社区获得性肺炎的诊断和治疗指南.ppt

军团菌肺炎01夏秋多发，可聚集发病02老年人、慢性病、免疫低下者为高危人群03急性或亚急性起病，稽留热、咳嗽、脓痰或血痰、呼吸困难04肺外症状明显，常有消化、神经系统症状、相对缓脉、低钠低磷血症等05白细胞升高，血清军团菌抗体滴度升高，尿抗原阳性06胸部X线：病变双侧、多发多样性；大片、斑片、斑点结节状、条索、纱网状影；可出现空洞肺炎支原体肺炎青年、儿童易感，秋季多发，可有小的爆发01010203040506干咳为突出症状，发热一般在38℃左右，偶有高热儿童可并发中耳炎、鼓膜炎胸部X线：浸润影、间质性炎症、实变影白细胞正常或略增高，以中性粒细胞为主冷凝集试验阳性，支原体抗体检查阳性0203040506衣原体肺炎衣原体抗体效价升高胸部X线：小片浸润影、实变影可并发心肌炎、心内膜炎、脑膜炎发热、咽痛、咳嗽，痰可呈脓性，常有呼吸困难儿童症状轻微，成人较严重儿童及青年为易感人群EDCBAF真菌性肺炎的临床特点多发生在免疫低下患者和长时间接受广谱抗生素治疗的患者01念珠菌肺炎：持续发热，痰粘稠不易咳出或呈胶冻状，胸片常见片状浸润和融合，常有空洞02侵袭性肺曲霉菌病：发热、咳嗽、胸痛，咯血常见。胸CT可见浸润影边缘有晕轮征，可有空洞03肺隐球菌病：发热、干咳、气急。胸片表现多样，常见单发或多发结节，常有空洞形成04肺毛霉菌病：高热、咳嗽、胸痛、呼吸困难。胸片示迅速融合的肺实变，常有空洞形成05白色念珠菌肺炎**Diffusebilateralair-spaceopacitiesconsistentwithpneumonia.PossiblecausativeorganismsincludePneumocystiscarinii.男性,43岁，４-６周来气短gaywhitemanwhopresentstoyourofficeforthefirsttimewithacomplaintofworseningshortnessofbreathoverthepast4to6weeks.GaryclaimshereceivedapositiveresultfromanHIVtest7yearsagoandhasseenadoctoronceortwicesincethen.Headmitsthathepreferredtoignorehisdiagnosisandsuspectsthatitmayhavebeenwrongbecausehehasfeltwell.Thedoctorshesawintheinterimpronouncedhimhealthy,butheacknowledgesthathewithheldbothhissexualityandtheearlierHIVtestresultsfromthemafebrile,withaheartrateof90beatsperminute;respiratoryrate,18breathsperminute;andbloodpressure,120/80mmHg.Hisoxygensaturationonroomairis92%Hislactatedehydrogenase(LDH)levelis599U/L,andhiswhitebloodcellcountis6.23103/μL.Hishemoglobinlevelis12.1g/dLandhematocritis35.4%.CD4cellcountis25/μL*非典型病原体指衣原体、支原体、军团菌**Chlamydiapneumoniaehasemergedasanimportantcauseofpneumoniainbothadultsandchildrenasyoungas2yearsold.[24,27,30,31]Over50%ofadultsworldwidehaveantibodiesagainstthepathogen,indicatingpriorinfection.Unfortunately,immunityisnotlonglived.Chlamyd