| Recently,with the broad-spectrum antibiotics, immunosuppressive agents, anti-tumor, cytotoxic drugs widely used as well as the continuous promotion of organ transplantation, pulmonary aspergillosis (PA) incidence of sharp rise high fatality.long time, the lack of aspergillosis associated myeloid and organ transplantation classic "immunosuppressed host" and "halo"sign, more concerned about the "crescent sign"typical imaging findings but non-classical imaging features, such as the characteristics of the nodules, ground-glass shadow and pleural effusion, did not attract enough attention, the Aspergillus detection of such patients ignored and considered allowed, resulting in a large number of misdiagnosis and missed diagnosis. In order to increase further understanding of the PA, the first part of this study collected Nanjing General Hospital from January 2004 to March 2012, diagnosed PA patients were retrospectively analyzed for the early diagnosis, proper treatment to provide a basis.Clinical antifungal agents not only expensive, but serious adverse reactions, clinicians try to be diagnosed before use. Depends on clinical symptoms, signs, laboratory and imaging tests, such as non-invasive means of diagnosis of pulmonary fungal disease increasingly unable to meet the need, and Chong take the technology to take histopathology favored by people, which the histopathological examination The most widely used method is the CT-guided percutaneous needle lung biopsy (Percutaneous CT-Guided needle biopsy, PCNB). PCNB has opened up a new way for the diagnosis of lung disease. It as a minimally invasive method has been widely used in the diagnosis of chest tumors, lung infection, especially for the diagnostic value of pulmonary fungal infection and complications, less domestic research. The second part of this study retrospectively reviewed Nanjing General Hospital of Nanjing Military Region, Department of Respiratory Medicine January 2005 2012 7 menstrual the PCNB diagnosis of pulmonary fungal patients were retrospectively analyzed to assess the clinical significance of the diagnosis and complications.For the Allergic bronchopulmonary aspergillosis (ABPA) is a rare disease before, the diagnosis of ABPA has improved significantly in recent years due to the development of serological and radiological diagnostic methods, but there are still high rate of misdiagnosis, to raise awareness of the disease and reduce the rate of misdiagnosis, the third part summarizes Nanjing General Hospital of Nanjing Military Region, Department of Respiratory Medicine from March 2005 to June 2012 confirmed the clinical features of 16 patients with ABPA parallel misdiagnosed analysis.In summary, this study from the summary of the the PA clinical features, explore the diagnostic value of PCNB in the pulmonary fungal disease, complications and summarized the clinical features of ABPA and misdiagnosis analysis to elaborateSectionl Clinical analysis of 167 pulmonary aspergillosisBackgroud Recently,pulmonary aspergillosis (PA) have been a sharp rise in the incidence and case fatality rate, and The clinical symptoms such as "signs" and "crescent signin" most not typically,easy to missed diagnosis.Objective This study analyzed the clinical characteristics of PA to appove the recognition of PA.Methods 167 cases of PA were recruited in this retrospective study from January 2004 to March 2012 in the Department of Respiratory and Critical Care Medicine of Nanjing General Hospital of Nanjing Military Command.Their basic diseases,clinical and imaging features were analyzed,treatment and prognosis were evaluated.Results 167 cases were collected. The basic disease were constituted by hematological malignancies 7 cases (4.2%), the lung basic disease 118 cases (70.7%) and 30 patients (18.0%) were without any basic disease.146 cases have a cough (87.4%); 112 cases (67.1%) have a fever; 98 cases (58.7%) were suffered with chest tightness and difficulty breathing,42 cases (25.1%) have a complication of hemoptysis.The"Halo sign"and "crescent sign "accounted for 5 cases 3.0%) and 3 cases (1.8%) respectively.This disease was diagnosed by Fiberoptic Transbronchial lung biopsy (TBLB) 31 cases (18.6%),61 cases (36.5%) by lung puncture,31 cases (18%),fiberoptic bronchoscopy lavage fluid (BAL) 13 cases (7.8%),surgical specimens confirmed 30 cases (18.0%),sputum culture in 32 cases (19.1%).The efficiency of Voriconazole, itraconazole and caspofungin were 71%.Conclusion In Respiratory