Values of G test and GM test combined with fungal culture method for diagnosis of invasive fungal infection in lungs / 军事医学

Objective To evaluate the diagnostic efficiency of deep fungal infection by detecting the serum galactomannan ( GM) and bronchoalveolar lavage fluid ( BALF) GM, serum G test and fungal culture of BALF in patients with suspected invasive fungal infection ( IFI) in lungs.Methods A retrospective analysis was performed of the results of serum /BALF GM test ,serum G test and BALF culture from 148 patients with suspected pulmonary IFI .The indexes involved sensitivity , specificity , positive predictive value , negative predictive value , as well as diagnostic capacity for deep fungal infection with separated or combined tests .Results Among the 148 cases, 48 cases were clinically diagnosed with IFI and the rest were excluded.Among the 48 IFI cases, 3 cases were positive in serum GM test , 25 cases were positive in BALF GM test , 31 cases were positive in G test and 30 cases were positive in fungal culture .The combined detection showed a sensitivity of 91.6%,specificity of 70.0%, positive predictive value of 59.5% and negative predictive value of 94.6%.Conclusion The combination of GM/G tests and fungal culture can significantly improve the clinical diagnostic efficiency of pulmonary IFI .

Laboratory diagnosis of rarely filamentous fungi / 军事医学

Objective To investigate the laboratory diagnosis of filamentous fungi which are rarely seen in clinical practice.Methods Five strains of fungi were isolated from clinical samples and initially identified by the morphological method.Total DNA of fungi was extracted and amplified by the PCR method using universal primers of ITS2-ITS4 gene, respectively.The PCR products were sequenced and the obtained sequences were then analyzed by the blastn program incorporated in NCBI.Results The five strains of fungi were diagnosed as Scedosporium apiospermum,Schizophyllum commune,Scopulariopsis brevicaulis,Rhizopus stolonifer,and Fusarium solani.Conclusion The laboratory diagnosis of filamentous fungi which rarely occur in clinical practice should integrate various methods,including morphological, microbiological,and molecular biological methods.

Main pathogenic bacteria and drug resistance in Affiliated Hospital of Academy of Military Medical Sciences between 2012 and 2013 / 军事医学

Objective To investigate the flora distribution and drug resistance status in the Affiliated Hospital of Academy of Military Medical Sciences so as to provide experimental data for clinical doctors to use antibiotics more efficiently.Methods The clinical data of pathogenic bacterial infections over nearly one year in our hospital were retro -spectively analyzed .Results There were 3815 strains of pathogenic bacteria isolated from the sample .The percentage of Gram-positive strains was 36.4%while that of Gram-negative bacteria was 63.6%.The most common bacteria were Esche-richia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus epidermidis.In terms of drug tolerance , Enterobacteriaceae remained highily sensitive to carbapenems .The total resistance rate was 2%-5%.The resistance rate of A.baumannii to meropenem and imipenem was 60%.There were still a few pan-drug resistant strains among K.pneumoniae,A.baumannii and P.aeruginosa,but there were no drug resistant strains to vancomycin , tige-cycline and linezolid in Staphylococcus.The resistance rate of Enterococcus faecium to vancomycin was 9%.The bacteria were distributed predominantly in ICU ,Department of Hematology and Department of Oncology .The samples were mainly composed of phlegm specimens .Conclusion The high distribution in the three departments mentioned above is largely re-lated to the diseases being treated .The specimens from the lower respiratory tract show more types of bacteria that are mostly drug-resistant, and the isolating rate of vancomycin resistant Enterococcus and carbapenems resistant K.pneumoniat is com-paratively high .

Studies on renal function injured by an accidental ~(60)Co irradiation in Shandong province / 解放军医学杂志

Objective To study the radiation effects on the serum concentration of urea nitrogen (BUN), creatinine (Cre), ?2-microglobulin (?2-MG) and uric acid (UA), and to evaluate the injuries to renal function induced by a 60 Co irradiation accident in Shandong province. Methods The concentrations of urea nitrogen, serum creatinine and serum uric acid were determined by enzymatic methods. The concentrations of serum ?2-microglobulin were determined by the immunoturbidity methods using HITACHI 7170s automatic biochemical analyzer. Results The serum concentrations of BUN and Cre of 2 patients increased significantly after irradiation, and the serum concentration of UA in the two cases elevated too after irradiation, but didn't reach the normal value. The serum concentrations of ?2-microglobulin also increased significantly after irradiation. In case A which received 20~25Gy irradiation, the concentrations of serum BUN, creatinine and ?2-microglobulin increased to 41.63mmol/L, 364?mol/L and 9.2mg/L, respectively. In case B which received 9~15Gy irradiation, the concentration of serum BUN, creatinine and ?2-microglobulin increased to 52.2mmol/L, 199?mol/L and 11.3mg/L, respectively. There seemed a dosage-dependent effect on the BUN, Cre and ?2-microglobulin concentration. Conclusion 60 Co may irradiate the tissues of kidney directly, and irradiate the cells of other tissues and organs, lead to necrosis and degenerations accordingly on the tissues of kidneys and other organs. In the process of necrosis and degenerations, a large amount of metabolic products was released which is poisonous to the kidney. The present results showed the concentrations increased of all the four renal serum markers mentioned above. It is supposed that the renal cells might be damaged by the Cobalt ? ray irradiation.

Identification and dynamic observation of fungous infections in two patients of ~(60)Co ? accident / 解放军医学杂志

Objective To identify the fungi isolated from two acute radiation sickness(ARS)patients as a result of an accidental 60Co irradiation,and to observe the sensitivity of the fungi to antifungal agents.Methods The pathogenic fungi were morphologically examined and identified with the VITEK 2 automatic microorganism analyzer and API 20C AUX yeast identifying card.The susceptibility of fungi to antifungal agents was tested with broth microdilution method.Results Candida parapsilosis and Sporothrix schenckii were identified from case A in the samples of blood,bone marrow,urine and stool etc.Most of pathogenic fungi were sensitive to the antifungal drugs in vitro.In case B,Candida parapsilosis,Candida tropicalis,Trichosporon asahii and Aspergillus terreus were identified in the samples of sputum,urine or stool etc.Accompanying with the prolongation of antifungal treatment,the sensitivity of fungi to the antifungal drugs were decreased remarkably.Conclusion Multiple infections in different organs could be caused by pathogenic fungi,such as Trichosporon asahii and Sporothrix schenckii.Although most of pathogenic fungi were sensitive to the antifungal drugs in vitro,the effects of antifungal treatment were not satisfactory owing to poor general conditions of 2 acute radiation sickness(ARS)patients and marked compromise of the immune system.Because of antibiotic and antifungal drugs were used early for preventive purpose,the clinical samples should be specially treated in order to raise the positive rate of fungal identification.