RESUMO
Objective To summarize the CT features of pulmonary mucormycosis in post hematopoietic stem cell transplantation (HSCT) patients with leukemia,to provide timely and accurate guidance for clinical treatment.Methods 9 pulmonary mucormycosis in post HSCT patients with leukemia confirmed by surgery,biopsy and sputum culture were analyzed retrospectively.Distribution,morphology and CT features of the disease were analyzed and summarized.All patients were underwent non-enhanced MSCT.Results Reversed halo sign (n=7);patchy ground glass opacity (GGO) (n =5);bilateral multiple pulmonary nodules and nodular GGO (n=3);bilateral multiple pulmonary micro-cysts with spiculate boundary (n=1);pleural effusion (n=2);pneumo-mediastinum (n 1) were seen.Two or more than two CT signs were seen in some patients.The interval time between the appeared reversed halo sign and the transplantation were 0.5-19 months in 7 patients,which median time was 10 months and 6 cases (85.7％) appeared within 18months.8 patients (88.9 ％) presented cough,expectorated white or yellow phlegm,among them,4 cases (50 ％) presented bloodstained sputum or hemoptysis.3 cases (37.5 ％) presented left chest pain.1 case was asymptomatic.6 patients (66.7 ％) presented significant increased body temperature with the range from 38.4 ℃ to 39.6 C,the median was 39 C.3 patients (33.3％) showed normal temperature.The WBC counting was between 0.16-3.31 × 109/L,the median was 0.7 × 109/L.The neutrophil cell counting was between 0-2.46 × 109/L,with the median of 0.09 × 109/L.Among them,7 patients (77.8％) found reversed halo sign with neutrophil counting between 0-1.63 × 109/L,and the median was 0.09 × 109/L.Conclusion Various imaging manifestations of pulmonary mucormycosis are seen in post HSCT patients with leukemia.When patients is in agranulocytosis phase after transplantation HSCT,it is highly suggested pulmonary mucormycosis infection when the characteristic reversed halo sign is found.
RESUMO
Background Penetrating keratoplasty (PKP) has become an effective method of treatment for fungal keratitis in recent years,but the application timing of glucocorticoids after PKP is still unclear.Literature reported that the concentration of tear (1,3)-β-D-glucan in fungal keratitis was significantly higher than that in normal.Objective This study was to investigate the change of tear (1,3)-β-D-glucan before and after PKP in fungal keratitis and to explore the application duration of anti-fungal drugs and application timing of glucocorticoids.Methods This study protocol was approved by ethic committee of Affiliated Hospital of Qingdao University.A serial cases-observational study was performed from August,2011 to December,2012.Twenty eyes of 20 patients with fungal keratitis were collected in Affiliated Hospital of Qingdao University.PKP was performed in affected eyes,and the fellow health eyes served as controls.Tear of 50 μl was obtained in the controls on 1 day before operation and 1 day,7,14,21 and 28 days after operation to detect tear (1,3)-β-D-glucan levels.Results Tear (1,3)-β-D-glucan levels were (14.67±3.84)mg/L,(1 861.66±196.17) mg/L,(927.71±155.82)mg/L,(392.30±71.22)mg/L,(179.60±40.47) mg/L,(40.20± 12.46) mg/L and (15.12± 1.80) mg/L in the control group,preoperative 1 day,postoperative 1 day,7,14,21,28 days,respectively,showing a significant difference among various time points (F=883.45,P=0.00).Tear (1,3)-β3-D-glucan levels were gradually reduced with the lapse of the postoperative time,with significant differences between adjacent timepoints (t' =13.84,t =16.67,t' =11.02,t' =13.97,t' =-8.45,all at P=0.00).Tear (1,3)-β-D-glucan levels in postoperative 28 days came near that of normal control group,without significant difference between them (P =0.64).Fungal keratitis recurred in 2 eyes on the fifth and sixth day after operation,with the tear (1,3)-β-D-glucan levels of 2 350.24 mg/L and 1 992.82 mg/L,respectively.Conclusions The concentration of (1,3)-β-D-glucan in the tears increases in the eyes with fungal keratitis and drops to normal range at 28 days after PKP,indicating that the antifungal eyedrops should be applied until 4 weeks after PKP,and this is an optimal timing of using corticosteroid eyedrops to resist reject reaction.