侵袭性真菌感染的诊断和治疗.pptx

侵袭性真菌感染的诊断和治疗(InvasiveFungalInfection,IFI)

华中科技大学同济医院血液内科

真菌按形态分类

□霉菌(mold)——组织内、培养基中均呈菌丝型生长

-如曲霉属、毛霉属、镰孢霉

□酵母菌(yeasts)——以芽殖为主，多数为单细胞的一类真菌，在组织和培养基内均为芽生孢子，一般无菌丝

-如念珠菌(假丝酵母)属、隐球菌属、球拟酵母属、丝孢酵母属

■双相型真菌(dimorphicfungus)—同一真菌在不同环境条件下，生长成酵母状或菌丝体状两种形态，这种形态可随条件改变而相互变更。大多数为病原性真菌

-如组织胞浆菌、球孢子菌、副球孢子菌、皮炎芽生菌等

37°C-酵母相

27°C-菌丝

真菌按形态分类

Candida

01998SteveKagetMD

AIRightsReserved.

C1998SteveKagen,

AllRightsReserved

Aspergillus

Blankophor

(OG.ArmstrongHopeHospital,

R.RuchelGoingen,Germany)Manchester.

00.6Y

online

Figure3.NumbersofCasesofSepsisintheUnitedStates,AccordingtotheCausativeOrganism,1979-2000.

Pointsrepresentthenumberofcasesforthegivenyear,andIbarsthestand-arderror.

G.S.MARTINetal.,NEJM2003

225,000-

——--i

150,000-Fungi

75,000-

25,000-

15,000

10,000-

5,000-H

ebacteri

vebacter

iv

t

posit

nega

Gram

Gram

0-

197919811983198519871989199119931995199719992001

No.ofCasesofSepsis

真菌感染死亡率

McNeilMMetal.ClinInfectDis2001;33:641-7.

Figure1.USAmortalityratesduetoinvasivemycoses,1980-1997

0

198019851990

Year

Candida

--Aspergillus

Othermycoses

0.7

0.6

0.5

0.4

0.3

0.2

0.1

Rateper100000population

19952000

Invasiveaspergillosis-mortality

0.0

0306090120150180210240270300330360

Days

Linetal,ClinInfectDis2001;32:358-366

Sinusitis(n=17)

Mull-site(n=11)

Aspergilloma(n=10)

Pulmonary(n=83)

CNSorDisseminated(n=35)

.9-

.8

.7

.6

.5

.4

.3

.2

.1

SurvivalFunctionsbySiteofInfection

CumulativeSurvivalRate

1.0-

病原

宿主

抗菌药

条件致病菌：Conditionalpathogen

0pportunisticpathogen

机会性感染(0pportunisticInfection)

HIPPOCRATES

FatherafIedicine

Bornin460B.C.Diedin377B.C.

PF