Current Issue

2018 Vol.3 No.3 Published:31 August 2018

Academician column

Frontiers and research focuses in the field of medical mycology LIAO Wan-qing, CHEN Min, FANG Wen-jie 2018, 3 (3):  129-133.  Abstract ( 436)    PDF (853KB) ( 945 )    Candida auris, a super fungi, is a hot and important topic of international mycologic research, due to its genetic diversity, multiple drug resistance and high fatality. In this paper, we summarized the frontiers and hot issues in the field of medical mycology research in recent years.① Epidemiological changes of superficial and deep fungal diseases based on larger-scale dynamic epidemiological study have demonstrated that the proportion of dermatophytes has decreased for decades, whereas yeast pathogens have the tendency of increasingly pathogenic. The diversity of pathogenic fungi has been more significant than ever before, and new pathogenic fungi have been increasingly reported. ② New diagnostic techniques of fungal diseases are developing continuously, an early, specific and rapid diagnosis is the hotspot of fungal diseases, especially deep fungal infections. Molecular diagnosis, real-time fluorescence quantitative technology and strome-assisted laser-assisted ionization time-of-flight mass spectrometry provide a basis for their accurate diagnosis and appropriate treatment. ③ The mechanism of fungi resistance to fungal drugs as well as the molecular and cellular mechanisms underlying the interaction between pathogenic fungi and host have been paid much attention in current researches.

Clinical diagnosis and treatment of emerging infectious diseases

Influenza-associated Encephalitis in Adult: a case report and literature review MEI Xue, DAI Fa-hui, WANG Wei, WU Fan, HUANG Qin, LING Yun, LU Hong-zhou 2018, 3 (3):  146-149.  Abstract ( 189)    PDF (1119KB) ( 553 )    Objective To describe the clinical manifestations, diagnosis and treatment of a case of adult influenza-associated encephalitis, and related literatures were reviewed to increase the knowledge about the disease. Methods A case of adult influenza-associated encephalitis admitted to Shanghai Public Health Clinical Center on Feb 2018 was analyzed. The clinical manifestations, diagnosis and treatment were described in detail. In addition, related literatures were reviewed to increase our knowledge about the disease for its early diagnosis and appropriate treatment. Results In the influenza prevailing season, central nervous system infection is possible. Influenza-associated encephalitis should be considered in the differential diagnosis. Cerebrospinal fluid, blood, pharynx swab and other specimens should be tested for its early diagnosis based on etiological (nucleic acid) and immunological evidence. Conclusion In patients with influenza and accompanying neurological symptoms, influenza-associated encephalitis may be possible. The susceptible populations should receive influenza vaccine annually to prevent the occurrence of influenza and its serious complications.

Original Articles

Acquired Immunodeficiency Syndrome related lymphoma: 29 clinical cases and the factors influencing their prognosis CHEN Li, LIU Min, HE Xiao-qing, WU Yu-shan, LI Qi-sui, CHEN Yao-kai 2018, 3 (3):  153-155.  Abstract ( 348)    PDF (848KB) ( 1056 )    Objective To analyze 29 clinical cases of AIDS-related lymphoma (ARL) admitted to Chongqing Public Health Medical Center during the period from 2015 to 2017. Methods The clinical data of 29 patients with ARL admitted to Chongqing Public Health Medical Center were analyzed retrospectively for the clinical features and the factors influencing their prognosis. The subjects were divided into the survival group and the death group. Their basic data and clinical symptoms were analyzed. Results A total of 29 patients were recruited as the subjects of the study, including 22 were males and 7 females. The mean age was (50.76±14.58) years, and the baseline CD4 cell count was (171.66±120.26)/μL. Fourteen cases showed fever with no known reason, 10 cases lymphadenopathy and 8 cases abdominal pain. Based on the pathological findings, 21 cases(72.41%) were diagnosed with B cell non-Hodgkin's lymphoma (NHL), 8 cases(27.59%) with T cell origin and Hodgkin lymphoma (HL), 4 cases at IPI score-related middle-risk and 25 cases at high-risk (86.21%). In total,15 cases(51.72%) had received highly active antiretroviral therapy (HAART) before their first presentation to our hospital or within one month after the diagnosis of lymphoma. And 11 cases (37.93％) received standard chemotherapy regimen formulated by the oncology specialists. Twenty-two cases of death occurred, with a mortality rate of 75.86%. Univariate analysis showed that prognostic factors included IPI score (OR=0.063, P<0.05) and standard chemotherapy (OR=20.4, P<0.05). Conclusion ARL is mainly B cell-originated NHL and it has various clinical manifestations. Most of the patients are already in their intermediate or advanced stage of lymphoma and the mortality rate is high. IPI score and standard chemotherapy regimen are the key to the prognosis of patients with ARL.

