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Objective To understand the clinical characteristics of children′s digestive tract deep fungal infection,avoid clinical misdiagnosis and missed diagnosis. Methods We analyzed the clinical characteristics and treatment effect in the children who were diagnosed with gastrointestinal tract deep fungus infection from January 2005 to May 2016 in guangzhou women and children′s hospital. Results Digestive tract deep fungal in-fection in 6 cases. All children are fungal esophagitis,fungal gastrointestinal diseases in 2 cases. The main clinical feature is vomiting,dysphagia and abdominal pain which lasted 4 ~12 weeks. Broad-spectrum antibiotics in 1 case,congenital immunodeficiency in 1 case,congenital esophageal atresia in 3 case. Gastroscopy found clusters of gray spots or jerry-built attachments (3 cases),Esophageal the week covered by gray jerry-built content, scope of 1/3-1/2 esophageal length,with esophageal lumen jams in 3 case. Large superficial ulcer in 2 cases. Le-sions involving the stomach and duodenum in 2 cases,one of which lesions involving the whole digestive gut. 6 cases by mucosa pathological examination or secretions smears identified as candida albicans infection. 3 cases of children with mild choose doxycycline tablets,treatment 2-3 weeks. 3 cases of children with severity choose Itra-conazole Capsules,treatment 3-4 weeks. Gastroscope review the digestive gut which was better than before. But 1 case was diagnosed immunodeficiency disease,death from lung infection. 1 case of whole digestive tract infec-tion,relapse after 3 month,at present is still in follow-up. Conclusion Children′s digestive tract of deep fungal infection is mainly characterized by vomiting,dysphagia and abdominal pain. Fungal can invade the whole diges-tive tract. Esophageal mucosa injury may be one of causes,and at the same time should pay attention to rule out congenital immunodeficiency. Diagnosis is dependent on the digestive endoscopy,mucosal biopsy.
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Objective To understand the clinical characteristics of children′s digestive tract deep fungal infection,avoid clinical misdiagnosis and missed diagnosis. Methods We analyzed the clinical characteristics and treatment effect in the children who were diagnosed with gastrointestinal tract deep fungus infection from January 2005 to May 2016 in guangzhou women and children′s hospital. Results Digestive tract deep fungal in-fection in 6 cases. All children are fungal esophagitis,fungal gastrointestinal diseases in 2 cases. The main clinical feature is vomiting,dysphagia and abdominal pain which lasted 4 ~12 weeks. Broad-spectrum antibiotics in 1 case,congenital immunodeficiency in 1 case,congenital esophageal atresia in 3 case. Gastroscopy found clusters of gray spots or jerry-built attachments (3 cases),Esophageal the week covered by gray jerry-built content, scope of 1/3-1/2 esophageal length,with esophageal lumen jams in 3 case. Large superficial ulcer in 2 cases. Le-sions involving the stomach and duodenum in 2 cases,one of which lesions involving the whole digestive gut. 6 cases by mucosa pathological examination or secretions smears identified as candida albicans infection. 3 cases of children with mild choose doxycycline tablets,treatment 2-3 weeks. 3 cases of children with severity choose Itra-conazole Capsules,treatment 3-4 weeks. Gastroscope review the digestive gut which was better than before. But 1 case was diagnosed immunodeficiency disease,death from lung infection. 1 case of whole digestive tract infec-tion,relapse after 3 month,at present is still in follow-up. Conclusion Children′s digestive tract of deep fungal infection is mainly characterized by vomiting,dysphagia and abdominal pain. Fungal can invade the whole diges-tive tract. Esophageal mucosa injury may be one of causes,and at the same time should pay attention to rule out congenital immunodeficiency. Diagnosis is dependent on the digestive endoscopy,mucosal biopsy.
