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Research Progress of Feasibility of Dendritic Cell Antifungal Vaccines

Fungal infection is an important clinical problem for patients with immune deficiency or immunosuppression. With deadly fungus infection case increasing, the development of antifungal vaccine attracts the attention of researchers. Dendritic cell (DC) is the unique antigen presenting cell (APC) to trigger the antifungal immune reaction, and recent studies indicate that the targeted vaccination strategy based on DC have prospective antifungal potentials. In this paper, we review the antifungal immunity mechanism and recent development of the targeted DC antifungal strategy.

Clinical Analysis of 30 Patients with Fungal Septicemia

Objective To investigate the fungal species distribution, liability factors, therapy and prevention of fungal septicemia.Methods A time-matched case-control study was conducted in 30 patients fromApril 2011 to November 2012 with fungal septicemia. Results Of the pathogens in 30 cases with fungal septicemia, 43.3% was Candida albicans, 23.3% was Candida tropicalis, and 10% was Candida parapsilosis. All 30 cases with fungal septicemia were hospital acquired. Malignant hematological system disease( 33.3% ) , COPD( 23.3% ) , and diabetes ( 20.0% ) were the main predisposing diseases. Broadspectrumantibiotic use( 86.7% ) , endovascular prosthesis( 60.0% ) , parenteral alimentation( 53.3% ) were the major risk factors. All 30 cases received systemic anti-fugal therapy. The efficacy rate of amphotericin B therapy was higher than that of fluconazol ( P =0.002) and voriconazole( P = 0.006) . 13 cases( 43.3% ) were cured or significantly improved, and 17 cases( 56.7% ) were dead. Conclusions The most frequently fungi was Candida albicans in fungal septicemia. Malignant hematological system disease and COPD were main predisposing diseases. Broad-spectrumantibiotic use and parenteral alimentation were independent risk factors. Anti-fugal therapy with amphotericin B can achieve better prognosis. Early diagnosis, controlling risk factors, and earlier empirical antifungal therapy are keys to reduce mortality of fungal septicemia.

Clinical analysis of two patients with frequent acute exacerbations of chronic obstructive pulmonary disease, both caused by Aspergillus?

ObjectiveTo investigate the role of Aspergillus in the severe refractory exacerbations of chronic obstructive pulmonary disease (COPD).MethodsThe clinical data of two COPD patients suffering from refractory acute exacerbations were analyzed and the relevant literature were reviewed.ResultsTwo patients were male, aging 72 and 64 years respectively. Both of them had a history of frequent acute exacerbations with severe COPD recently. Meanwhile, they received intravenous use of antibiotics repeatedly, one of them took oral corticosteroids to control wheezing, but failed. Their serum Aspergillus-specific IgG antibody was weakly positive. Besides traditional treatment, they received additional antifungal therapy, and the symptoms alleviated. There was no acute exacerbation in the half a year follow-up period after appropriate therapy.ConclusionsAspergillus colonization, sensitization, infection should be considered in patients with severe COPD. When Aspergillus-associated evidence are acquired, antifungal therapy will be unexpected helpful.

新生儿感染聚集性病例调查及流程改进实践

目的通过新生儿疑似医院感染聚集发病后控制过程回顾，探索有效的控制措施。 方法2013年3月22日-4月1日，通过对一起新生儿疑似医院感染聚集发病事件的现场调查及病原学检测，了解探讨病因线索，提出有效控制措施，包括鼓励报告，不一味责备，管理部门介入，病例调查，环境采样，分组隔离，奶具由消毒供应中心处理，强化手卫生，强化环境消毒，改用小包装无菌棉签，病例讨论等。 结果该新生儿室在短时间内连续发生4例口腔真菌感染患儿，其中2例口腔分泌物涂片见真菌孢子，临床判断为疑似医院感染聚集性病例。经及时采取干预措施，疫情得到了有效改善，未造成不良后果。 结论在临床中，医院感染聚集病例受同源性检测设备昂贵、时间长的限制，常不能及时确诊，该起疑似医院感染聚集病例的调查及处理对类似案例的处置可供借鉴。

类风湿关节炎合并毛霉菌肺部感染一例

Traditional laboratory detection methods and metagenomic next-generation sequencing in pulmonary fungal infection diagnosis

In recent years, due to the extensive usage of immunosuppressant and the rise of patients with cancers and organ transplantation, the incidence rate of invasive fungal infection, especially invasive pulmonary fungal infection, has increased. Besides the clinical manifestations, medical history and imaging, the diagnosis of pulmonary mycosis mainly depends on pathogen detection methods in clinical microbiology laboratory. However, due to the difficulty in fungi culturing and the low sensitivity of smear microscopy, better molecular biology methods are needed. To date, the emergence of metagenomic next-generation sequencing (mNGS) has improved the identification rate of pulmonary fungal infections. mNGS is significantly superior to traditional detection methods in rapid, accurate, and comprehensive determination of fungi from various clinical specimens, especially atypical fungi. However, some problems in mNGS method have to be addressed including sample collection, report interpretation, and its combination with traditional microbiology methods. With the in-depth discussion and solution of the above problems, mNGS will be indispensable to the etiological diagnosis of pulmonary invasive fungal infection.

