Immunocompromised Host Pneumonia: Cov ntsiab lus thiab Kev Ntsuas Kev Ntsuas

Abstract

Pneumonia ua rau lub nra hnyav rau cov neeg uas muaj kev tiv thaiv kab mob. Ntau lab tus tib neeg nyob nrog kev tiv thaiv tsis zoo vim yog kev kho mob qog noj ntshav cytotoxic, kev kho mob lom neeg, hloov khoom nruab nrog cev, tau txais txiaj ntsig thiab tau txais kev tiv thaiv kab mob, thiab lwm yam kev tiv thaiv kab mob. Txawm hais tias muaj kev paub dav dav ntawm cov kws kho mob tias cov neeg mob no muaj kev pheej hmoo ntau ntxiv rau kev mob ntsws ntsws, cov neeg tiv thaiv kab mob feem ntau raug cais tawm ntawm kev kho mob ntsws ntsws thiab cov kev sim kho mob. Qhov tsis muaj kev lees paub dav dav rau kev tiv thaiv kab mob ntsws ntsws yog qhov kev paub tseem ceeb uas cuam tshuam kev kho mob thiab kev tshawb fawb txog kev sib kis mob ntsws hauv cov neeg tsis muaj zog no. Txhawm rau hais txog qhov sib txawv no, American Thoracic Society tau teeb tsa lub rooj cob qhia uas cov neeg koom nrog muaj kev paub txog kab mob ntsws, kab mob sib kis, kev tiv thaiv kab mob, noob caj noob ces, thiab tshuaj hauv chaw kuaj mob, txhawm rau txheeb xyuas qhov chaw ntawm kev tiv thaiv kab mob ntsws thiab nws cov txheej txheem kuaj mob.

cistanche tubulosa- txhim kho lub cev tiv thaiv kab mob

Nyem qhov no mus saib Cistanche Enhance Immunity khoom

【Nug ntxiv】 Email: cindy.xue@wecistanche.com / Whats App: 0086 18599088692 / Wechat: 18599088692

Lo lus tseem ceeb: mob ntsws; immunocompromised party; kev tiv thaiv kab mob; kuaj mob

Txheej txheem cej luam

Pneumonia ua rau lub luag haujlwm tseem ceeb rau cov neeg uas muaj kev tiv thaiv kab mob tiv thaiv kab mob vim yog kev kho cytotoxic, kev kho mob lom neeg, hloov khoom nruab nrog cev, tau txais kev tiv thaiv kab mob, thiab lwm yam kev tiv thaiv kab mob. Qhov tsis muaj kev lees paub dav dav rau kev tiv thaiv kab mob ntsws ntsws (ICHP) yog qhov kev paub tseem ceeb uas cuam tshuam kev saib xyuas kev kho mob thiab kev tshawb fawb txog kev sib kis mob ntsws hauv cov neeg tsis muaj zog no. Txhawm rau hais txog qhov sib txawv no, ATS (American Thoracic Society) tau teeb tsa lub rooj cob qhia uas nws cov neeg koom nrog muaj kev paub txog kab mob ntsws, kab mob sib kis, kev tiv thaiv kab mob, noob caj noob ces, thiab tshuaj hauv chaw kuaj mob, txhawm rau txheeb xyuas qhov chaw ntawm ICHP thiab nws cov txheej txheem kuaj mob. Peb cov lus xaus suav nrog cov hauv qab no:

ICHP txhais tau tias yog kab mob ntsws uas tshwm sim hauv ib tus neeg uas muaj ntau lossis ua haujlwm ntawm lub cev tiv thaiv kab mob.

Cov txheej txheem kuaj mob ntawm ICHP suav nrog kev soj ntsuam kev ua xyem xyav ntawm kev mob ntsws ntsws, nrog lossis tsis muaj cov tsos mob thiab cov tsos mob sib xws, thiab cov pov thawj hluav taws xob ntawm cov kab mob pulmonary infiltrate tshiab.

Taw qhia

Pneumonia yog ib qho tseem ceeb ua rau muaj kev mob nkeeg thiab kev tuag rau txhua tus neeg, tab sis nws cuam tshuam tsis zoo rau cov tib neeg uas tsis muaj kev tiv thaiv kab mob rau ntau yam etiologies. Ntxiv nrog rau cov neeg mob uas tau txais kev kho mob pob txha pob txha los kho cov kab mob malignancies, ntau lab tus tib neeg noj cov tshuaj tiv thaiv kab mob thiab cov phiaj xwm biologics los tswj cov kab mob autoimmune thiab inflammatory (1). Yuav luag txhua tus neeg tau txais kev hloov pauv hauv nruab nrog cev (SOT) yuav tsum tau txhaj tshuaj tiv thaiv kab mob mus ntev los tiv thaiv kev tsis lees paub allograft (2). Xyoo 2020, ntau dua 37 lab tus tib neeg thoob ntiaj teb tau nyob nrog tib neeg kev tiv thaiv kab mob HIV (HIV), nrog rau 1.5 lab tus kab mob HIV tshiab tau kuaj pom txhua xyoo (3). Cov tshuaj tiv thaiv kab mob tsis zoo, txawm tias tsawg dua li kev kho mob uas cuam tshuam nrog kev tiv thaiv kab mob, kuj ua rau cov neeg mob muaj kev pheej hmoo kis mob. Immunocompromised hosts (ICHs) tuaj yeem tsim mob ntsws vim muaj cov kab mob txawv txawv uas nyuaj rau kev kho, nrog rau cov kab mob xws li Streptococcus pneumoniae lossis mob hnyav ua pa nyuaj rau tus mob coronavirus 2 (SARS-CoV-2) uas tuaj yeem ua rau mob hnyav dua. cov txiaj ntsig (4–7). Txawm hais tias kev lees paub dav dav ntawm lub nra ntawm kev mob ntsws hauv ICHs, lub koom haum ICHP tseem tsis tau txhais tsis zoo. Community-acquired pneumonia (CAP) cov txheej txheem kev kho mob qhia meej tsis suav nrog cov neeg mob immunocompromised vim yog heterogeneity ntawm lub hauv paus immunocompromising tej yam kev mob, teeb meem nyob rau hauv kev kuaj mob vim hais tias ntawm atypical presentations, raws li zoo raws li lub dav array ntawm opportunistic pathogens confound empiric txoj kev kho (8). Tsuas yog tsis ntev los no muaj txoj hauv kev kho mob rau CAP hauv ICH tau raug txiav txim siab, lees paub tias tsis muaj kev pom zoo nyob ib puag ncig leej twg yuav tsum tau txiav txim siab tiv thaiv kab mob (9). Feem ntau ICHs raug txiav txim siab hauv cov ntsiab lus dav yam tsis muaj kev lees paub ntawm heterogeneity thiab qib ntawm kev tiv thaiv kab mob. Txog rau tam sim no, tsis muaj kev pom zoo txhais tau tias ntawm ICHP muaj nyob rau kev coj noj coj ua lossis qhia txog kev tsim cov kev sim cuam tshuam. Qhov tsis muaj lub ntsiab lus tsis sib xws yog qhov txwv tsis pub muaj kev saib xyuas zoo ib yam thiab kev txheeb xyuas tus qauv ntawm cov neeg mob rau cov phiaj xwm kev sim. Txhawm rau daws cov teeb meem no, ATS Rhiav tau tsim nrog lub hom phiaj ntawm kev txheeb xyuas ICHP thiab tsim cov txheej txheem kuaj mob rau lub koom haum no.

