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（三）破伤风抗毒素的应用只能中和尚未与神经组织结合的毒素。 | [
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精制破伤风抗毒素（TAT）1万～2万U肌内注射或静脉注射，用前须作皮试。 | [
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人体破伤风免疫球蛋白（TIG）不会产生血清病等过敏反应，其血浓度较高，半衰期长达24天，故更理想，但其价格昂贵不易获得，新生儿肌注500～1500U即可。 | [
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（四）抗生素青霉素：能杀灭破伤风梭菌，10万～20万U/（kg•d），每天分2次，疗程10天左右。 | [
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甲硝唑：首剂15mg/kg，然后15mg/（kg•d）或30mg/（kg•d），分2次静滴，1个疗程7天，有报告其疗效略优于青霉素。 | [
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（五）脐部处理用氧化消毒剂（3%过氧化氢或1∶4000高锰酸钾溶液）清洗脐部，再涂以碘酒以消灭残余破伤风梭菌。 | [
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五、预后ICH的预后与其发病年龄、病因、出血部位及出血量大小等有关。 | [
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脑动静脉畸形易反复出血，复发者病死率较高；如血液流入脑室系统与蛛网膜下腔后，易致脑脊液循环通路阻塞，吸收障碍，产生脑积水。 | [
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"entity": "产生脑积水",
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脑动脉瘤破裂常产生脑实质内出血，80%以上的病例于早期死亡，幸存者多留有神经系统后遗症。 | [
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"entity": "神经系统后遗症",
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继发于全身性疾病的ICH预后与原发病、出血部位及其产生的病理反应有关。 | [
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脑室周围-脑室内出血的近期预后与出血量大小有关，出血量越大，并发脑积水的发生率或病死率越高；远期随访，出血量大者多发生严重智能减退和运动功能障碍等。 | [
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新生儿蛛网膜下腔出血主要系静脉破裂所致，出血量较小，大多预后良好；少数也可因先天性颅内动脉瘤破裂所致，病情多危重，预后较差，病死率高达40%。 | [
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幕上硬膜下出血预后相对较好，而幕下硬膜下出血预后差。 | [
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二、肺炎衣原体感染【病原和流行病学】20世纪60年代在研究沙眼中首次分离到肺炎衣原体，以后用血清学方法证实该病原引起1978年芬兰学生的轻症肺炎流行，1986年从患急性呼吸道疾病的大学生呼吸道分离到该病原，并于1986年被正式命名为肺炎衣原体TWAR株。 | [
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肺炎衣原体属革兰阴性菌，没有细胞壁，是人呼吸道的常见病原，尚未发现动物储存宿主。 | [
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通过呼吸道飞沫在人与人之间传播，在家庭成员中造成感染传播。 | [
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任何年龄均可感染肺炎衣原体。 | [
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【临床表现】临床上，肺炎衣原体感染不易与其他病原体感染特别是肺炎支原体感染相鉴别。 | [
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肺炎患者常表现为非典型肺炎，症状轻到中等，有发热、不适、头痛和咳嗽等。 | [
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胸部X线表现多较临床症状重，示肺叶浸润影，并可有胸腔积液。 | [
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听诊可闻及湿啰音并常有哮鸣音。 | [
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与肺炎支原体感染一样，肺炎衣原体感染也可有肺外表现，如结节性红斑、甲状腺炎、脑炎和吉兰-巴雷综合征等。 | [
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"entity": "吉兰-巴雷综合征",
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【诊断】肺炎衣原体感染的特异性诊断依据组织培养、病原分离和血清学检查，衣原体的分离培养相对较困难，目前多用血清抗体水平作为诊断衣原体感染的依据。 | [
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血清学诊断可采用微量免疫荧光法（microimmunoflurescence，MIF），急性衣原体感染的血清学诊断标准是：IgG滴度4倍升高；或IgM滴度≥1∶16；或IgG滴度≥1∶512。 | [
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酶联免疫吸附法（ELISA）可用于痰标本中肺炎衣原体抗原的检测。 | [
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DNA探针检测衣原体具有较高的特异性和敏感性，聚合酶链技术快速、准确，也具有广泛的应用前景。 | [
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【治疗】肺炎衣原体由于缺乏细胞壁，对β内酰胺类抗生素无效。 | [
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较为有效的抗菌药物主要包括大环内酯类、四环素类和氟喹诺酮类。 | [
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大环内酯类中以阿奇霉素和克拉霉素效果较好，其中四环素类和氟喹诺酮类不推荐在儿童中使用。 | [
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此外由于利福平及其衍生物具有较高细胞内浓度，因此，对于专性细胞内寄生的衣原体有十分明显的抗菌作用。 | [
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肺炎衣原体感染的治疗简单而有效，临床上耐药不多见，但主张长疗程，以避免复发。 | [
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第七章真菌感染性疾病第一节概况真菌（fungus）亦称霉菌，广泛分布于自然界，是医学微生物学的一个重要组成部分，和其他病原微生物一样，也可引起各种类型的疾病。 | [
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{
"id": 1,
"entity": "真菌",
"start_offset": 15,
"end_offset": 17,
"label": "mic"
},
{
"id": 2,
"entity": "fungus",
"start_offset": 18,
"end_offset": 24,
"label": "mic"
},
{
"id": 3,
"entity": "霉菌",
"start_offset": 27,
"end_offset": 29,
"label": "mic"
}
] |
真菌是异养的真核生物，有真正的细胞核和细胞器，能进行有丝分裂。 | [
{
"id": 0,
"entity": "真菌",
"start_offset": 0,
"end_offset": 2,
"label": "mic"
}
] |
真菌种类繁多，数目有10万种以上，其中能引起人或动物感染的仅占极少部分，约400种。 | [
{
"id": 0,
