CAJ | 학술논문

目的分析肾脏科住院患儿合并侵袭性真菌感染的临床特点.方法回顾性分析1999年至2014年27例肾脏科住院患儿并发侵袭性真菌感染的临床资料.结果 9例为泌尿系念珠菌感染,8例为肺孢子菌病肺炎,4例侵袭性肺曲霉菌病和1例侵袭性泌尿系曲霉菌感染,2例新型隐球菌脑膜炎,2例为肺念珠菌病,1例为肺丝状真菌感染.均存在基础病变,其中10例为原发性肾病综合征,7例继发性肾病综合征,6例伴有泌尿系统发育畸形,4例为＜32周早产儿和低出生体质量儿.均使用过抗生素.17例患儿有接受糖皮质激素和/或免疫抑制剂史.16例有侵入性操作史.27例均有发热症状,14例出现喘憋,7例进行性呼吸困难和呼吸衰竭,5例合并多脏器衰竭.8例肺孢子菌病患儿胸部CT示弥散磨玻璃影伴“马赛克”征;4例肺曲霉菌病患儿见肺多发结节影、易形成空洞.2例肺念珠菌病患儿病灶边缘模糊、浓淡不均,呈小斑片影,位于双肺中下野、不累及肺尖.23例接受足疗程抗真菌治疗,经治疗后16例痊愈,3例好转,4例死亡.4例放弃治疗.结论长期使用激素和免疫抑制剂、不恰当使用抗生素、低出生体质量早产儿、泌尿系统发育畸形、侵入性操作等是侵袭性真菌感染的易感因素.不同的真菌感染影像学有不同特点,尽管不具备诊断特异性,但其相对特征性表现可为早期诊断提供一定的线索.
목적 분석신장과주원환인합병침습성진균감염적림상특점.방법 회고성분석1999년지2014년27례신장과주원환인병발침습성진균감염적림상자료.결과 9례위비뇨계념주균감염,8례위폐포자균병폐염,4례침습성폐곡매균병화1례침습성비뇨계곡매균감염,2례신형은구균뇌막염,2례위폐념주균병,1례위폐사상진균감염.균존재기출병변,기중10례위원발성신병종합정,7례계발성신병종합정,6례반유비뇨계통발육기형,4례위＜32주조산인화저출생체질량인.균사용과항생소.17례환인유접수당피질격소화/혹면역억제제사.16례유침입성조작사.27례균유발열증상,14례출현천별,7례진행성호흡곤난화호흡쇠갈,5례합병다장기쇠갈.8례폐포자균병환인흉부CT시미산마파리영반“마새극”정;4례폐곡매균병환인견폐다발결절영、역형성공동.2례폐념주균병환인병조변연모호、농담불균,정소반편영,위우쌍폐중하야、불루급폐첨.23례접수족료정항진균치료,경치료후16례전유,3례호전,4례사망.4례방기치료.결론 장기사용격소화면역억제제、불흡당사용항생소、저출생체질량조산인、비뇨계통발육기형、침입성조작등시침습성진균감염적역감인소.불동적진균감염영상학유불동특점,진관불구비진단특이성,단기상대특정성표현가위조기진단제공일정적선색.
Objective To explore the clinical features of invasive fungal infection in 27 children treated at nephrology department between 1999 and 2014.Methods Twenty-seven cases of invasive fungal infection at nephrology department were analyzed retrospectively.Results Candida urinary infection was found in 9 cases,pneumocystis carinii pneumonia were found in 8 cases,invasive pulmonary aspergillosis and urinary aspergillosis found in 4 cases and 1 case respectively,cryptococcus neoformans meningitis and pulmonary candidiasis found respectively in 2 cases,and pulmonary filamentous fungal disease was found in 1 case.These 27 cases showed different features of illness:10 primary nephrotic syndrome,7 secondary nephrotic syndrome,6 malformation of urinary development and 4 preterm birth ＜ 32 weeks gestational age with low birth weight.All of the cases had the history of taking antibiotics.Seventeen cases of them had used corticosteroid and cytotoxic drugs in a long-term.Sixteen cases had experienced invasive procedures.All children had fever in varying degrees,14 cases showed gasp,7 cases had progressive hypoxia and respiratory failure,and 5 cases developed into multiple organs failure.Chest computed tomographic (CT) imaging data showed diffuse ground-glass opacity with mosaic sign of pneumocystis carinii pneumonia(8 cases).The features of pulmonary aspergillosis included multiple nodules and cavity in bilateral lungs (4 cases).The radiologic findings showed patching lesions with indistinct edge and uncertained density of bilateral middle-lower lung fields with pulmonary candidiasis (2 cases).Full dose of antifungal drug was given to 23 cases of them,16 cases recovered completely,3 got better,4 cases died.Four cases gave up full dose antifungal therapy.Conclusions Long-term use of corticosteroid and cytotoxic drugs,use of broad-spectrum antibiotics,invasive therapies,such as indwelling centralvenous catheters,endotracheal intubation with mechanical ventilation,and preterm birth with low birth weight were risk factors in predicting invasive fungal infection.Chest CT findings were different among these cases.Even though not specific,the relatively differences were helpful to the differential diagnosis of these diseases.