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Objective Not much information is available on the comparative analysis of G test on diagnosis of deep fungal in -fection by colormetric and turbidimetric measurements .The purpose of this paper was to explore the clinical value of fungal (1-3)-β-D-glucan detection kit ( colormetric measurement ) . Methods 89 clinical samples collected from Hainan Branch of PLA General Hos-pital were detected by fungal (1-3)-β-D-glucan detection kit (turbidimetric measurement) and fungal (1-3)-β-D-glucan detection kit ( colormetric measurement ) respectively , among which 32 cases were from disease group ( deep fungal infection in patients ) and 57 ca-ses were from control group ( healthy person ) .The comparison was made on the sensitivity , specificity and accuracy of these two meth-ods. Results The sensitivity, specificity and accuracy of colormetric measurement kit on the diagnosis of deep fungal infection were obviously higher than those of turbidimetry method kit (81.2%vs 53.1%, 91.2%vs 75.4%, 87.6%vs 67.4%, P<0.05), which was of significant difference .Detection result of colormetric method had a positive coincidence rate with other systems '( except respira-tory system) deep fungal infection, which was obviously higher than turbidimetry method (92.8%vs 57.1%, P<0.05).Positive co-incidence rate and total coincidence rate between colormetric method kit and clinical diagnosis result on differentiate samples were obviously higher than those of turbidimetric method kit (P=0.01). Conclusion Colormetric measurement kit has higher accuracy and higher coincidence rate with clinical diagnosis than turbidimetry meas-urement kit , which is better for clinical service .
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Objective To explore the clinical application of jiont detection of critical patients procalcitomin (PCT)and (1,3)-beta D-glucan with deep fungus infection in ICU.Methods From November 2012 to August 2014 diagnosed with deep fun-gal infection of ICU critical patients,106 cases of patients with serum PCT and (1,3)-beta-D glucan content detection,and ICU of deep fungal infection in critically ill patients,519 cases were analyzed,with differencesbetween the paired t test to compare the results.Results 106 patients with deep fungal infection of ICU critical patients serum PCT for 0.701 ±0.22 pg/ml and (1,3)-beta-D glucan for 37.82±18.43 pg/ml,significantly higher than the 519 cases of ICU of deep fungal infec-tion in critically ill patients in the serum PCT for 0.238±0.12 pg/ml and (1,3)-beta-D glucan for 14.96 ±4.37 pg/ml, comparing differences between both results was statistically significant (t=7.426,8.179,P <0.05).106 patients with deep fungal infection of ICU critical patients serum PCT positive detection rate was 57.5% (61/106),significantly lower than the (1,3)-beta-D glucan positive detection rate 89.6% (95/106),difference was statistically significant (χ2 = 13.645,P <0.05).Conclusion Deep fungal infection in critical care patients in the ICU in the serum PCT and (1,3)-beta-D glucan con-tent of deep fungus infection in critically ill patients was significantly higher than the ICU,PCT and (1,3)-beta-D glucan joint detection of deep fungal infection in patients with ICU critical patients diagnosis has important clinical significance.
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Objective:To investigate the rationality of anti-fungal agents for deep fungal infection used in one hospital and the effects of national rectification of antimicrobial drugs. Methods: The retrospective analysis method was used to survey the inpatients administrated anti-fungal agents for deep fungal infection from April 2010 to Mard 2012, and assessed the rationality. Results:The ir-rational utilization of anti-fungal agents for deep fungal infection included loading dosage lack during the treatment,inappropriate loading dosage and administration frequency. The irrational utilization of anti-fungal agents for deep fungal infection was decreased significantly (P<0. 05)after the national rectification of antimicrobial drugs. Conclusion:After the national rectification of antimicrobial drugs, the hospital can amtrol the irrational use of anti-fungal agents to some extent, while still needs more management and education.
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Objective To investigate the risk factors related to mortality of children with deep fungal infection in pediatric intensive care unit(PICU).Methods A retrospective case-control study was applied.Ninty-six patients admitted to PICU with clinical or definite diagnosis of deep fungal infection from Nov 2005 to Mar 2009 were included.The risk factors related to mortality wereanalyzed with the logistic regression analysis.The research factors included:sex,age,primary diseases,complications,invasive operations and therapeutic measures etc.Results Of all 96 children,28 died (28.2％).According to the analytical results of multivariate logistic regression,the variables significantly associated with mortality were immunosuppressive (OR =185.770,95 ％ CI 11.467 ～ 3 009.507),mechanical ventilation (OR =11.555,95 ％ CI 2.780 ～ 48.039),hypoproteinemia (OR =1.246,95％ CI 1.133 ～ 1.369) and low pediatric critical illness score (OR =1.086,95 ％ CI 1.008 ～ 1.169).Conclusion The risk factors related to mortality of children with deep fungal infection in PICU were immunosuppressive,mechanical ventilation,hypoproteinemia and low pediatric critical illness score.