cistanche tubulosa- txhim kho lub cev tiv thaiv kab mob

Rhiav hom thiab txoj kev

Cov neeg koom nrog Rhiav tau raug caw los ntawm cov kws tshaj lij hauv kev mob ntsws thiab cov neeg muaj kev tiv thaiv kab mob tiv thaiv kab mob, sawv cev rau thaj chaw tshuaj pulmonary, tshuaj kuaj mob, kab mob sib kis, kev tiv thaiv kab mob, noob caj noob ces, thiab kev tshawb fawb. Txhua tus neeg koom tau raug kuaj xyuas rau qhov tsis sib haum xeeb ntawm kev txaus siab raws li ATS txoj cai. Txhawm rau tsom mus rau kev sib tham txog kev cob qhia, ob qhov kev tshawb fawb Delphi uas tsim los ntawm cov rooj sib tham (SEE, G.-SC, thiab KC) tau tswj hwm hluav taws xob rau txhua tus neeg koom ob peb lub lis piam ua ntej lub rooj cob qhia nyob (saib cov ntaub ntawv ntxiv). Cov no tau tso cai rau cov thawj coj sib koom ua tus yam ntxwv ntawm cov ncauj lus uas tau txais kev pom zoo los ntawm kev tsis pom zoo. Ib puag ncig muaj 34 cov lus nug uas hais txog lub ntsiab lus ntawm ICHP, suav nrog cov neeg mob thiab cov kev pheej hmoo, cov txheej txheem kuaj mob uas muaj cov kab mob microbiology thiab hluav taws xob, thiab kev sim tshuaj ntsuam xyuas. Cov neeg koom tau teb rau txhua qhov Delphi nqe lus ntawm Likert scale (pom zoo / pom zoo / nruab nrab / tsis pom zoo / tsis pom zoo), nrog kev pom zoo txhais tau tias tsawg kawg yog 70% kev pom zoo ntawm cov neeg koom nrog cov lus teb. Ib txheej thib ob ntawm Delphi nqe lus tau tsim los ntawm cov lus teb rau thawj txheej, tso cai rau kev kho kom zoo ntawm thaj chaw ntawm kev pom zoo. Cov cheeb tsam ntawm qhov kev pom zoo muaj zog tau khaws cia raws li lub hauv paus ntsiab lus ntawm cov ntsiab lus txhais, thiab cov cheeb tsam ntawm kev pom zoo tsawg dua tau suav nrog hauv cov txheej txheem kev cob qhia nyob rau kev sib tham los ntawm tag nrho pawg neeg.

Lub rooj cob qhia nyob tau ua rau lub Tsib Hlis 6–7, 2021, ntawm ob ntu kev sib tham video. Thawj hnub suav nrog kev nthuav qhia luv luv los txiav txim siab txog cov neeg ICH tshwj xeeb los tsim cov ntsiab lus ntawm ICHP txhais. Hnub thib ob tsom mus rau cov txheej txheem ntawm kev kuaj kab mob kom tau txais kev kuaj mob algorithm rau ICHP. Tom qab lub rooj cob qhia nyob, ob lub rooj sib tham video txuas ntxiv tau muaj los ua kom tau txais kev pom zoo ntawm cov lus hais qhia. Cov nqe lus no tsis yog ib qho kev qhia ua pov thawj tab sis yog qhov kev pom zoo ntawm kws tshaj lij. Cov ntsiab lus ntawm kev nthuav qhia kev cob qhia thiab cov lus pom zoo tau tshaj tawm ntawm no.

Txhais ICHP

Txhawm rau muab cov ntsiab lus ntawm ICHP, peb suav hais tias yog qhov spectrum ntawm cov neeg tiv thaiv kab mob tiv thaiv kab mob. Kev sib tham nyob ib ncig ntawm cov yam ntxwv sib koom ntawm cov neeg mob uas tau pom zoo suav tias yog kev tiv thaiv kab mob, uas cov neeg mob yuav tsum tau txiav txim siab hauv qhov rubric no, thiab raws li qhov xwm txheej kho mob yuav tsum xav tias ICHP. Peb cov lus nug tseem ceeb tau hais txog kev sib tham: Dab tsi yog qhov tsis xws luag hauv kev tiv thaiv tus tswv tsev? Rau cov kab mob dab tsi yog cov neeg tiv thaiv kab mob uas muaj kev pheej hmoo ntxiv? Puas muaj tus lej biomarker uas muaj feem cuam tshuam nrog qib ntawm kev pheej hmoo?

ICH Cov neeg

Cancer thiab Hematopoietic Cell Transplant (HCT) Recipients

Hauv kev tshawb fawb txog kev ua tau zoo ntawm cov tshuaj tiv thaiv thiab mob ua pa tsis ua haujlwm (9-11), cov neeg mob qog noj ntshav tau muab faib ua ke dav, tsis hais hom mob qog noj ntshav lossis theem kab mob. Txawm li cas los xij, qhov kev mob nkeeg thiab kev tuag ntawm CAP tau nce siab rau cov neeg mob qog noj ntshav feem ntau, qhov xwm txheej sib txawv ntawm hom malignancies thiab kev kho mob theem: cov neeg mob ntsws cancer muaj 21-fold nce hauv mob ntsws piv nrog 1.{{ 4}}fold nce hauv cov neeg mob qog noj ntshav mis piv nrog cov pej xeem (12). Cov neeg mob uas muaj myelodysplastic syndromes muaj kev pheej hmoo ntau dua ntawm kev mob ntsws ntsws tom qab siv tshuaj khomob ntau dua li cov neeg mob leukemias, feem ntau yog vim muaj qhov mob cytopenias (13). Qhov yooj yim tshaj plaws ntawm kev tiv thaiv kab mob tsis zoo hauv kev kho mob rau cov neeg mob qog noj ntshav thiab tau txais HCT yog neutropenia, uas tshwm sim thaum lub sij hawm sib txawv ntawm cytotoxic chemotherapy rau cov qog nqaij hlav sib txawv. Neutropenia kuj tseem yog qhov tseem ceeb rau cov kab mob hauv cov kab mob hauv cov kab mob xws li hematologic malignancies. Qhov tob thiab lub sijhawm ntawm neutropenia ua rau muaj qhov tsis zoo rau cov kab mob hauv cov neeg no (14). Lub sijhawm ntawm neutropenia rau feem ntau cov neeg mob uas muaj cov qog nqaij hlav uas tau txais kev khomob yog luv, feem ntau tsawg dua 7 hnub. Cov neeg mob uas mob leukemias thiab pre-engraftment HCT cov neeg tau txais feem ntau muaj ntau tshaj 10 hnub ntawm neutropenia, ua rau lawv muaj kev pheej hmoo loj rau ICHP. Qhov ntau neutropenia tuaj yeem tshwm sim ua ke nrog lossis ywj pheej ntawm lymphopenia, monocytopenia, thiab hypogammaglobulinemia, uas ua rau muaj kev pheej hmoo ntxiv. Cov kab mob tiv thaiv kab mob no nyob ntawm seb cov txheej txheem ntawm kev ua rau kev kho mob qog noj ntshav tau tswj hwm. Lymphopenia kuj tseem muaj nyob rau hauv cov neeg mob uas tau txais kev kho mob qog noj ntshav cytotoxic. Txawm hais tias kev siv cov lymphocyte nkaus xwb los ua kom muaj kev pheej hmoo kis tus kab mob tsis tau txhais tau zoo, nws yuav raug siv los coj cov kev xav tau ntawm Pneumocystis pneumonia (15) prophylaxis lossis qhia qhov tshwm sim ntawm tus kab mob ntsws (16-19).

