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Pulmonary mycosis

Pulmonary mycosis. I ntroduction. Antibiotics Chemotherapy Immunosuppressant Intervention Organ transplantation HIV/AIDS Corticosteroids. Fungal infections. Pathogens of pulmonary mycosis. Candida Aspergillus Cryptococcus neoformans Pneumocystis.

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Pulmonary mycosis

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  1. Pulmonary mycosis

  2. Introduction Antibiotics Chemotherapy Immunosuppressant Intervention Organ transplantation HIV/AIDS Corticosteroids Fungal infections

  3. Pathogens of pulmonary mycosis Candida Aspergillus Cryptococcus neoformans Pneumocystis

  4. Risk factors Granulocytopenia，<0.5×109/L Immunosuppressant、 Organ transplantation History of fungal infection AIDS Corticosteroids for 3 weeks Chronic underlying diseases ICU，Mechanical ventilation Antibiotics Indwelling catheter，Total parenteral alimentation

  5. Clinical manifestations of pulmonary candidiasis • Cough productive of purulent sputum, dyspnea, and fever • The entirely nonspecific manifestations of pulmonary involvement help to explain why it is often not diagnosed until autopsy • A typical case would be a patient with faradvanced cancer developing a terminal mixed pneumonia with bacteria and Candida

  6. Chest roentgenograms of pulmonary candidiasis patchy or lobar infiltrates

  7. Treatment of pulmonary candidiasis • Fluconazol，200－400mg/d (double at 1st time) • Vorionazole 6mg/kg，q12h，d1 4mg /kg，q12h • Caspofungin 70mg/d，d1; 50mg/d • Amphotericin B, 0.6-0.7mg/(kg·d)

  8. Pulmonary aspergillosis • Invasive pulmonary aspergillosis Nonproductive cough, high fever, and pleuritic chest pain are common; pleural friction rubs also occur

  9. Pulmonary aspergillosis • Aspergilloma Many fungus balls are asymptomatic and are discovered only during routine roentgenographic surveillance. Some patients present with hemoptysis, which is the most important clinical feature of this illness

  10. Pulmonary aspergillosis • Allergic bronchopulmonary aspergillosis (ABPA) fleeting pulmonary infiltrates, eosinophilia, wheezing, fever, and expectoration of brownish plugs is characteristic of ABPA. Some exacerbations of ABPA mimic bacterial pneumonia. Other exacerbations of ABPA have prominent wheezing and may appear at first to be exacerbations of ordinary asthma

  11. Pathology

  12. CT

  13. Treatment • Vorionazole • Amphotericin B, 1-1.5mg/(kg·d) • Itraconazoled1、2，200mg,iv,bid； d3－14，200mg,iv,qd； • Caspofungin • ABPA－prednisone 0.5mg/(kg·d)

  14. Pulmonary cryptococcosis • Fever, malaise, chest pain, and cough occur frequently in symptomatic patients • Many patients have no pulmonary symptoms but have infiltrates on routine chest roentgenograms obtained during evaluation for symptoms of chronic meningitis.

  15. Pathology of pulmonary cryptococcosis

  16. Treatment of pulmonary cryptococcosis • Fluconazol • Itraconazole • Amphotericin B

  17. Pneumocystis carinii pneumonia • Classically, PCP presents with fever, a nonproductive cough, and dyspnea on exertion. • High fevers, rigors, purulent sputum, and pleuritic chest pain are uncommon and can be used to distinguish PCP from pyogenic pneumonia. • Physical examination of the chest may be normal

  18. Pathology of PCP 果莫里环六亚甲基四胺银染色法的高倍镜图像

  19. Treatment of PCP • SMZ-TMP: SMZ 75 mg/(kg·d)+ TMP15mg/(kg·d) iv drop, bid, 6~8h/each time, 21d • Dapsone: 100mg,po,qd + TMP 15 mg/kg, po,tid, 21d • Pentamidine: 4mg/(kg·d) iv drop, 21d

  20. 宿主因素 临床特征 微生物学 组织病理学 确诊 ± ﹢ ﹢△ ﹢ 临床诊断 ﹢ ﹢ ﹢ ﹣ 拟诊 ﹢ + _ _ 侵袭性肺真菌病诊断 注：﹢有，﹣无，△肺组织、胸液、血液真菌培养阳性（除肺孢子菌外）

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