Measurement of hepatic and splenic SWV by VTR technique for assessment of endoscopic sclerotherapy BAO Ming-wen, DONG Chang-feng, FENG Cheng, HUANG Ting, QIU Zhi-hui, ZHU Zhi-bin 2018, 3 (3):  156-159.  Abstract ( 461)    PDF (922KB) ( 496 )    Objective To evaluate the clinical value of VTQ in the measurement of hepatic and spleen SWV non-invasive evaluation of endoscopic sclerotherapy for severe EV in patients with hepatitis B cirrhosis. Methods Ninety patients with severe EV who underwent sclerotherapy and microsurgery were enrolled, 59 of whom underwent microsurgical sclerotherapy (group A) and 31 underwent routine gastroscopy (group B). The blood, routine liver function, blood coagulation and ultrasonography were collected on the next day. The liver and spleen SWV were measured one day before, one day after and one month after surgery in group A. The liver and spleen underwent SWVmeasurement before and after gastroscopy in group B. Group A underwent EUS to evaluate the effect of sclerotherapy in the first month after surgery. EUS results were used as the gold standard to evaluate the efficacy of subsurgical sclerotherapy with liver and spleen SWV. Results The SWV of liver and spleen in group A was significantly higher than that before operation [(2.68±0.54) m/s VS (1.98±0.36) m/s, P<0.05; (3.75±0.33) m/s VS (3.15±0.28) m/s, P<0.05]. There was no significant change in SWV of liver and spleen before and after endoscopy in group B [[1.91±0.43) m/s VS(1.87±0.64) m/s, P>0.05; (3.18±0.36) m/s VS (3.32±0.48) ) m/s, P>0.05]. At 1 month after operation, the liver and visceral SWV of the hardened group were slightly higher than that of the day after surgery [[2.88±0.42] m/s VS (2.79±0.38) m/s, P>0.05; (3.81±0.28) m/s VS (3.79±0.26) m/s, P>0.05], SWV of liver and spleen in the incomplete group was lower than that in the day after surgery [(2.21±0.29) m/s VS(2.49±0.36) m/s, P<0.05 ]; [(3.15±0.41) m/S VS (3.61±0.38) m/s, P<0.05]. The SWV 2.55m/s was used as the threshold for complete hardening under the microscope. The sensitivity was 0.78 and the specificity was 0.73. The spleen SWV 3.61m/s was used as the threshold for complete hardening under the microscope. The sensitivity was 0.89 and the specificity was 0.77. The AUROC of the spleen SWV for the evaluation of subsurgical varicose veins was 0.88, and the predictive power was higher than that of the liver SWV (AUROC: 0.71, Z= 2.5, P= 0.025). Conclusion The sclerotherapy of the liver can significantly increase the SWV of the liver. The application of VTQ technique to measure the liver and spleen SWV can evaluate the curative effect of subsurgical sclerotherapy to a certain extent. The evaluation efficacy of spleen SWV is higher than that of liver SWV which means it has certain potential value for affecting the clinical efficacy of EV sclerotherapy.

18F-FDG PET/CT in differential diagnosis of solitary pulmonary tubercular nodule and clinical stage I non-small cell lung cancer LUO Zhe-huang, JIN Ai-fang, PENG Ying, LIAO Feng-xiang, LUO Xiao-yan 2018, 3 (3):  160-163.  Abstract ( 399)    PDF (1128KB) ( 950 )    Objective To investigate the value of 18F-FDG PET/CT in differential diagnosis of solitary tubercular nodule (STN) and clinical stageⅠnon-small cell lung cancer (NSCLC). Methods The PET/CT images of STNs confirmed from January 2012 to December 2016 were collected, and the PET/CT images of clinical stageⅠNSCLC diagnosed from January to December 2016 were used as controls. The CT images and metabolic features were compared between the two groups. Results The lesion presented as round or round like were 70.6% in the group of clinical stageⅠNSCLCs and 30.8% in the group of STNs, respectively. The difference was statistically significant (P<0.05). In the group of clinical stageⅠNSCLCs, 26.5% of the lesion was shown with short spikes but no short spikes in the group of STNs. The difference was statistically significant (P<0.05). The distribution, size, and pleural tag of lesions showed no significant differences between the two groups (P>0.05). The average SUVmax in the group of clinical stageⅠNSCLCs was higher than that in the group of STNs, but the difference was not statistically significant (P>0.05). There was no significant differences in terms of tumor metabolic volume (TMV) and total lesion glycolysis (TLG) between the two groups (P>0.05). Twelve cases in the group of STNs received delayed imaging, with the lowest retention index (RI) of 0%, the highest 84% and a mean of 46.53±21.22. Twenty-seven cases in the group of clinical stage I NSCLC received delayed imaging, with 1 case showing an RI of -10.20. Among the 27 cases, the maximum value was 56%, and the mean was 24.91±15.51. The RI of STNs group was significantly higher than that in the group of clinical stageⅠNSCLC (P<0.05). Conclusion The morphology, short spike sign, and the value of RI are key points facilitating the differential diagnosis of STN and clinical stageⅠNSCLC.