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Fusarium spp are molds found in the soil and may be saprophytic or fa c u l t a t ive plant p a t h ogens. These are rare but important opportunistic pathogens in immunocompromised patients especially those with hematologic malignancies. Fusarium spp usually cause local infections such as onychomycosis and infections of surgical and burn wound. However more importantly, these pathogens can lead to severe disseminated infection with invo l vement of multiple organs including skin. This disseminated form of fusariosis occurs exclusively in patients with prolonged, severe neutropaenia especially in patients with acute leukaemia or those u n d e rgoing bone marrow transplantation. Prognosis of disseminated fusariosis is usually guarded if not recognized early. We report a rare case of disseminated fusariosis in a patient with acute lymphoblastic leukaemia.
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Adiaspiromycosis is known as an infection that is due to Chrysosporium species which are filamentous soil saprophytes that cause pulmonary infection in rare cases but are classified mainly as a contaminant rather than a pathogen in dermatological areas. Deep fungal infections, commonly by Aspergillosis and Candida, are associated with patients who have an impaired skin barrier or immunosuppression and it takes a long time to identify the pathogen because it is hard to diagnosis it without clinical suspicion. In our case, a 56-year-old female living in a rural area who took immunosuppressants including cyclophosphamide, mycophenolate mefetil, and prednisolone due to pemphigus vulgaris presented at our clinic with an erythematous patch with pustular discharges on the left forearm for 2 months. She had been treated with antibiotics under the impression of cellulitis but was not responsive to it. A Chrysosporium species was identified by tissue culture and treatment was successful with an antifungal agent. We here report a case of deep fungal infection caused by Chrysosporium species without pulmonary infiltration which is a rare manifestation.
Subject(s)
Female , Humans , Middle Aged , Anti-Bacterial Agents , Aspergillosis , Candida , Cellulitis , Chrysosporium , Cyclophosphamide , Forearm , Immunosuppression Therapy , Immunosuppressive Agents , Pemphigus , Prednisolone , Skin , SoilABSTRACT
OBJECTIVE To investigate the risk factors of deep fungal infection in intensive care unit(ICU)and discuss the strategy of this disease control.METHODS A total of 502 patients with the risk factors of deep fungal hospital infection from Jan 2001 to Dec 2006 were investigated with retrospective method.RESULTS The percentage of deep fungal infection in early preventive treatment group was 7.9%,but it was 16.2% in the control group.CONCLUSIONS To early prevent the deep fungal infection with the risk factors plays a great role in prevention and treatment of the patients with deep fungal infection in intensive care unit.
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OBJECTIVE To investigate the manifestation,fungal spectrum,diagnosis,antifungal therapy and(outcome) of deep fungal infection(DFI) in patients with hematopoietic malignancies.METHODS Fifty-two(patients) of SFI admitted in Shandong Provincial Hospital during Oct 1998 to Sept 2004 were enrolled in this(investigation,) including 34 males and 18 females with mean age of 54 years old.Clinical data,such as manifestation,fungal(spectrum,) treatment and outcome,were observed prospectively and retrospectively.RESULTS Lower respiratory tract,gastrointestinal tract,urinary tract and blood were the main DFI infection sites by order of prevalence.The clinical manifestation was various among cases.Pathogen detection determined the subtypes of fungi were Candida albicans(57.14%),C.tropicalis(21.43%),yeast(47.14%),C.parapsilosis(7.14%),and Aspergillus((5.36%).) Nystatin,fluconazole,flucytosine,and(amphotericin) B were used alone or in(combination) to treat DFI.The rates of curing,improvement and death were 44.23%,23.08% and 32.69%,(respectively).(Among) 52 cases,25(48.08%) were occurred during Oct 2002 to Sept 2004,compared with 27((51.92%)) during Oct 1998 to Sept 2002,suggested the elevated incidence of DFI.CONCLUSIONS The incidence of DFI in patients with hematopoietic malignancies is increasing these years.The clinical manifestation of DFI may be nonspecific.It is critical to pay more attention to the fungal infection among the high-risk patients,therefore fungus detection from various(samples) should be recommended for the sake of early diagnosis of DFI. Though(C.albicans) remains the top in pathogen spectrum analysis,infection of other fungi tends to increase.The mortality of DFI is still very high thus more investigations about early diagnosis and treatment of DFI should be conducted.