病原生物學病例討論第二部分(編輯修改稿)

　

【文章內容簡介】 gA CT scan of his brain revealed an intracranial calcified cyst, and further imaging with MRI confirmed the presence of similar lesions, some with a scolex visible (Fig. 641).Diagnostic WorkUpTable 641 lists the likely causes of illness (differential diagnosis). The presumptive diagnosis should be on the basis of clinical picture and epidemiologic information. The likelihood of exposure during foreign travel, and characteristic findings on CT or MRI scans, are adjuncts to clinical diagnosis. Lumbar puncture and peripheral blood collection are an essential beginning of investigation. Microbiologic investigation may include.Gram stain and acidfast stain of CFSCultures of CSF and blood for bacteria, fungi, mycobacteriaAntibody detection (., immunoblot assay of IgG in serum or CSF specific for the invasive stage of a parasite)In failed tests above Cryptococcal antigen in CSF and serum CSF VDRL Serologic tests for others included in differential diagnosisTable 641 Differential Diagnosis and Rationale for Inclusion (consideration)Brain abscessCraniopharyngiomaCryptococcal meningoencephalitisMedulloblastomaNeurocysticercosisToxoplasmosisTuberculomaRationale: Intracerebral mass lesions have many possible causes (mon ones are listed above). Homogeneous masses may be malignancies, and ring enhancement is classically associated with brain abscess. Cystic masses may be malignant, but they are also classically associated with neurocysticercosis. Other infectious causes of intracerebral masses include toxoplasmosis, tuberculoma, and cryptococcoses.COURSEThe patient was admitted to the hospital for observation and diagnostic investigation. A lumbar puncture was performed. The CSF analysis revealed a WBC count of 35/ , with lymphocytic and eosinophilic pleocytosis, slightly elevated protein (62 mg/dL), and a normal glucose level. A positive serologic investigation specific for a parasite yielded the diagnosis.病例十五患者李某，男，36歲，上海市浦東人，汽車司機，家中飼養以只從青海來的狼犬。因持續咳嗽半年余，間斷咳血痰3個月。于1998年4月以“雙飛陰影待查，先天性肺囊腫帶排除”入院治療。體檢：心律齊，腹平軟，肝腎正常。左肺叩診濁音，呼吸音減低，雙肺未聞及干啰音和濕啰音。胸部X線片：，左下肺內內帶可見7cm，雙側陰影均邊緣光滑，密度均勻一致，陰影周圍清晰，未見鈣化及浸潤性病灶。病人入院后痰量增加，辦左側胸痛和低熱。經抗炎藥治療，肺部病灶無改變。后經B超定位下行左側經費內包塊穿刺抽去少許液體。穿刺液內查到棘球蚴的原頭節，經包蟲皮試和ELISA試驗均為強陽性，診斷為肺棘球蚴病；即行左下肺切除術。術后給予阿苯達唑600mg/d治療，口服一年，隨訪至今健康。1. 上述癥狀中哪些與包蟲病有關？2. 包蟲病是如何感染人體的？應該怎樣預防？3. 包蟲病多流行于西北地區，上海出生和生長且從未去過牧區的居民是真陽怎樣感染包蟲病的？病例十六A 49yearold woman presented with high fever and chills, jaundice, and upper abdominal pain for 3 days.The patient was a recent immigrant from Argentina. One year before, she first noticed a sensation of fullness in the right upper quadrant of her abdomen. Her part medical history was unremarkable. In her country of origin, she had been, healthy and active, working in the field and breeding and raising sheepdogs.PHYSICAL EXAMINATIONVS: T ℃, P 112/min, R 18/min, BP 102/60 mmHgPE: The patient appeared acutely ill and was obviously jaundiced. Right upper quadrant abdominal tenderness was noted.LABORATORY STUDIEDBloodHematocrit: 34%WBC: 22, 400/μlDifferential: 55% PMNs, 20% bands, 12% lymphs, 8% eosinophilsSerum chemistries: alkaline phosphatase 340 U/L。 bilirubin ImagingA CT scan of the liver demonstrated a large multiloculated cyst with bile duct dilation (Fig. 511).Diagnostic WorkUpTable 511 lists the likely causes of the woman’s illness (differential diagnosis). A clinical diagnosis of hepatic hydatid cyst (tapeworm) disease was considered based on the imaging studies (CT scans of liver). Serologic tests specific for a tapeworm mat include.ELISA to detect IgG in patient’s serum (screening)Immunoblot assay to confirm the diagnosisTABLE 511 Differential Diagnosis and Rationale for Inclusion (consideration)CholanditisHydatid cyst (tapeworm) diseaseLiver abscessViral hepatitisRationale: Clinical diagnosis is difficult。 the history of exposure is helpful. The symptoms are suggestive of biliary tract infection, which may have many causes. Vital hepatitis would not produce lesions seen in the CT scan. The more mon causes are listed above. Hydatid cyst is a possibility when appropriate epidemiology is present.COURSEGiven the patient’s clinical status, she was taken to the operating room. The liver lesion was pletely removed surgically, and the biliary obstruction was relieved. The patient received an antihelminthic drug postsurgery. An ELISA and subsequent immunoblot test for antibodies against a tapeworm confirmed the specific etiology.病例十七A 9yearold boy was brought to the hospital by his parents with plaints of repeating intense chills and daily high fever for 4 parents said that when his fevers would abate,he would bee drenched in sweat and feel exhausted and drained.