Magnetic resonance imaging for brain cysticercosis QIN Zhuan-li, HUANG Cong, HAN Ning, PAN Gao-zheng, FU Mao-lin 2018, 3 (3):  164-166.  Abstract ( 234)    PDF (1270KB) ( 719 )    Objective To investigate the characteristics of cerebral cysticercosis by magnetic resonance imaging (MRI). Methods The MRI data of 26 cases of cerebral cysticercosis confirmed clinically and surgically was retrospectively analyzed. Results In the total 26 cases, 20 were brain parenchymal type and the other 6 were mixed type. By staging, 2 cases were at the active stage, 6 at the degenerating and dying stage, 4 at the calcification stage, and 14 at the mixed stage. Conclusion MRI is capable of demonstrating clearly the quantity, location and size of cerebral cysticercosis. And it facilitates the judgment on the typing and staging of cerebral cysticercosis. In combination to CT scan and clinical symptoms, MRI can increase the diagnostic rate of cerebral cysticercosis.

Pneumocystis jirovecii colonization in intensively cared patients with non-HIV infection HU Shui-xiu, HUANG Kui, LAN Zheng, QIN Hai-yuan, TANG Xiu-wen 2018, 3 (3):  167-170.  Abstract ( 201)    PDF (873KB) ( 571 )    Objective To investigate the prevalence of Pneumocystis jirovecii（P.jirovecii）colonization in patients admitted into ICU with non-HIV infection, and to explore the correlationship between P.jirovecii colonization and occurrence of various diseases as well as CD4+T cell count. Methods A total of 33 non-HIV-positive patients with P.jirovecii positive identified in bronchoalveolar lavage fluid (BALF) specimen and confirmed as colonization in intensive care unit (ICU) in our hospital from April 2016 to March 2018 were chosen as the subjects of the P.jirovecii colonization group. Meanwhile,48 non-HIV-positive patients with P.jirovecii negative were selected as the control. The clinical data of the two groups were analyzed. Results The colonization rate of P.jirovecii was 40.7% in 81 patients. The incidence of shock in the P.jirovecii colonization group was significantly higher than that in the P.jirovecii negative group(P<0.05). The incidence of severe pneumonia in the P.jirovecii colonization group was significantly higher than that in the P. jirovecii negative group（P<0.05). No statistical differences were found concerning the incidences of pulmonary malignanttumor, interstitial lung disease (ILD), acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and pulmonary tuberculosis between the P.jirovecii colonization group and the P. jirovecii negative group (P>0.05). The incidences of P.jirovecii colonization was 45.5%, 35.0% and 44.1% in the groups of CD4+>400 cells/μl, CD4+ 400~200 cells/μl and CD4+<200 cells/μl, respectively, with no statistical significance between the three groups (P>0.05). Conclusion The colonization rate of P.jirovecii is high in intensively cared non-HIV-positive patients. Shock and severe pneumonia more commonly occur in patients with P.jirovecii colonization. The occurrences of pulmonary malignant tumor, ILD, AECOPD, and pulmonary tuberculosis are not related to P.jirovecii colonization. And the occurrence of P.jirovecii colonization is not related to CD4+T cell count.

