儿童侵袭性真菌病课件.ppt

Various antifungal therapies and approaches may be desirable depending on the stage of the fungal infection (remote, possible, probable, proven culture, or proven tissue diagnosis). Treatment decisions are also based on the length of time the patient has been neutropenic, the degree of granulocytopenia, and the presence of unrelenting fever. The slide represents the factors that influence the decision-making regarding treatment. Therapeutic options run the gamut from prophylaxis when the disease likelihood is remote, to empirical, to pre-emptive, and finally, to specific therapy when there is a proven positive tissue culture. The accompanying signs become more severe as fungal infection progresses. As seen before, the probability of disease increases with the duration of neutropenia. Courtesy of Ben DePauw, MD, EORTC. Slide * N2-108 Antifungal After FDM * The problems associated with diagnosis and treatment of IFI in oncology patients provide the rationale for using preventative strategies. Evidence-based recommendations for preventing exposure to and disease caused by microbial pathogens, including fungi, are detailed in recent joint publications by the Centers for Disease Control and Prevention, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. MMWR 2000;49:1-125. * * * 联合GM检测及CT检查用于早期诊断侵袭性肺真曲霉感染，并可提示开始抗真菌治疗的时机1 肺泡灌洗液GM检测可用于早期诊断侵袭性曲霉感染，且优于血清GM检测及肺泡灌洗液培养或直接检测2 1、Maertens J et al. Clinical Infectious Diseases.2005;41:1242-50. 2、Meersseman W et al. Am j Respir Crit Care Med. 2008;177:27-34. G试验和GM试验联合使用 种属 G试验 GM试验 念珠菌属 ＋ － 镰刀菌属 ＋ － 隐球菌属 － ＋ 曲霉菌属 ＋ ＋ 青霉/拟青霉 ＋ ＋ 接合菌纲 － － 微生物学检查 合格痰液经直接镜检发现菌丝，真菌培养2次阳性 BALF经直接镜检发现菌丝，真菌培养阳性 合格痰液或BALF直接镜检或培养新生隐球菌阳性 BALF或痰液中发现肺孢子菌包囊、滋养体或囊内小体 血液标本