Kev kho mob qog noj ntshav tshiab, tshwj xeeb yog cov uas siv cov tshuaj tiv thaiv kab mob hauv lub cev tiv thaiv kab mob qog noj ntshav, tau qhia txog kev tiv thaiv kab mob iatrogenic tshiab. Hauv cov neeg mob uas tau txais kev kho mob chimeric antigen receptor T-cell, qhov pib neutropenia ntawm kev mob yog luv luv, thaum cov qog nqaij hlav hypogammaglobulinemia tuaj yeem ua rau ntev, ua rau muaj kev pheej hmoo rau cov kab mob sinopulmonary (20). Cov neeg mob lymphoid malignancies (nrog rau cov kab mob autoimmune thiab lwm yam mob) tau txais kev kho mob los tiv thaiv CD20, xws li rituximab, muaj qhov tsis zoo ntawm B-cell cov lus teb rau kev txhaj tshuaj tiv thaiv ntau tshaj 12 lub hlis tom qab tau txais kev kho mob (21). Lwm cov txheej txheem ntawm kev tiv thaiv kab mob hauv cov neeg mob qog noj ntshav muaj xws li raug rau corticosteroids thiab lwm yam kev tiv thaiv kab mob rau kev kho mob ntawm cov kab mob graft-piv rau-tus tswv tsev lossis checkpoint inhibitor pneumonitis. Cov neeg mob uas muaj mob qog noj ntshav uas rov qab tau lawv cov neutrophil suav tom qab kev kho cytotoxic tsis suav tias muaj kev pheej hmoo kis mob (14); tej zaum tseem yuav muaj cov kab mob leukocyte tsis tu ncua los ntawm kev kho mob myelosuppressive, thiab kev pheej hmoo ntawm mob ntsws feem ntau tseem nce siab vim yog lwm yam mob, xws li kev cuam tshuam ntawm epithelial teeb meem (xws li, mucositis), kev noj zaub mov tsis zoo, thiab kab mob ntsws (22).

HIV nyob rau hauv Era of Antiretroviral Therapy (ART)

Xyoo 1997, qhov tshwm sim ntawm ART tau hloov pauv HIV mus rau cov kab mob ntev thiab txo qis kev tuag los ntawm cov kab mob pulmonary xws li Pneumocystis pneumonia (23, 24). Cov neeg muaj kab mob HIV (PWH) (tshwj xeeb yog cov uas tsis muaj ART) tseem muaj kev cuam tshuam rau ntau yam kab mob ntsws nyob ntawm lawv cov CD41 T-cell suav (25). CD4 cell suav yog qhov yooj yim tshaj plaws ntawm lub cev tiv thaiv kab mob hauv PWH, nrog rau kev pheej hmoo rau ntau tus kab mob kis tau tus kab mob nce ntxiv thaum CD4 cell suav poob qis dua 200 hlwb / microliter. Qhov kev pheej hmoo rau kab mob ntsws kuj nce ntxiv nrog rau qhov txo qis ntawm CD4 cell suav. Txawm li cas los xij, txawm tias cov neeg mob ntawm ART nrog cov kab mob HIV tswj tau zoo thiab cov CD4 suav ib txwm muaj qhov cuam tshuam loj rau lub cev tsis muaj zog (26) thiab muaj kev pheej hmoo ntawm cov kab mob ntsws tsis zoo los ntawm cov kab mob xws li Streptococcus pneumoniae, Hemophilus influenza, Staphylococcus aureus, thiab Klebsiella. mob ntsws (27). PWH nrog CD4 suav saum 500 hlwb/microliter muaj tsib npaug ntawm kev pheej hmoo ntawm S. pneumoniae pneumonia thiab invasive pneumococcal kab mob piv nrog rau cov pej xeem (28, 29). Tsis tas li ntawd, tus kab mob HIV tau ua rau muaj kev cuam tshuam tseem ceeb hauv ntiaj teb cov kab mob Mycobacterium tuberculosis, thiab PWH tseem muaj kev pheej hmoo siab rau tuberculosis txawm tias tsim nyog ART thiab khaws cia CD4 cell suav (30). Yog li, txawm hais tias CD4 cell suav yog ib qho kev lees paub ntawm kev tiv thaiv kab mob, ntau yam ntawm lwm yam kev tiv thaiv kab mob, suav nrog ntau thiab zoo B-cell abnormalities uas ua rau muaj qhov tsis zoo ntawm cov kab mob tshwj xeeb antibody ntau lawm, abnormalities nyob rau hauv neutrophil muaj nuj nqi los yog zauv, abnormalities nyob rau hauv alveo. kev ua haujlwm, thiab kev hloov pauv hauv mucociliary muaj nuj nqi thiab cov tshuaj tiv thaiv soluble molecules hauv cov pa ua pa tawm, kuj tseem cuam tshuam rau kev mob ntsws ntsws hauv PWH (31).

