肺曲霉病诊治进展 .ppt

* 感染类型 治疗 首选 备选 经验性抗真菌治疗和抢先抗真菌治疗 经验性抗真菌治疗用药如下：L-AMB (3-5 mg/kg/d IV),卡泊芬净（第一天 70mg IV,随后50 mg/d IV),伊曲康唑（ 200mg/d IV或200mg bid 口服）伏立康唑（第一天6mg/kgIV q12h,随后3mg/kg IV q12h；口服剂量为200mg q12h） 侵袭性曲霉病的预防用药 泊沙康唑（200mg q8h) 伊曲康唑(最初2天200mg q12h IV,然后200mg q24h iv)或伊曲康唑200mg口服q12);米卡芬净（50 mg/d) 2008 IDSA 曲霉病诊治指南 曲霉病治疗 * The Sanford Guide to Antimicrobiol Therapy, 39 ed, 2009-2010. 首选治疗 伏立康唑6mg/kg IV q12h第一日，继以4mg/kg IV q12h 或200mg po q 12h (≥40 kg)，100mg po q12h(40kg) 备选治疗 脂质AmB 3-5mg/(kg.d) IV 或两性霉素B脂质复合物 5mg/(kg,d) IV 或卡泊芬净70mg IV第一日，继以50mg/d IV 或米卡芬净100-150mg/d 或泊沙康唑 200md qid,病情稳定后400mg bid 侵袭性肺及肺外曲霉病(IPA) 治疗方案 感染 * 通常推荐侵袭性肺曲霉病的疗程最短为6-12周;免疫缺陷患者,应在免疫缺陷时期持续治疗直至病灶消散.病情稳定的患者,口服伏立康唑长期治疗更加方便.在已治疗成功的侵袭性曲霉病患者,若预期将发生免疫抑制,重新应用抗真菌治疗可预防感染复发. 2008 IDSA 侵袭性肺曲霉病诊治指南 谢 谢 ! * 同样为机会性病原菌，最常见为烟曲霉及黄曲霉的感染，图为烟曲霉和黄曲霉的镜下观。 曲霉菌虽不如念珠菌感染普遍，但致死率更高。 值得注意的是，曲霉菌病的发病率常被低估，而今年来，随着易感病人数量的增加，以及诊断技术的不断改进，其发病率也不不断提高。 Aspergillus species are globally ubiquitous saprophytes found in a variety of ecological niches. Almost 200 species of aspergilli have been identified, less than 20 of which are known to cause human disease. Among them, Aspergillus fumigatus is the most prevalent and is largely responsible for the increased incidence of invasive aspergillosis (IA) in the immunocompromised patient population. IA is a devastating illness, with mortality rates in some patient groups reaching as high as 90%. Studies identifying and assessing the roles of specific factors of A. fumigatus that contribute to the pathogenesis of IA have traditionally focused on single-gene deletion and mutant characterization. In combination with recent large-scale approaches analyzing global fungal responses to distinct environmental or host conditions, these studies have identified many factors that contribute to the overall pathogenic potential of A. fumigatus. Here, we provide an overview of the significant findings regarding A. fumigatus pathogenesis as it pertains to invasive disease. * Object