Objective To describe the underlying conditions of chronic pulmonary aspergillosis (CPA). Methods A retrospective study was performed. Details of the clinical, imaging features, and the underlying conditions of CPA patients admitted to a tertiary university teaching hospital from January 2009 to December 2016 were extracted from clinical records. The classification distribution of CPA, and underlying conditions were analyzed. Results Among the 108 CPA patients, 87 cases had underlying conditions, 21 cases had no underlying conditions. Seventy two (66.7%) patients were engaged in agriculture, the proportion of which was significantly higher in the cases without underlying conditions (85.7% vs. 62.1%). Chronic necrotizing pulmonary aspergillosis (CNPA) was the most common type of these CPA cases. The cases without underlying conditions had significantly more proportion of CNPA than the cases with underlying conditions (85.7% vs. 62.1%). The cases with systemic underlying conditions had significantly more proportion of CNPA than the cases only with pulmonary underlying conditions (82.8% vs. 51.7%). Chronic cavity pulmonary aspergillosis (24/108, 22.2%) only existed in the cases with pulmonary underlying conditions. Underlying conditions were identified in 87 cases of CPA, with 85.1% (74/87) pulmonary and 33.3% (29/87) systemic underlying diseases. Previous tuberculosis mycobacterial infection, bronchiectasis and chronic obstructive pulmonary disease were the most common pulmonary underlying conditions (40.2%, 39.1% and 35.6%, respectively). Diabetes (16.1%) and glucocorticoid using (13.8%) were the most two common systemic underlying conditions. Conclusions CPA can occur in patients with and without underlying diseases. CNPA is the most common type of these CPA, the proportion of which is higher in cases without underlying conditions and cases with systemic underlying conditions. Farming maybe the risk factors of CPA. Chronic pulmonary primary diseases are the most common underlying conditions. The most common systemic factors are diabetes and glucocorticoid using.
随着免疫抑制人群的增多、检测技术的发展, 深部真菌感染日益受到人们的关注。真菌中的曲霉属成了这些免疫功能低下患者致病性感染的重要原因, 而烟曲霉在侵袭性曲霉病例中最常见。侵袭力是烟曲霉菌极为重要的致病原因;病原菌侵入上皮、内皮细胞等组织细胞后才导致了可怕的侵袭性感染。从上世纪90 年代来, 对于侵袭的研究已逐步深入, 为探讨复杂的致病机制打下了基础。侵袭性烟曲霉病一般的致病过程认为是烟曲霉孢子被宿主吸入下呼吸道, 侵入呼吸道上皮细胞后发育成菌丝, 菌丝进一步生长, 可侵入血管、进入血液, 造成全身播散[ 1] 。因此曲霉与宿主细胞( 上皮细胞、内皮细胞等) 的相互作用成了致病过程的重要环节。目前对病原体与宿主细胞作用的研究取得了一些进展, 对阐明致病机制、研究治疗靶点等有重要意义。
Objective To investigate the correlation between persistent wheezing and positive result of sputum fungal culture in patients with chronic obstructive pulmonary disease ( COPD) . Methods The COPD patients who hospitalized in the respiratory department of Shanghai First People’s Hospital, Zhongshan Hospital and Huadong Hospital fromJanuary 2005 to December 2007 were analyzed retrospectively. Results Thirty-five cases were enrolled in the persistent wheezing group and 43 cases in the non-wheezing group. In the wheezing group, sputumfungal culture revealed positive yield in 32 cases while Aspergillus were isolated in 12 cases. In the non-wheezing group, sputum fungal culture revealed only 11 cases positive, and none of which were Aspergillus positive. Aspergillus distributions in the two groups were significantly different( P lt;0. 05) . There was also significant difference in the positive result of sputum fungal culture ( 91. 4% vs 25. 6%, P lt;0. 01) , while there was no significant difference in positive result of bacterial culture( 28. 6% vs 39. 5%, P gt; 0. 05) . In the wheezing group, the patients with antifungal treatment showed better prognosis than those without antifungal treatment( 81. 0% vs 36. 4% , P lt;0. 05) . Conclusion The persistent wheezing in the patients with COPD is correlated with the fungi, especially Aspergillus airway colonization.
Objective To evaluate the efficacy and safety of inhaled amphotericin B ( AmB) in prophylaxis of invasive pulmonary aspergillosis ( IPA) in both animal studies and clinical researches. Methods MEDLINE, ISI, EMBASE and Wanfang Periodical Databases were searched until march 2011 for case-control study on the efficacy and safety of inhaled AmB in prophylaxis of IPA. The articles were evaluated according to inclusion criteria. Poor-quality studies were excluded, and RevMan 4. 22 sofeware was applied for investigating the heterogeneity among individual studies and calculating the pooled odds ratio ( OR) and 95% confidence interval ( CI) . Results Five animal studies with a total of 626 animals were included. The overall survival rate of the immunosuppressed animals with pulmonary aspergillosis treated with nebulized AmB was increased ( 38.3% vs. 9.7% , OR=13.93, 95% CI 7.46 ～26.01, Plt;0. 000 01) . Six clinical trials including 1354 patients were considered. Our meta-analysis showed that inhaled AmB could significantly reduce the incidence rate of IPA ( 2.6% vs. 9.2% , OR=0.27, 95% CI 0.16 ～0.46, P lt;0. 000 01) , but had no definite benefit on mortality. Four studies evaluated the potential side effects of nebulized AmB and showed that there were no significant adverse events. Conclusions Empirical inhaled AmB is associated with a lower rate of IPA but no significant
Objective To assess the quality of current domestic literature about enzyme-linked immunosorbent assay (ELISA) for invasive aspergillosis diagnosis by detecting Aspergillus galactomannan (GM) antigen, and to analyze the sources of bias and variability, as well as the diagnostic ability of different thresholds. Methods Both computer-based online search and manual retrieval were employed to identify relevant articles. The statistical information and quality of science were assessed and classified. The data were analyzed using Meta Disc 1.4 software. The best cutoff value for defining a positive test result was selected by summarizing the following statistical indicators as sensitivity, specificity, likelihood ratio (LR) and summary receiver operating characteristic curve (SROC curve), and by calculating the area under the curve (AUC) as well. Results A total of 20 studies among 2658 literatures were included in accordance with the inclusion criteria, and were divided into different groups based on different cutoff values. Though heterogeneity tests showed no threshold effect, and there were other reasons of heterogeneity. So the data were analyzed by random effects model. The results showed that, compared with other groups, the one with cutoff value set at 0.7 (AUC=0.9456, Q= 0.884 6) showed the best accuracy in diagnosing. Conclusion ELISA detection of Aspergillus GM antigen with cutoff value set at 0.7 has important significance in the early diagnosis of invasive aspergillosis, and it can be conducive to reduce mortality in patients at high risk for Aspergillus infection.