Medicine,The most common basic disease is lung disease.These cases lack of typical imaging features; Clinical diagnosis requires a combination of symptoms, signs, imaging, experimentalroom inspection and other means, and recommended early invasive inspection,obtain pathologic evidence.Treatment, Drug therapy still main strategy for PA.Surgery can significantly improve prognosis.Section 2 The diagnosis value of PCNB on mycosisBackground Currently, PA diagnosis is mainly based on clinical manifestations, chest imaging studies, sputum bacteriology examination, serum G, GM test, but biopsy is the "gold standard" confirmed Clinical biopsy use most of the way as the CT guided Percutaneous lung biopsy (PCNB),PCNB as a minimally invasive method has been widely used in the diagnosis in lung cancer, but in terms of lung infection, especially the value to the diagnosis of pulmonary fungal infection and complications,its less domestic research.Objective To evaluate the diagnosis value of PCNB on mycosisMethods Retrospective study the diagnosis value of PCNB on mycosis from January 2005 to July 2012 in the Department of Respiratory and Critical Care Medicine of Nanjing General Hospital of Nanjing Military Command.Results 158 confirmed cases were collected,127 patients (80.3%) under the PCNB,98 cases after 1 puncture pathology and (or) culture positive,4 cases were diagnosed after second times of puncture,25 cases of patients with once puncture negative after bronchoscopy, blood culture, water culture in the way of diagnosis, There are 102 (80.3%) cases dignosised by the PCNB,Pathogenic species in 102 cases confirmed cases:Aspergillus 48 (47.0%) cases, Cryptococcus neoformans and 22 (21.6%) cases,5 (5.0%) cases of Mucor and Histoplasma capsulatum 3 (3.0%) patients; The most common complications are blood in the sputum, pneumothorax and postoperative fever, incidence rates were 24.4%, 17.3%,11.0%, there are 2 cases massive hemoptysis after PCNB, after active treatment they are all recovered; Lots of pneumothorax cases, after the drainage of pleural cavity were recovery; no pleural reaction, air embolism and other rare complications of pin tract dissemination.Conclusion PCNB is an effective,safe method in the diagnosis of pulmonary mycosis.Section 3 Clinical analysis and misdiagnose of 16 Allergic bronchopulmonary aspergillosisesBackground ABPA in PA proportion of smaller, used to think it is a rare disease, in recent years, thanks to the development of serology and imaging diagnostic methods of the diagnosis of ABPA obviously improved, but there are still a high misdiagnosis rate.Objective To study the clinical featuers and prognosis of ABPA.Methods Retrospective analyzed the clinical materials and misdiagnosed of 16 cases of ABPA,to enhance understanding of the disease.Results 16 cases were mail,The increase of Peripheral blood eosinophil cells (PBEC) and total IgE (T-IgE) to a different extent,some cases GM and G test to rise,some respiratory disorder.The most common CT images is central bronchiectasis, patchy consolidation, lobar, consolidation shadows.Among them,3 cases showed BAL,sputum culture and biopsy histopathology Aspergillus,in 16 patients were initially misdiagnosis,the rate was 100%, a clear diagnosis from the onset time of (8-105) months.Conclusion The clinical features of ABPA onset occult, not typical, it is easily misdiagnosed.For high-risk groups, early ABPA examination need to Implement.SummaryPulmonary fungus disease cases fatality rates. Respiratory diagnostic pulmonary aspergillosis with more basic diseases, based on the lung disease, see more, more lack of typical clinical symptoms, signs, diagnosis should be combined with symptoms, signs, imaging. Histopathological examination for diagnosis of the "gold standard",histopathological examination is most widely used PCNB, through the second part, the study found in the contraindications strictly, skilled operation under the premise of PCNB is safe and effective way of checking. For pulmonary aspergillosis of ABPA, with the continuous improvement of diagnostic technology, the diagnostic rate increased significantly, but there are still a high misdiagnosis rate, in the third part of the study, we concluded that ABPA is still the misdiagnosis rate is high, so as to prompt our clinical staff should attach great importance to the disease, high-risk group, line of ABPA related inspection as soon as possible... |
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