cistanche cov txiaj ntsig rau txiv neej-ua kom muaj zog tiv thaiv kab mob

Kev tiv thaiv kab mob ntev ntev thiab Novel Biologics

Kev siv corticosteroids ntev yog kab tias feem ntau ua rau iatrogenic tiv thaiv kab mob. Corticosteroids tseem yog thawj kab kev kho mob rau ntau yam kab mob autoimmune, inflammatory mob, cancer, SOT rejection, thiab graft-piv rau-tus tswv tsev kab mob. Cov txheej txheem ntawm kev tiv thaiv lub cev muaj xws li kev txo qis ntawm proinflammatory cytokines thiab chemokines thiab kev ua haujlwm ntawm ntau lub cev tiv thaiv kab mob, tshwj xeeb tshaj yog macrophages thiab T hlwb (32). Qhov no ua rau cov neeg mob muaj kev pheej hmoo ntau ntxiv rau ntau tus kab mob, suav nrog Pneumocystis pneumonia, invasive aspergillosis, nrog rau cov ua rau CAP (33-35), txawm hais tias qhov kev pheej hmoo no yog nyob ntawm koob tshuaj. Kev pheej hmoo ntau ntxiv tshwm sim thaum raug tsawg kawg yog 20 mg sib npaug ntawm prednisone txhua hnub rau ntau tshaj 2-4 lub lis piam (36); Cov koob tshuaj qis dua (piv txwv li, 10 mg / d) noj rau lub sijhawm ntev kuj tuaj yeem ua rau muaj kev pheej hmoo ntau ntxiv (5). Cov neeg uas noj cov tshuaj biologics tshiab rau cov kab mob autoimmune thiab cov kab mob inflammatory yog raug rau mob ntsws nyob rau hauv ib qho kev kwv yees vim yog kev puas tsuaj ntawm ob qho tib si myeloid thiab T- thiab B-cell caj npab ntawm lub cev tiv thaiv kab mob (37). Blockade ntawm TNFa (cov qog necrosis factor-a), uas tswj cov macrophage thiab T-cell teb rau mycobacteria thiab granuloma tsim, ua rau muaj kev cuam tshuam rau tuberculosis (TB) (38, 39) thiab tsawg dua, lwm yam kab mob granulomatous, nrog rau cov kab mob fungal endemic ( 40). Kev siv TNFa blockers, suav nrog etanercept thiab infliximab, yog nce (41); Yog li ntawd, cov neeg mob TB tau tshaj tawm nrog lawv cov kev siv tej zaum yuav nce ntxiv hauv cov cheeb tsam, txawm tias muaj kev kuaj mob TB (42, 43). IL-6 (interleukin 6) inhibitors thiab tsom me me molecule inhibitors zoo li JAK kinase inhibitors tau cuam tshuam nrog kev pheej hmoo siab TB (44-48). B-cell depletion agents thiab T-cell costimulatory therapy (abatacept) ua rau muaj kev pheej hmoo tsawg. Lwm cov cytokine blockers (anti-IL-12/IL-23, anti-IL-23, thiab anti-IL-17) kuj muaj cov lus ceeb toom TB, tab sis qhov kev pheej hmoo siab TB tsis tau tshwm sim rau hnub tim (49, 50 ). Txawm li cas los xij, qhov tshwm sim ntau ntxiv ntawm TB tuaj yeem xav tau vim tias muaj kev paub nrog cov neeg ua haujlwm tshiab sib sau ua ke dhau sijhawm. Kev pheej hmoo ntxiv tshwm sim nrog kev siv biologics hauv kev teeb tsa ntawm lwm yam kev pheej hmoo, suav nrog ntshav qab zib, kev haus luam yeeb, hnub nyoog siab, thiab kev siv lwm yam tshuaj tiv thaiv kab mob (51).

SOT

Nrog rau ntau tus txheej txheem SOT tau ua nyob ib ncig ntawm lub ntiaj teb, kev hloov pauv cov pej xeem muaj kev pheej hmoo rau mob ntsws txuas ntxiv. Qhov kev pheej hmoo ntawm kev mob ntsws muaj zog thiab nyob ntawm lub sijhawm dhau los ntawm kev hloov pauv thiab lub xeev ntawm kev tiv thaiv kab mob, uas nyob ntawm qhov xwm txheej ntawm induction thiab kev saib xyuas cov tshuaj tiv thaiv kab mob, kab mob hauv qab, thiab kis kab mob (52). Raws li cov neeg tau txais SOT feem ntau yog nyob ntawm ntau yam tshuaj tiv thaiv kab mob ib txhij, lawv muaj kev pheej hmoo siab rau mob ntsws vim muaj cov kab mob kis tau zoo, nrog rau cov uas feem ntau txheeb xyuas hauv cov neeg tiv thaiv kab mob. SOT cov neeg tau txais kev pom muaj qhov tsis txaus ntseeg hauv kev tiv thaiv kab mob ntawm tes, ua rau lawv kis mus rau cov kab mob viral, fungal, thiab mycobacterial pulmonary infections. Cov neeg tau txais kev hloov lub ntsws yog qhov txaus ntshai tshaj plaws rau kev mob ntsws ntawm cov neeg tau txais SOT, nrog rau cov neeg tau txais kev tuag siab, tshwj xeeb tshaj yog thawj xyoo tom qab hloov pauv (53). Qee cov kab mob ua pa, uas yog cov kab mob ua pa hauv zej zog, muaj feem cuam tshuam nrog kev pheej hmoo ntawm lub ntsws allograft dysfunction thiab kev tsis lees paub ntev (54).

Inborn yuam kev ntawm kev tiv thaiv

Thawj cov tshuaj tiv thaiv kab mob (PIDs) suav nrog cov kab mob sib txawv ntawm cov kab mob tshwm sim los ntawm kev yug me nyuam tsis raug ntawm kev tiv thaiv kab mob (IEI) lossis cov kev hloov caj ces tshwj xeeb uas cuam tshuam rau kev kis kab mob, kab mob autoimmune, kev ua xua, pob txha tsis ua hauj lwm, thiab malignancy (55). Fungal pneumonia nthuav tawm nyob rau hauv lwm qhov pom tau tias cov neeg noj qab haus huv tau coj mus rau kev tshawb pom ntawm ib leeg-gene IEI thiab kev nkag siab rau hauv cov txheej txheem ntawm kev tiv thaiv tus tswv (56). Germline variants ntawm cov noob koom nrog oxidative tawg nyob rau hauv cytoskeleton / actin polymerization, nyob rau hauv cytokine signaling, nyob rau hauv C-type lectin receptor signaling, los yog lwm yam transcription yam underlies lub hauv paus ntawm ntau PID syndromes, xws li mob granulomatous kab mob (xws li, CYBB / gp91phox. [X-linked] thiab NCF1/p47phox [autosomal recessive, AR]), Wiskott-Aldrich syndrome (WAS/WASP [Xlinked]), hyper-IgE syndrome (eg, IL6ST / gp130 [autosomal recessive (AR) lossis autosomal dominant ( AD)], IL6R/IL-6R [AR], STAT3/STAT3 [AD]), rau npe ob peb (57). Cov kev poob- lossis nce-ntawm-kev ua haujlwm gene variants ua rau lub cev tsis muaj zog ntawm tes ua haujlwm thiab / lossis lub ntsws epithelial cell function, predisposing cov tib neeg mus rau cov kab mob hnyav, kab mob, tshaj tawm mycobacterial, thiab fungal kab mob. Tsis tas li ntawd, tau txais cov tshuaj tiv thaiv cytokine autoantibodies yog ib qho tseem ceeb thiab nthuav dav ntawm PID mimics uas tau coj tawm tsam cov hom phiaj xws li IFNg (interferon g) (mycobacterial susceptibility), IFNa (mob mob coronavirus [COVID-19] susceptibility), thiab GM-CSF (granulocyte-macrophage colony-stimulating factor) (cryptococcal thiab Nocardia susceptibility) (58, 59).

