamannanby-ELISAanti-CandidamannanbyELISA实验室检查血清学检查：半乳甘露聚糖Galactomannan）抗原检测是FDA