Clinical Research on Correlation Factors of Concurrent Fungal Infections in Old Patients with Pulmonary Diseases: 49 Case Reports

摘要:目的: 探讨我院呼吸内科病房老年肺部疾病患者并发真菌感染发病的相关因素,分析其易患因素、临床特征和治疗。 方法 : 采用回顾性调查方法对2002年1月至2008年6月收住内科的经微生物检查证实49例继发真菌感染的患者进行分析,并与同期无真菌感染的肺部疾病患者(对照组)比较。 结果 : 在呼吸内科病房中,老年患者院内肺部真菌感染发生率为378%,主要感染部位为泌尿系(218%),呼吸道(269%),消化道(409%)。慢性阻塞性肺疾病(498%)是继发院内肺部真菌感染最常见的基础疾病,其感染因素为长期使用广谱抗生素(962%)和糖皮质激素(332%)、营养状况不良(583%)出现低蛋白血症及合并糖尿病、白细胞减少和侵袭性诊疗操作等。肺部真菌感染的临床表现无特异性,确诊需结合痰培养,组织病理学和临床表现来确定,感染菌种以白色念珠菌为主,占626%。氟康唑治疗有效率914%。研究组与同期无真菌感染的肺部疾病患者(对照组)比较:病死率分别为612%和082%,两组治疗无效的病例(恶化和死亡病例)比较差异有显著性。 结论 : 院内真菌是呼吸系统疾病继发感染的重要病原体,而白色假丝酵母菌是院内肺部真菌感染的主要致病菌,宿主免疫状态、感染播散和疾病严重程度是影响预后的因素。该研究认为老年肺部疾病患者并发真菌感染的相关因素和影响预后的因素对其预防、诊断、治疗、改进预后和生存质量有重要的临床意义。除有效的抗真菌治疗外,积极的综合治疗有助于提高真菌感染的治愈率。Abstract: Objective: To study the susceptible factors,clinical features and treatments of nosocomial pulmonary fungal infection in the ward of respiratory department.〖WTHZ〗Methods : The chart files of 49 patients with nosocomial pulmonary fungal infection admitted from January 2002 to June 2008 in the ward of Respiratory Department were reviewed. Results : The incidence rate of nosocomial pulmonary fungal infection was 378%.COPD(498%)was the main predisposing disease,and candidiasis(626%) was the most common pathogen. The main susceptible factors associated with nosocomial pulmonary fungal infection are longterm use of broadspectrum antibiotics(962%),hypoalbuminemia(583%),longterm use of adrenocortical steroid(332%),and diabetes mellitus.There is no specific clinical feature.Fluconazole(914%)is more efficient in the treatment.〖WTHZ〗Conclusion : Nosocomial pulmonary fungis are important pathogenin the secondary infection in respiratory disease.The most common pathogen is candida albicans.Combined therapy as well as treating fungus infection are important measures to increase the cure rate of nosocomial pulmonary fungal infection.

Choice of Intranasal Endoscopic Minimally Invasive Surgeries for Non-invasive Fungal Maxillary Sinusitis

目的　观察鼻内镜下三种不同微创手术治疗非侵袭型真菌性上颌窦炎的疗效及氟康唑冲洗术腔的临床意义。 方法　回顾性分析我科2006年1月－2010年12月收治的284例非侵袭型真菌性上颌窦炎住院患者资料。患者分别采用单纯鼻内镜下上颌窦窦口开放术（术式1）、鼻内镜下上颌窦窦口开放联合经唇龈沟上颌窦前壁开窗（术式2）、以及鼻内镜下上颌窦窦口开放联合下鼻道开窗（术式3）进行治疗；术式3治疗的患者术后定期换药时，分别使用生理盐水或氟康唑反复冲洗鼻腔和上颌窦。所有患者门诊随访至少半年。 结果　在本组接受术式1、术式2和术式3治疗的患者分别有51例、45例和188例。上述三种术式治疗的患者中，分别有15例，9例和6例患者出现复发，复发率分别为29.6%、20.0%和3.2%；其中术式3治疗的患者复发率显著性低于术式1或术式2治疗的患者（P＜0.05）。在术式3治疗的患者中，生理盐水和氟康唑冲洗的伤口愈合时间分别为3.8周和 3.7周，两种冲洗方式对伤口的愈合影响差异无统计学意义（P＞0.05）。 结论　鼻内镜下上颌窦窦口开放联合下鼻道开窗是治疗非侵袭型霉菌性上颌窦炎的最佳方式，且伤口愈合时间与冲洗液种类无关。

真菌蛋白酶在变应性哮喘发病中的作用

近年来, 支气管哮喘的发病率在许多国家均呈上升趋势, 带来沉重的经济和社会负担 。许多研究表明, 室内真菌和变应性哮喘之间存在着密切关系, 给予对真菌存在免疫学致敏的哮喘患者抗真菌治疗能够改善症状, 提高生活质量。目前对于室内真菌引起变应性哮喘的详细机制还远未阐明, 本文主要论述真菌蛋白酶在变应性哮喘中的可能作用。

The Interpretation of Diagnosis and Treatment Guideline of Invasive Fungal Disease in Patients with Hematological Diseases