Cov ntsiab lus

Muaj kev pom zoo dav dav tias ICH yog ib tus neeg uas muaj kev tiv thaiv kab mob ntau lossis ua haujlwm tsis zoo, thiab yog li ntawd ICHP lub ntsiab lus yuav tsum tau muab tso rau ntawm tus tswv tsev nrog lub cev tiv thaiv kab mob. Lub vaj huam sib luag tau lees paub tias qhov kev kuaj mob tus yam ntxwv ntawm tus tswv teb thiab nws qhov kev ua haujlwm tsis zoo yog txwv rau qhov ntsuas tsis tseeb (xws li leukocyte suav thiab raug rau cov tshuaj tiv thaiv kab mob). Ib qho kev tiv thaiv kab mob tsis zoo tuaj yeem ua tau rau qee yam mob, xws li HIV, uas tiv thaiv kab mob tsawg kawg yog ib feem cuam tshuam los ntawm CD4 cell suav. Txawm li cas los xij, kev nthuav tawm ntawm cov cim no rau lwm yam kab mob tsis tas yuav tsum tau lees paub, raug, lossis kwv yees. Qee tus neeg yuav tsis muaj qhov tsis txaus ntseeg ntawm lub cev tiv thaiv kab mob los ntawm kev kuaj sim tam sim no thiab tseem muaj kev tiv thaiv kab mob ua haujlwm, xws li cov kab mob corticosteroids ntev lossis cov kab mob granulomatous. Lwm tus neeg, xws li cov neeg tau txais SOT thiab HCT, raug cuam tshuam rau ntau yam kev tiv thaiv kab mob thiab kev tiv thaiv kab mob uas ua rau muaj kev sib txawv thiab sib tshooj ntawm lub cev, cellular, thiab caj npab humoral ntawm lub cev tiv thaiv kab mob uas hloov lub sijhawm (60). Ib txoj hauv kev los ntsuas lub xeev ntawm kev tiv thaiv kab mob, raws li tau thov rau SOT (61), yuav tsum tau tshawb xyuas thiab siv tau rau lwm tus neeg ICH. Muaj cov cim qhia tsis ncaj ntawm lub cev tiv thaiv kab mob tuaj yeem suav nrog cov tshuaj yeeb dej caw, cov xov tooj ntawm lub cev tiv thaiv kab mob (CD3, CD4, CD8, thiab cov neeg tua neeg ntuj), cov cim soluble (Ig, C3, MLB, thiab sCD30), thiab cov cim ntawm T-cell muaj nuj nqi . Thaum tsis muaj biomarkers tshwj xeeb, qhov kev pheej hmoo ntawm mob ntsws nyob rau hauv ICH yog qhov zoo tshaj plaws gauged siv ib tug multifactorial mus kom ze uas txiav txim siab ntau yam kev tiv thaiv kab mob thiab kev kho mob yam nyob rau hauv ib tug dynamic zam (62). Xav txog tag nrho cov ntsiab lus no, lub vaj huam sib luag tau pom zoo cov lus hauv qab no.

cistanche tubulosa- txhim kho lub cev tiv thaiv kab mob

Kev pom zoo txhais

ICHP yog kab mob ntsws uas tshwm sim hauv ib tus neeg uas muaj ntau lossis ua haujlwm ntawm lub cev tiv thaiv kab mob.

Nqe Lus Tshaj Tawm 1: Tus tswv tsev tiv thaiv kab mob tiv thaiv kab mob yog ib qho txheej txheem uas ua rau muaj qhov tsis zoo ntawm kev kuaj kab mob, tua, thiab / lossis tshem tawm. Yog li, lub ntsiab lus ntawm ICHP yog nyob ntawm tus tswv tsev es tsis yog kev txheeb xyuas tus kab mob. Cov kab mob tiv thaiv kab mob tiv thaiv kab mob suav nrog hauv lub cev, cellular, thiab humoral immune mechanisms (Table 1).

Nqe Lus Tshaj Tawm 2: Tus tswv tsev tiv thaiv kab mob tiv thaiv kab mob tshwm sim thaum lub sijhawm kis kab mob. Kev tsis taus ntawm lub cev tsis muaj zog, raws li yuav tshwm sim nyob rau hauv qhov teeb meem ntawm sepsis hnyav, tsis txaus rau tus neeg mob yuav tsum suav tias yog kev tiv thaiv kab mob. Cov neeg mob uas muaj keeb kwm ntawm kev tiv thaiv kab mob tiv thaiv kab mob uas tau daws yuav tsum tsis txhob suav tias yog ICHs. Piv txwv li, cov neeg mob qog noj ntshav tsis tu ncua leukopenia, lymphopenia, immunoglobulin tsis xws luag, lossis kev siv tshuaj tiv thaiv kab mob tsis ntev los no tsis muaj kev tiv thaiv kab mob ntxiv lawm. Qhov no suav nrog cov neeg mob uas muaj mob malignancies uas tsuas tau txais kev kho mob hauv zos xwb, xws li kev phais phais lossis kev kho lub cev tshwj xeeb hluav taws xob.

Nqe Lus Tshaj Tawm 3: Cov kab mob uas muaj cov kab mob metabolic paub txog kev tiv thaiv kab mob yuav tsum raug suav hais tias yog cov kab mob sib kis tab sis tsis yog kev tiv thaiv kab mob tiv thaiv kab mob. Cov mob no suav nrog ntshav qab zib thiab mob siab ua haujlwm tsis zoo. Cov neeg muaj hnub nyoog siab, txawm hais tias muaj kev pheej hmoo ntau ntxiv rau mob ntsws, yuav tsis raug suav hais tias yog ICH raws li cov lus qhia, vim tias muaj kev pheej hmoo ntau ntxiv rau kev mob ntsws tsis zoo nrog kev tiv thaiv kab mob.

Nqe Lus Tshaj Tawm 4: Cov kab mob kho tshuab thiab cov kab mob hauv lub ntsws uas ua rau muaj kev pheej hmoo mob ntsws tsis suav nrog hauv cov ntsiab lus ntawm ICHP. Cov no suav nrog cov xwm txheej uas ua rau muaj kev xav rov qab los, kev ua pa loj, kev ua tsis zoo ntawm bronchiectasis, kab mob ntsws ntev, lossis lwm yam kab mob ntsws ntev. Txawm hais tias cov xwm txheej no ntxiv kev pheej hmoo rau mob ntsws, lawv tsis yog lub cev tiv thaiv kab mob.

Nqe Lus Qhia 5: Tus tswv tsev tiv thaiv kab mob ua rau muaj kev pheej hmoo rau tus neeg mob ntau dua lossis mob hnyav los ntawm cov kab mob hauv zej zog. Nqe lus no lees paub tias CAP hauv ICHs nrog cov kab mob ib txwm muaj, xws li S. pneumoniae, tuaj yeem tshwm sim ntau zaus, hnyav, ntev, lossis rov tshwm sim dua piv nrog cov neeg tiv thaiv kab mob.

Nqe Lus Tshaj Tawm 6: Tus tswv tsev tiv thaiv kab mob tiv thaiv kab mob ua rau muaj kev pheej hmoo ntawm mob ntsws vim tsis muaj kab mob los yog lwm yam kab mob. ICHs muaj kev cuam tshuam rau ntau yam kab mob ntsws ntau dua li cov pej xeem.

Nqe Lus Tshaj Tawm 7: Ib qho ICH uas muaj mob ntsws muaj peev xwm txiav txim siab txog kev kuaj mob ntxiv thiab / lossis lwm cov tswv yim kho mob tshaj li cov lus pom zoo hauv cov lus qhia mob ntsws rau cov neeg mob. Cov kab mob kis tau zoo thiab ntau yam kab mob tuaj yeem tshwm sim nrog tus tswv tsev tiv thaiv kab mob; Yog li ntawd, nrhiav kev txheeb xyuas qhov tshwj xeeb etiology yog ib qho tseem ceeb thaum xav txog kev pab them nqi kho mob rau cov neeg mob uas yog ICHs ntawm lub hauv paus ntawm kev tiv thaiv kab mob.

