Clinical and laboratory characteristics of 71 patients with acquired immunodeficiency syndrome complicated with disseminated nontuberculous mycobacterial disease / 中华传染病杂志

Objective:To explore the clinical and laboratory characteristics of acquired immunodeficiency syndrome (AIDS) patients complicated with disseminated nontuberculous mycobacterial (NTM) disease, in order to provide basis for clinical therapy.Methods:The clinical findings, imaging and etiological data of the 71 AIDS patients complicated with disseminated NTM disease admitted to Beijing You′an Hospital from June 2016 to June 2021 were retrospectively analyzed.Results:Among 71 patients with disseminated NTM disease, the most common initial symptom was fever, followed with cough, expectoration, fatigue, poor appetite, abdominal pain and diarrhea. Seventy point four percent (50/71) of these patients had at least two comorbidities, with oral candida infection, cytomegalovirus infection, syphilis, pneumocystis pneumonia and bacterial pneumonia being the most common. Hemoglobin ((87.8±24.2) g/L) and albumin ((27.3±7.0) g/L) levels significantly decreased, while erythrocyte sedimentation rate ((59.8±28.6) mm/1 h) and C-reactive protein ((74.7±50.8) mg/L) levels increased in most cases. The median CD4 + T lymphocyte count was 7×10 6/L. The median time of positive blood culture of NTM was 260 h. Among the 71 patients, 40 cases (56.3%) were infected with Mycobacterium avium, 15 cases (21.1%) with Mycobacterium intracellulare, 10 cases (14.1%) with Mycobacterium colombiense, three cases (4.2%) with Mycobacterium marseillense and three cases (4.2%) with Mycobacterium kansasii.The frequent imaging findings were patchy and nodular shadows in lungs, and most patients had mediastinal or hilar lymph node enlargement and splenomegaly. Conclusions:AIDS complicated with disseminated NTM disease is prevalently occurred in patients with severe immune deficiency, and most of the bacteria belong to the Mycobacterium avium- intracellulare complex. Early obtaining positive etiological results of NTM is essential to guide the correct clinical diagnosis and accurate treatment.

Advance of resistance mechanisms of echinocandins against Candida and antifungal activity in vitro / 中华检验医学杂志

Although echinocandins,a new generation of antifungal drugs,shows good fungicidal activity against distinct species of Candida,with the extending usage,the activity of echinocandins is gradually to decline,which is caused by different resistance mechanisms.Also,a number of factors may influence its results of susceptibility in vitro (e.g.,human serum,culture temperature in vitro,the pH of the culture medium,and others).Paradoxical effect of echinocandins has its own characteristics and need a further study.In China,there are a few reports about the instances of drug resistance because of the limited clinic application.The study on the echinocandins in prevalence rate of drug resistance and antifungal activity under different status has important clinical significance.