AIDS complicated by pulmonary tuberculosis and/or Talaromyces marneffei: An analysis of radiological images QIN Jiang-long, LIANG Gang, LU Xiang-chan, ZHANG Jian-feng, NING Zong, LU Yi-bo, WU Nian-ning, WU Feng-yao 2018, 3 (3):  171-174.  Abstract ( 182)    PDF (852KB) ( 656 )    Objective To analyze the radiological characteristics of AIDS complicated by pulmonary tuberculosis and/or Talaromyces marneffei. Methods A total of 972 cases of HIV positive diagnosed at our hospital from January to December 2015 was retrospectively analyzed. The clinical radiological characteristics of the lungs in patients with different complications of AIDS were comparatively analyzed. Results In the 972 patients with AIDS, 11.52% suffered from the complication of pulmonary tuberculosis (PTB), 6.06% suffered from the complication of Talaromyces marneffei (TM), and 9.56% suffered from the complications of PTB and TM. In the cases of AIDS complicated by PTB, CT scan of lungs demonstrated cord-like lesions,nodules,pleural thickening and pleural effusion, accounting for 39.2%, 15.1%, 17.8%, and 21.4%, respectively. In the patients with AIDS complicated by TM, CT scan of lungs demonstrated cord-like lesions,nodules,pleural effusion,and mediastinal lymphadenectasis, accounting for 20.3%, 15.2%, 13.6%, and 13.6%, respectively. In the patients with AIDS complicated by PTB and TM, CT scan of lungs demonstrated cord-like lesions,nodules,pleural effusion,and mediastinal lymphadenectasis, accounting for 29.1%, 18.3%, 16.1%, and 13.9%, respectively. Conclusion Radiology of AIDS complicated by pulmonary tuberculosis and/or Talaromyces marneffei presents multiple atypical changes, mainly including cords like opacity and nodule with accompanying pleural effusion, pleural thickening and lymphadenectasis. A better understanding about the clinical and radiological characteristics of opportunistic infections complicating AIDS contributes to the treatment of AIDS.

Multidrug abuse in HIV-positive patients receiving methadone maintenance therapy before and after highly active antiretroviral therapy LIANG Gang, WU Feng-yao, YANG Chu-yu, LI Fei, CHEN Wan, WANG Guang-cai 2018, 3 (3):  175-177.  Abstract ( 187)    PDF (845KB) ( 576 )    Objective To understand the prevalence of multidrug abuse in HIV-positive patients receiving methadone maintenance therapy before and after highly active antiretroviral therapy (HAART). Methods A questionnaire survey was conducted in HIV-positive patients receiving methadone maintenance treatment before and after their administration of HAART. And the questionnaire, Survey of IDU Patients Receiving Anti-viral Therapy was developed by the National Center for Disease Control in China. Results The most frequently abused drug by HIV-positive patients who received methadone maintenance treatment before HAART was heroin, followed by tramadol, diazepam, promethazine, and mahgu. After receiving HAART, the percentage of subjects abusing heroin and promethazine increased significantly (P<0.05). The most common way of drug abuse turned to intravenous drug abuse, and the quantity of heroin abuse increased significantly after receiving HAART. The monthly cost on drug abuse was ￥(103.24 ±36.17) and (370.16±87.25), respectively before and after HAART therapy. Conclusion sIn HIV-positive patients who received methadone maintenance treatment, drug abuse, including heroin, diazepam, tramadol and other drugs, prevails. The drug abuse exacerbates after they receive HAART. The effects of drug abuse on methadone maintenance treatment and HAART need further study.

CT demonstrations of cavitary pulmonary tuberculosis before and after antituberculotic treatment: A comparative study for signs of convertion PENG Cheng, WANG Li-fei, LANG Fang-fang, CAO Yi, CHEN Xiao-fang, ZHENG Guang-ping 2018, 3 (3):  178-181.  Abstract ( 207)    PDF (1255KB) ( 637 )    Objective To investigate and compare the HRCT demonstrations of cavitary pulmonary tuberculosis before and after treatment for signs of converstion. Methods A total of 48 cases of cavitary pulmonary tuberculosis were collected. And all of the patients received at least two CT scans before and after antituberculotic treatment. The differences of CT scan demonstrations of and around the cavitary lesions were analyzed, and the evolvement of cavitary lesions were observed comparatively. Univariate and multivariate logistic regression analysis were performed for statistical differences before and after treatment. The residual ratio of residual cavitary lesion after treatment was selected as the control to calculate the odds ratio. Results Univariate analysis of the diameter of cavitary lesion (P<0.05), satellite foci (P<0.05), and adjacent bronchiectasis (P<0.001) were significantly associated with active cavitary lesions. The spikes and cords like demonstrations were significantly associated with residual cavitary lesions after treatment (P<0.001). Multivariate analysis revealed that the diameter of cavitary lesion and bronchiectasis were significantly correlated with active cavitary lesion (P<0.05). And the spike and cords like demonstrations were significantly associated with the residual cavitary lesion after treatment (P<0.05). Conclusion The spike and cords like demonstrations formed after anti-tuberculotic treatment are signs signaling the activation of cavitary lesions.