Table 1. Hom kev tiv thaiv tus tswv tsev tsis xws luag thiab pom zoo kev ntsuam xyuas

Txhais Kev Ntsuas Kev Ntsuas ntawm ICHP

Lub ntsiab lus ntawm ICHP yog kwv yees los ntawm kev kuaj mob ntawm mob ntsws thiab tus tswv tsev yam tsis yog ntawm kev kis kab mob etiology. Txawm li cas los xij, kev txheeb xyuas tus kab mob yog qhov tseem ceeb rau kev tswj hwm ntawm ICHP. Ib yam li peb lees paub tias lub ntsiab lus ntawm ICHP raug txwv los ntawm qhov tsis muaj cov cim qhia thoob plaws ntiaj teb ntawm lub cev tiv thaiv kab mob, cov txheej txheem kuaj mob rau ICHP yog qhov nyuaj los ntawm kev txwv hauv cov cuab yeej kuaj mob. Qhov thib ob ntawm lub rooj cob qhia tau tsom mus rau cov txheej txheem kuaj mob rau ICHP. Kev sib tham ntawm cov lus qhia tsis ntev los no, kev kuaj mob, thiab tam sim no muaj cov cuab yeej kuaj mob rau kev txheeb xyuas tus kab mob yog ua raws li cov lus pom zoo kuaj mob thiab cov lus qhia meej.

Tam sim no Diagnostic Approaches

Clinical Diagnosis of Pneumonia: Lessons Learned from Hospital acquired Pneumonia (HAP) / Ventilator-associated Pneumonia (VAP) thiabCAP Cov Lus Qhia

Lub vaj huam sib luag uas tau sau 2016 HAP/VAP (63, 64) thiab 2019 CAP (8) cov lus qhia yav dhau los tau ntsib cov teeb meem uas tau qhia peb txoj hauv kev tam sim no los tsim cov lus pom zoo rau kev kuaj mob ntawm ICHP. Tag nrho peb qhov chaw kho mob muaj qhov zoo sib xws: ib qho kev kawm dav dav, cov neeg mob heterogeneous, thiab cov txheeb ze ntawm cov pov thawj zoo. HAP/VAP thiab CAP cov kws tshaj lij cov kws tshaj lij ntseeg tau tias yav dhau los lees paub kev kho mob txhais tau hais tias mob ntsws, uas yuav tsum tau txais cov tsos mob thiab cov tsos mob sib xws nrog cov pov thawj hluav taws xob tshiab los yog cov kab mob pulmonary infiltrate, txawm hais tias tsis meej 100% rhiab lossis tshwj xeeb, tau txais txiaj ntsig zoo ntawm kev kho mob. bedside thiab feem ntau txais. Hauv lwm lo lus, txhua yam kev kuaj mob lossis cov ntsiab lus uas tso siab rau cov txiaj ntsig kev sim uas tsis muaj nyob rau lub sijhawm pib kev txiav txim siab hauv tsev kho mob yuav muaj kev txwv siv rau kev kho mob. Peb, yog li ntawd, siv lub moj khaum no los ua lub hauv paus los txheeb xyuas qhov kev kuaj mob ntsws ntsws hauv cov neeg mob ICH, raws li cov lus qhia hauv qab no, pom tau tias cov neeg no yuav tsis muaj cov tsos mob xws li kub taub hau lossis leukocytosis.

Table 2. Muaj cov kev kuaj mob los ntawm cov kab mob bronchoalveolar lavage rau kev ntsuam xyuas ntawm tus neeg mob ntsws ntsws ntsws.

Culture-dependent Pathogen Identification hauv ICHP

Microbial txoj kev loj hlob raws li txoj hauv kev tshwj xeeb rau kev kuaj pom cov kab mob feem ntau ntsib cov kab mob, txawm hais tias rhiab heev txawv nyob ntawm qhov chaw kho mob. Kev txheeb xyuas cov kab mob ntawm cov kab mob nrog cov kab mob antimicrobial susceptibility qauv tuaj yeem tsim tau thaum muaj microbial loj hlob. Txawm li cas los xij, ntau qhov teeb meem tseem ceeb ntawm kev coj noj coj ua ntawm kev coj noj coj ua tseem nyob. Kev tshaj tawm qeeb qeeb, yuav tsum tau siv ntau zaus ntawm empiric antimicrobials hauv ICHP. Cov kab mob pwm nthuav tawm ib qho kev sib tw tshwj xeeb hauv cov neeg mob uas yog ICHs thaum qhov kev kuaj pom tseeb yog qhov tsim nyog los txhim kho txoj kev kho kom zoo thiab tsis txhob muaj tshuaj lom ntawm empiric antifungals. Hmoov tsis zoo, pwm kev loj hlob qeeb, thiab peb lub peev xwm rov qab pwm, xws li Aspergillus spp., Scedosporium spp., thiab ntau yam mucormycetes, tsawg dua 10% (65-67). Kev thov rau bronchoalveolar lavage (BAL) cov qauv yog nce, ib feem vim yog kev qhia txog kev kuaj mob tshiab (Table 2), uas ua rau muaj kev cuam tshuam ntxiv, kev pheej hmoo rau tus neeg mob, thiab sijhawm ntxiv kom tau txais cov ntaub ntawv.

Kab lis kev cai-kev ywj pheej Pathogen Identification hauv ICHP

Xyoo kaum xyoo dhau los tau pom kev loj hlob sai hauv kab lis kev cai ywj pheej kuaj mob rau cov kab mob ua pa. Cov no suav nrog cov kev hloov pauv hloov pauv txhua qhov-quantitative polymerase chain reaction (qPCR) kev sim rau SARS-CoV-2, cov vaj huam sib luag dav dav rau cov qauv ua pa sab saud thiab qis, thiab plasma cell-free DNA rau cov qauv ua pa qis. Txawm hais tias tsis yog kev sim tshuaj molecular, enzyme immunoassay antigen kuaj rau Legionella pneumophilia thiab kab mob fungi yog kab lis kev cai ywj pheej uas tuaj yeem ua rau cov zis lossis BAL kuaj. Cov kev ntsuam xyuas no muab lub sijhawm hloov pauv sai dua thiab muaj kev nkag siab zoo dua li kev ua pa. Lawv txoj kev siv tau pom cov kab mob dav dav uas ua rau ICHP, suav nrog Pneumocystis, nrog rau qhov tsis muaj tus kab mob ua pa tsis raws caij nyoog (68) thiab lub sijhawm ntev ntawm cov kab mob nucleic acids uas feem ntau pom hauv ICHs (69). Ua ntej tus kab mob COVID-19 muaj thoob qhov txhia chaw, cov kab mob ua pa qis dua tshiab tau muab kev sim dav dav ntawm ntau dua 24 lub hom phiaj nrog tsawg dua 90-feeb hloov pauv ua ke nrog rau qhov muaj pes tsawg leeg ntawm cov kab mob kuaj pom (70); COVID-19 tau ua kom nrawm dua qhov muaj cov tshuaj ntsuam xyuas molecular high-throughput. Cov vaj huam sib luag no, tsis xav tsis thoob, feem ntau pom cov kab mob ntau dua li kev coj noj coj ua raws li kev coj noj coj ua (71). Txawm li cas los xij, cov cuab yeej no tsis muaj kev tiv thaiv rau cov kab mob fungi, cytomegalovirus, thiab ntau yam kab mob tseem ceeb hauv ICH, xws li Nocardia, Actinomyces, thiab Stenotrophomonas (72).