曲霉在自然界中广泛分布，约20种曲霉能感染人类和动物，其中最常见的有烟曲霉、黄曲霉、土曲霉和黑曲霉等。曲霉孢子在空气中传播，人吸入后曲霉可以在气道内定植、致敏、感染，当人体免疫功能低下时可产生危及生命的侵袭性肺曲霉病（IPA）。近年来IPA发病率呈上升趋势，已成为仅次于念珠菌病的主要肺部真菌感染性疾病[1]。虽然IPA已成为器官移植受者、恶性血液病和恶性肿瘤患者等高危人群的重要死因，但对其发病机制了解甚少。本文着重论述近年来IPA发病机制的研究进展。
Objective To improve the diagnosis and treatment of pulmonary infiltration with eosinophilia (PIE). Methods Patients who were diagnosed with PIE in the First Affiliated Hospital of Guangzhou Medical University from January 2004 to December 2013 were recruited and retrospectively analyzed. Data of etiology, clinical manifestation, imaging and pathological features were recorded. Results pulmonary eosinophilic granuloma (PEG) (n=2), eosinophilic granulomatosis with polyangiitis (EGPA) (n=7), Löffler syndrome (n=4), allergic bronchopulmonary aspergillosis (ABPA) (n=16), and chronic eosinophilic pneumonia (CEP) (n=19). There were 27 males and 21 females. 47.9% of the PIE patients were diagnosed as asthma and treated with regular treatment but had not been controlled well. PEG was characterized with wheeze and anhelation in clinical manifestations, unelevated blood eosinophil counts and percentage, significant small airway abnormalities in lung function, diffuse pneumonectasis in Chest CT, and appearance of eosinophil cells in alveole. EGPA shows dyspnea and cough in clinical manifestations, as well as other organs function damaged, unelevated blood eosinophil counts and percentage, significant FEV1/FVC and small airway abnormalities in lung function, tree-in-bud in Chest CT, appearance of eosinophilic granuloma outside blood vessels. Löffler syndrome also showed cough, shorter course of disease, normal lung function and diffusion. ABPA showed wheeze and cough, 31.3% of them with hemoptysis, normal blood eosinophil count, central bronchiectasis in Chest CT. CEP also showed dyspnea and cough. 21.1% of CEP patientshad chest pain, increasing sputum eosinophil percentage compare with blood eosinophil percentage, and small airway abnormalities in lung function. Conclusions Most of PIE patients are diagnosed as asthma but haven’t gotten well controlled under the regular anti-asthmatic treatment. Patients with PIE have increasing eosinophil counts and decreasing lung function. The diagnosis of PIE still depends on clinical manifestation, laboratory test, imaging and pathological examination.
Objective To analyse the clinical characteristics of allergic bronchopulmonary aspergillosis (ABPA). Methods The clinical data of 26 patients diagnosed as ABPA from September 2016 to February 2018 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Results Among 26 patients with ABPA, 15 were female, 11 were male, with a mean age of (47.6±11.7) years. Before the diagnosis of ABPA, 13 cases had been misdiagnosed as bronchial asthma, 8 as bronchiectasis, 8 as pulmonary infection, 3 as tuberculosis. All patients had cough, sputum production, wheeze in 2, fever in 5, hemoptysis in 4, chest pain in 4, dyspnea in 2. The wheezing sound were heard in 20 patients and wet rales were heard in 4 cases. All patients had increased total IgE level ［median 5 000 (654 – 5 337)IU/ml］. The eosinophil counts were increased in 23 patients ［median 0.99 (0.50 – 3.69)×109/L］ and percentages of peripheral blood eosinophil were elevated to (0.36±0.10). Skin prink test was positive in 10 cases. All patients had increased Aspergillus fumigatus specific IgE ［median 15.1 (0.4 – 29.6)kU/L). Chest X-ray showed fleeting consolidation. Chest CT showed multiple pachy, central cylindrical bronchiectasis, mucous plugging, band linear or glover-finger opacities. Sixteen cases underwent bronchoscopy, out of them 5 cases underwent transbronchial lung biopsy, 2 cases underwent CT guided percutaneous lung biopsy. Fourteen cases were treated with oral corticosteroids combined with antifungal therapy. Conclusions ABPA is a relatively rare and without specific clinical manifestations. In the early period, it is mostly misdiagnosed as bronchial asthma, so it is necessary to improve the early diagosis of ABPA and give appropriate treatment. Regular follow-up should be made to prevent the recurrence.