肺隱球菌感染的影像學(xué)改變

1、肺隱球菌感染的影像學(xué)改變肺部真菌感染/真菌病影像學(xué)特征是什么？Specific pulmonary infiltrates on CT scanhalo signair crescent signcavitynodules思考：肺細(xì)菌感染影像學(xué)特征？不同細(xì)菌引起的肺部感染表現(xiàn)肺炎鏈球菌肺炎克雷伯菌銅綠假單胞菌金黃色葡萄球菌厭氧菌軍團(tuán)菌結(jié)核分枝桿菌肺真菌感染影像學(xué)特征隨著真菌病例的積累，需要分析不同真菌感染的影像學(xué)特點(diǎn)肺曲霉病肺隱球菌病肺念珠菌病肺孢子菌病肺毛霉菌病肺隱球菌感染罕見(jiàn)病還是常見(jiàn)病嗎？2022/7/26Dr.HU Bijie7Fungal Species Identified Fro

2、m 140 Patients With Pulmonary Fungal InfectionsAspergillus 曲霉80Cryptococcus 隱球菌30A fumigatus12C neoformans30A flavus9Mycelium sterila3A niger2Penicillium marneffei2A terreus1Coccidioides immitis1Candida 念珠菌20Mucor spp1C albicans9Rhizopus spp1C tropicalis4Histoplasma capsulatum1C glabrata4Rhodotorula

3、 glutinis1C parapsilosis2Chen KY, Ko SH, Hsueh PR, et al.Pulmonary Fungal Infection. Chest 2001;120:177-1842022/7/268肺隱球菌感染發(fā)病率在中國(guó)有地區(qū)差異嗎？南京軍區(qū)福州總醫(yī)院-，38例廣州呼吸病研究所, 1995 to 2021， 78例上海肺科醫(yī)院，2001-2021，76例上海中山醫(yī)院 100例2022/7/269肺隱球菌感染胸部CT的特征性表現(xiàn)？2022/7/26Dr.HU Bijie11【病例】右肺多發(fā)結(jié)節(jié)男，43歲 ，體檢發(fā)現(xiàn)右肺多發(fā)小結(jié)節(jié)。無(wú)咳嗽、咳痰、咯血、胸痛、發(fā)

4、熱盜汗。 入院2006.11.8 經(jīng)皮肺穿刺：病理報(bào)告無(wú)殊，培養(yǎng)：新型隱球菌4cfu。2006.11.17 支氣管鏡：TBLB右上葉支氣管壁及肺泡組織，其間見(jiàn)炎癥細(xì)胞浸潤(rùn)伴多核巨細(xì)胞反響，未見(jiàn)凝固性壞死，真菌感染可能。PAS(-) 六胺銀(-) 抗酸(-)。隱球菌乳膠凝集試驗(yàn)：及兩次，滴度均1:3202022/7/26Dr.HU Bijie13男，61歲，5月前鼻咽癌行放化療；1周前檢查發(fā)現(xiàn)雙肺陰影。偶有干咳，無(wú)咯血、胸痛。胸部CT示雙肺多發(fā)片狀、類結(jié)節(jié)狀陰影。支氣管鏡TBLB病理：慢性炎癥。CT引導(dǎo)下經(jīng)皮肺穿刺病理：炎性病變。2次隱球菌乳膠定性試驗(yàn)：陽(yáng)性；2次乳膠凝集定量試驗(yàn)：滴度1：80肺

5、隱球菌感染女，73歲，發(fā)熱20天，2021-7-14入院。，稍咳無(wú)痰。多種抗菌藥物治療無(wú)效血清隱球菌乳膠凝集試驗(yàn)：1:1280G試驗(yàn)：-病理B超引導(dǎo)經(jīng)皮肺活檢：肉芽腫性病變，多核巨細(xì)胞內(nèi)見(jiàn)孢子樣物，傾向新型隱球菌感染肺隱球菌感染男性，28歲， 2周前出現(xiàn)發(fā)熱，T39.0，伴咳嗽，咳黃膿痰，痰中帶少許鮮紅色血絲。 2006-5-26入院。支氣管鏡檢查：左下葉支氣管開(kāi)口呈外壓性狹窄，下葉后基地段一亞段官腔狹窄、變形，粘膜光滑，未見(jiàn)新生物。左下葉后基底段活檢：鏡下大量多核巨細(xì)胞，胞漿內(nèi)見(jiàn)大量孢子，傾向新型隱球菌感染。PAS 六胺銀。隱球菌乳膠凝集試驗(yàn)：陽(yáng)性；滴度1：640。痰培養(yǎng)：新型隱球菌72-y