Metagenomics thiab yav tom ntej txoj hauv kev rau ICHP

Lub ntsiab lus kho mob uas twb muaj lawm ntawm kev mob ntsws ntsws yog syndromic thiab tsis muaj qhov tshwj xeeb. Lub tswv yim zoo rau kev kuaj mob rau kev txheeb xyuas cov kab mob hauv ICHP yog kev koom ua ke ntawm cov txheej txheem metagenomic thiab metatranscriptomic, uas DNA lossis RNA los ntawm cov kab mob ua pa tau muab rho tawm, ua ntu zus (nrog lossis tsis muaj PCR amplification), cais, thiab txhais. Txoj hauv kev no muaj qhov zoo ntawm kev ua taxonomically agnostic: muaj peev xwm txheeb xyuas cov kab mob ywj pheej ntawm lawv cov phylogeny (bacterial, fungal, viral, thiab protozoal). Kev tshawb nrhiav nrawm ntawm cov noob tiv thaiv tuaj yeem qhia txog kev xaiv cov tshuaj tua kab mob sai dua li kev kuaj kab lis kev cai. Kev nce qib tsis ntev los no hauv nanopore sequencing tau ua rau lub sijhawm tiag tiag, ntawm qhov kev xav tau ua tiav, thiab cov kev tshawb fawb ua pov thawj ntxov tau pom tias nws muaj peev xwm txheeb xyuas cov kab mob ua pa hauv cov sij hawm ua piv txwv (73, 74). Tsis tas li ntawd, metatranscriptomics ntawm lub sijhawm tiag tiag tuaj yeem muab cov kws kho mob nrog kev nplua nuj, kev ua haujlwm siab ntawm tus tswv teb thiab nws qhov kev puas tsuaj. Txawm li cas los xij, qhov kev siv tshuaj kho mob yuav nyuaj vim qhov kev kuaj pom tus yam ntxwv, kev xav tau ntawm bioinformatics, thiab cov teeb meem them rov qab (75). Tsis tas li ntawd, qhov nce siab ntawm cov txheej txheem ua raws li cov txheej txheem tau ua kom pom qhov sib txawv ntawm cov kab mob, cov kab mob, cov kab mob, thiab cov kab mob, vim tias kev tshawb nrhiav cov kab mob hauv cov kab mob ua pa tsis tas yuav cuam tshuam tus kab mob. Kab lis kev cai raws li txoj hauv kev rau kev txheeb xyuas cov kab mob microbial feem ntau qeeb thiab tsis hnov ​​​​tsw kom qhia raws sij hawm lub hom phiaj kev kho mob antimicrobial, tsim nyog siv cov kev kho mob empiric. PCR-raws li txoj kev sai dua, tab sis cov no xav tau lub hom phiaj ua ntej rau kev txheeb xyuas; Txawm hais tias lub vaj huam sib luag dav dav tsis tuaj yeem suav nrog qhov dav dav ntawm cov kab mob hauv ICHP. Metagenomics tuaj yeem sawv cev rau pem hauv ntej rau kev nkag siab txog kab mob-tus tswv kev sib cuam tshuam, tab sis daim ntawv thov kho mob xav tau kev tshawb fawb ntxiv. Nrog rau cov kev txwv no nyob rau hauv lub siab, lub vaj huam sib luag tau tsim kho qhov kev tshuaj ntsuam xyuas cov txheej txheem rau ICHP, uas suav nrog ntau hom kev nthuav qhia kev kho mob thiab ntau qhov sib txawv ntawm cov kab mob vim yog cov txheej txheem hauv qab ntawm cov lus teb tsis zoo thiab tam sim no muaj cov kev kuaj mob.

Table 3. Cov kab mob kis tau zoo hauv lub ntsws uas yuav tsum tau txiav txim siab txog tus tswv tsev tiv thaiv kab mob (yog tias tsis tau paub tias yog tus tswv tsev tiv thaiv kab mob)

Table 3. (Ntxiv mus)

Daim Ntawv Pom Zoo

Kev kuaj mob ntawm ICHP yuav tsum tau soj ntsuam qhov tsis txaus ntseeg ntawm kev mob ntsws ntsws, nrog lossis tsis muaj cov tsos mob thiab cov tsos mob sib xws, thiab nrog cov pov thawj hluav taws xob ntawm cov kab mob ntsws tshiab lossis mob ntsws ntxiv. Vim tias muaj ntau tus tswv tsev tsis xws luag thiab cov kab mob uas tuaj yeem tshwm sim raws li ICHP, lub vaj huam sib luag tau txiav txim siab tias cov txheej txheem kuaj mob raug cai rau ICHP yuav yog qhov zoo tshaj plaws los ua ib qho algorithm. Raws li tau hais hauv daim duab 1, hauv ib tus tswv tsev uas paub txog kev tiv thaiv kab mob tsis zoo, kev kuaj mob ntawm ICHP tau txiav txim siab ntxiv los ntawm kev nthuav qhia kev kho mob sib xws, kev txheeb xyuas tus kab mob, thiab tsis suav nrog kev sib tw ua rau kev kho mob, microbiologic, thiab radiographic manifestations. Daim duab 2 nthuav qhia lwm qhov kev kuaj mob algorithm rau ICHP hais txog cov neeg mob uas tsis tau paub txog kev tiv thaiv kab mob hauv lub cev uas muaj pov thawj ntawm kev mob ntsws los ntawm ib qho kab mob txawv txav lossis lwm yam kab mob, ua rau muaj peev xwm ntawm ICHP.

Nqe lus piav qhia 1: Kev nthuav qhia kho mob ntawm mob ntsws feem ntau atypical hauv ICHs; Yog li ntawd, tsis tas yuav muaj cov tsos mob thiab cov tsos mob ntawm mob ntsws. Txawm li cas los xij, yuav tsum muaj cov pov thawj hluav taws xob ntawm cov kab mob ua pa qis rau kev kuaj mob ntawm ICHP. Cov cim qhia thiab cov tsos mob sib xws nrog mob ntsws muaj xws li hnoos tshiab, ua npaws, leukocytosis, hypoxemia, ua tsis taus pa luv, mob hauv siab pleuritic, thiab ua pa bronchial suab. Cov tsos mob thiab cov tsos mob no tsis yog ib txwm muaj nyob rau hauv ICHs, txawm tias thaum muaj hluav taws xob opacities qhia txog kev mob ntsws. Piv txwv li, invasive pulmonary aspergillosis nyob rau hauv tus neeg tau txais HCT ntawm corticosteroids rau cov kab mob graft-tiv thaiv tus tswv tsev tuaj yeem tshwm sim asymptomatically, nrog mob ntsws kuaj pom tshwm sim ntawm lub hauv siab suav tomography. Hloov pauv, tej zaum yuav muaj qhov tsis txaus ntseeg siab rau kev mob ntsws ntsws hauv ICH tus neeg uas muaj cov tsos mob sib xws tab sis qhov tsis txaus ntseeg ntawm kev tshawb pom ntawm lub hauv siab X-rays niaj hnub. Qhov no yuav tsum ua kom muaj kev ntsuam xyuas ntxiv nrog lub hauv siab suav tomography scan. Muab ntau yam uas tsis yog lub ntsws ua rau kis kab mob thiab mob hauv ICH, kev tshawb pom zoo ib yam nrog kev kis kab mob ntawm cov duab yuav tsum muaj rau kev kuaj mob ICHP.

Nqe Lus Tshaj Tawm 2: Txawm hais tias muaj qhov txawv txav ntawm cov duab hluav taws xob yuav tsum tau kuaj pom tus mob ntsws, tsis yog txhua qhov kev tshawb pom hluav taws xob sawv cev rau tus kab mob. Cov neeg ICH kuj tseem muaj kev pheej hmoo rau ntau yam mob ntsws tsis muaj kab mob, uas yuav tsum tau ua kom paub qhov txawv ntawm kev mob ntsws. Piv txwv li, kev kuaj mob sib txawv ntawm lub ntsws nodules hauv tus neeg mob uas muaj mob caj dab rheumatoid ntawm etanercept suav nrog rheumatoid nodules thiab malignancy nrog rau TB thiab kab mob fungal endemic.

cistanche tubulosa- txhim kho lub cev tiv thaiv kab mob

Cov Lus Qhia Tshaj Tawm 3: Kev kuaj mob ntawm ICHP tsis tas yuav kuaj pom cov kab mob ua rau muaj kab mob, tshwj xeeb tshaj yog tias tsis muaj lwm txoj kev kuaj mob tsis muaj kab mob. Kev txheeb xyuas raws sij hawm ntawm ib qho etiology hauv ICHP tsis yog ib txwm ua tau tab sis yuav tsum tsis txhob ncua kev kho empiric yog tias kev kho mob sai yog hais los ntawm qhov chaw kho mob. Txawm hais tias muaj kev pom zoo dav dav tias qhov kev kuaj mob ntawm ICHP tsis xav kom kuaj pom cov kab mob ua rau muaj kab mob, kev sib koom ua ke yuav tsum tau ua los txheeb xyuas cov kab mob tshwj xeeb los ntawm kev muaj kab lis kev cai-nyob thiab-txoj kev ywj pheej muab qhov dav sib txawv hauv ICHP thiab cuam tshuam rau kev kho mob. Qhov no feem ntau yuav koom nrog bronchoscopy nrog BAL thiab/lossis transbronchial biopsies los soj ntsuam cov kab mob uas raug thiab siv sijhawm, nrog rau lwm yam kev kuaj mob uas tsis muaj kab mob (Table 2). Nqe lus piav qhia 4: Kev txheeb xyuas cov kab mob uas muaj feem cuam tshuam rau hauv lub ntsws yuav tsum tau soj ntsuam xyuas qhov kev tiv thaiv kab mob hauv lub cev (Daim duab 2 thiab Table 3). Kev kuaj pom tus kab mob txawv txawv hauv ib tus tswv tsev pom zoo yuav yog qhov qhia txog kev tiv thaiv kab mob hauv qab. Piv txwv li muaj xws li cov ntaub ntawv ntawm invasive aspergillosis yam tsis muaj teeb meem tshwm sim, uas yuav ua rau muaj kev tshawb nrhiav rau PID vim yog yug los ntawm kev tiv thaiv kab mob. Pneumocystis pneumonia nyob rau hauv ib tug neeg uas tsis muaj iatrogenic immunosuppression yuav tsum tam sim ntawd soj ntsuam ntawm tus kab mob HIV los yog PID. Yog tias pom muaj kev tiv thaiv kab mob hauv qhov teeb meem ntawm kev mob ntsws, ces ICHP raug kuaj.

Daim duab 1. Cov txheej txheem kuaj mob thiab cov txheej txheem rau kev mob ntsws hauv ib tus tswv tsev uas paub txog kev tiv thaiv kab mob. Cov tsos mob thiab cov tsos mob muaj xws li kub taub hau, hnoos, hnoos qeev, nrog rau hypoxemia, uas yuav tsum tau soj ntsuam nrog lub hauv siab. Nyob rau hauv tus tswv tsev immunocompromised, lub ntsws infiltrates yuav tsis tshwm sim los ntawm lub hauv siab X-ray thiab tej zaum yuav xav tau ib tug xam tomography scan kom paub. Nws yuav tsum raug sau tseg tias cov neeg tiv thaiv kab mob tiv thaiv kab mob tuaj yeem muaj ntau yam sib kis thiab tsis muaj kab mob ntawm lub ntsws infiltrates (xws li, kab mob ntsws, mob aspergillosis, thiab mob plawv tsis ua hauj lwm). ICH=immunocompromised hosts.

Daim duab 2. Kev kuaj mob thiab cov txheej txheem rau kev mob ntsws ntsws hauv ib tus tswv tsev uas tsis paub txog kev tiv thaiv kab mob. Hauv qhov xwm txheej no, tus kab mob kis tau tus kab mob raug kuaj pom nyob rau hauv tus neeg mob nrog radiographic infiltrates. Kev tiv thaiv kab mob hauv qab kuj tseem tuaj yeem xav tias muaj qhov txawv txav ntawm cov duab hluav taws xob uas qhia txog kev kis tus kab mob kis tau zoo (xws li, cystic lesions raws li kev nthuav qhia ntawm Pneumocystis pneumonia). ICH=immunocompromised hosts.

Cov lus xaus

Kev siv lub tswv yim txhais ntawm ICHP thiab kev kuaj mob algorithms yog ob npaug: ua ntej, muab lub tswv yim rau cov kws kho mob kom paub thiab kuaj mob ntsws hauv ICHs; Qhov thib ob, muab cov qauv zoo ib yam rau kev suav nrog ICH hauv kev tshawb fawb soj ntsuam thiab kev sim ua haujlwm. Los ntawm kev pom zoo, peb thauj cov ntsiab lus ntawm ICHP ntawm kev muaj tus tswv tsev tiv thaiv kab mob uas ua ntej kis mob ntsws. Cov ntsiab lus ntawm ICH thiab ICHP yuav hloov zuj zus nrog kev nkag siab ntxiv ntawm kev tiv thaiv. Peb tau hais txog qhov yuav tsum tau txheeb xyuas cov biomarkers ntxiv kom muaj nuj nqis thiab cov cim qhia txog kev tiv thaiv kab mob tsis zoo uas cuam tshuam rau tib neeg lub xeev ntawm kev tiv thaiv kab mob. Immunophenotyping ntawm ICH cov pej xeem thiab kev sib raug zoo nrog cov kab mob nthuav tawm thiab cov kab mob hnyav yuav tso cai rau ICHP kev pheej hmoo stratification uas tuaj yeem muab txhais rau hauv tsev kho mob. Txoj kev loj hlob ntawm cov txheej txheem rhiab ntau hauv kev tshawb pom kab mob, xws li metagenomics, nrog rau kev kho mob immunophenotyping, yuav txhim kho cov kev kuaj mob thiab kev kho mob thiab pab txhim kho peb txoj kev nkag siab ntawm ICHP. ICHs yog cov neeg tsis muaj zog thiab tsis tau txais kev pabcuam uas nws txoj kev saib xyuas yuav tau txais txiaj ntsig los ntawm cov ntsiab lus meej dua thiab kev tshawb nrhiav ntxiv.

Cov ntaub ntawv

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