6、ear-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

7、lower lobe.2022/7/2616肺隱球菌病影像學(xué)多樣性多發(fā)性結(jié)節(jié)單個(gè)結(jié)節(jié)結(jié)節(jié)可伴空洞形成團(tuán)塊/實(shí)變型斑片型廣泛微小結(jié)節(jié)非獲得性免疫缺陷綜合征患者肺隱球菌病42例影像學(xué)特征及診斷方法中華內(nèi)科雜志2021；48：362-366病理確診的肺隱球菌病38例臨床分析南京軍區(qū)福州總醫(yī)院2003年3月至2021年2月均社區(qū)獲得，男29，女9，2170歲4713。伴根底疾病者9例。CD4細(xì)胞正常20例。影像學(xué)表現(xiàn)：35例病變靠近胸膜，以下肺部受累多見(jiàn)，其中左下肺21例，右下肺23例；單發(fā)結(jié)節(jié)影11例，多發(fā)結(jié)節(jié)影16例，多發(fā)斑片狀影3例，腫塊伴多發(fā)結(jié)節(jié)5例，彌漫性肺實(shí)質(zhì)浸潤(rùn)影3例；4例PET-CT檢

8、查，病灶均有較高SUV值。經(jīng)皮肺穿刺活檢確診33例，開(kāi)胸手術(shù)確診1例，胸腔鏡手術(shù)確診3例，淋巴結(jié)活檢確診1例。治愈34例，顯效3例，死亡1例。中華結(jié)核和呼吸雜志2021；34：653-6562022/7/2619Retrospective analysis of 76 immunocompetent patients with primary pulmonary cryptococcosiprimary pulmonary cryptococcosis from 1995 to 2021 confirmed histologically among all patients. Mean age

9、 = 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 characteri

10、zed by patchy consolidations. Lung. 2021 Jun;190(3):339-462022/7/2620目前對(duì)肺隱球菌病的病例總結(jié)，進(jìn)展胸部CT表現(xiàn)分析，可能存在嚴(yán)重偏差！2022/7/2621免疫功能受損人群肺隱球菌感染胸部CT的特征是否不同？免疫功能正常與受損宿主肺隱球菌病臨床特征CHEST 2006; 129:3333402022/7/2623免疫功能正常與受損宿主肺隱球菌病胸部CT表現(xiàn)的比較CHEST 2006; 129:3333402022/7/2624免疫功能正常與受損宿主肺隱球菌病治療隨訪的比較CHEST 2006; 129:3333402022

11、/7/2625胸部CT的隨訪比較，對(duì)鑒別肺隱球菌病的價(jià)值較大病灶的變化速度曲霉菌?。翰欢?？隱球菌?。和ǔ］^慢念珠菌?。狠^快？毛霉菌病：快速進(jìn)展？特殊細(xì)菌：奴卡菌、放線菌結(jié)核病與非結(jié)核分枝桿菌普通細(xì)菌：金葡菌、銅綠假單胞菌、厭氧菌非感染性疾?。耗[瘤、肺栓塞Clinical analysis of 76 patients pathologically diagnosed with pulmonary cryptococcosisShanghai Pulmonary Hospital-2001-2021males 54, females 2241 immunocompetent (53.95%),

12、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

13、 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. 2021 Mar 9PET/CT：局部隱球菌感染病灶顯示高SUV值！2022/7/2628肺隱球菌病的其他病理類型？2022/7/26302022/7/2631肺隱球菌病的實(shí)驗(yàn)室診斷？2022/7/26Dr

14、.HU Bijie33Pulmonary Fungal InfectionEmphasis on Microbiological Spectra, PatientOutcome, and Prognostic FactorsCHEST 2001; 120:177184入選標(biāo)準(zhǔn)：明顯肺部病變合并如下一項(xiàng)： 活檢標(biāo)本病理組織中發(fā)現(xiàn)真菌open thoracotomythoracoscopytransbronchial lung biopsyultrasound-guided percutaneous needle biopsy； 上述標(biāo)本涂片和培養(yǎng)別離到真菌； 胸水或血液中別離到真菌，無(wú)肺外感染征

15、象。肺隱球菌感染：經(jīng)皮肺吸引物顯微鏡檢查鑒定為隱球菌，或陽(yáng)性隱球菌抗原，滴度=1:82022/7/2634隱球菌病 vs 結(jié)核?。篢-Spot-+2022/7/26352022/7/26Dr.HU Bijie36Patients and Mortality Rate With Different Patterns of Pulmonary Fungal InfectionsNo.Mortality, No. (%)Total14051 (36.4)Aspergillus spp曲霉8032 (40.0)Aspergilloma413 (7.3)Invasive aspergillosis 3324 (72.7)Systemic65 (83.3)Cryptococcus spp隱球菌302 (6.7)Cryptococcoma230 (0)Pneumonia50 (0)S