"entity": "真菌",
"start_offset": 0,
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"label": "mic"
}
] |
与医院感染有关的有200余种，包括致病真菌、条件致病真菌（机会真菌，opportuniticfungi）、致敏真菌和产毒、促癌及致癌真菌。 | [
{
"id": 0,
"entity": "致病真菌",
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"end_offset": 21,
"label": "mic"
},
{
"id": 1,
"entity": "条件致病真菌",
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"end_offset": 28,
"label": "mic"
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{
"id": 2,
"entity": "机会真菌",
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"label": "mic"
},
{
"id": 3,
"entity": "opportuniticfungi",
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"label": "mic"
},
{
"id": 4,
"entity": "致敏真菌",
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"end_offset": 57,
"label": "mic"
},
{
"id": 5,
"entity": "致癌真菌",
"start_offset": 64,
"end_offset": 68,
"label": "mic"
}
] |
同一种疾病可由不同种类的真菌引起，一种真菌也可引起不同种类的疾病。 | [
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"id": 0,
"entity": "真菌",
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"label": "mic"
},
{
"id": 1,
"entity": "真菌",
"start_offset": 19,
"end_offset": 21,
"label": "mic"
}
] |
放线菌介于细菌和真菌之间，并不属于真菌，但因其所引起的疾病症状和体征都酷似真菌感染，故传统上一直将放线菌病归在真菌病中描述。 | [
{
"id": 0,
"entity": "放线菌",
"start_offset": 0,
"end_offset": 3,
"label": "mic"
},
{
"id": 1,
"entity": "细菌",
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"label": "mic"
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{
"id": 2,
"entity": "真菌",
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"label": "mic"
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{
"id": 3,
"entity": "真菌",
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"label": "mic"
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{
"id": 4,
"entity": "真菌感染",
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{
"id": 5,
"entity": "放线菌病",
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"label": "dis"
},
{
"id": 6,
"entity": "真菌病",
"start_offset": 55,
"end_offset": 58,
"label": "dis"
}
] |
（一）真菌感染的影响因素1.真菌因素当机体缺乏对致病真菌的特异性免疫时，致病真菌可使正常健康人感染发病。 | [
{
"id": 0,
"entity": "真菌感染",
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"label": "dis"
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{
"id": 1,
"entity": "真菌",
"start_offset": 14,
"end_offset": 16,
"label": "mic"
},
{
"id": 2,
"entity": "致病真菌",
"start_offset": 24,
"end_offset": 28,
"label": "mic"
},
{
"id": 3,
"entity": "致病真菌",
"start_offset": 36,
"end_offset": 40,
"label": "mic"
}
] |
在机体抗感染能力低下时，条件致病真菌可进入人正常的无菌部位或不常寄生的组织器官，其种类最多，感染率最高，危害性最大。 | [
{
"id": 0,
"entity": "条件致病真菌",
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"end_offset": 18,
"label": "mic"
}
] |
2.宿主因素除致病真菌外，宿主的易感性也与感染密切相关。 | [
{
"id": 0,
"entity": "致病真菌",
"start_offset": 7,
"end_offset": 11,
"label": "mic"
}
] |
机体缺乏抵抗力，如婴儿，由于体内产生抗体的器官尚未发育完善，抗体缺乏，全身抵抗力低下；伴有影响机体抵抗力的各种疾病，如白血病、恶性肿瘤、结核、糖尿病、严重烧伤、营养不良、肝脏疾病及维生素缺乏等某些疾病后机体抵抗力受损或低下；特别是中性粒细胞减少的患者最容易并发念珠菌感染等真菌感染，此类患者使用抗生素后仍有发热，并有肌痛、关节痛、内眼炎，或有心动过速、呼吸困难或皮肤有红斑丘疹结节，高度提示有系统性或播散性念珠菌病的可能。 | [
{
"id": 0,
"entity": "白血病",
"start_offset": 59,
"end_offset": 62,
"label": "dis"
},
{
"id": 1,
"entity": "恶性肿瘤",
"start_offset": 63,
"end_offset": 67,
"label": "dis"
},
{
"id": 2,
"entity": "结核",
"start_offset": 68,
"end_offset": 70,
"label": "dis"
},
{
"id": 3,
"entity": "糖尿病",
"start_offset": 71,
"end_offset": 74,
"label": "dis"
},
{
"id": 4,
"entity": "严重烧伤",
"start_offset": 75,
"end_offset": 79,
"label": "dis"
},
{
"id": 5,
"entity": "营养不良",
"start_offset": 80,
"end_offset": 84,
"label": "dis"
},
{
"id": 6,
"entity": "肝脏疾病",
"start_offset": 85,
"end_offset": 89,
"label": "dis"
},
{
"id": 7,
"entity": "维生素缺乏",
"start_offset": 90,
"end_offset": 95,
"label": "dis"
},
{
"id": 8,
"entity": "机体抵抗力受损或低下",
"start_offset": 101,
"end_offset": 111,
"label": "sym"
},
{
"id": 9,
"entity": "中性粒细胞",
"start_offset": 115,
"end_offset": 120,
"label": "bod"
},
{
"id": 10,
"entity": "中性粒细胞减少",
"start_offset": 115,
"end_offset": 122,
"label": "sym"
},
{
"id": 11,
"entity": "念珠菌感染",
"start_offset": 130,
"end_offset": 135,
"label": "dis"
},
{
"id": 12,
"entity": "真菌感染",
"start_offset": 136,
"end_offset": 140,
"label": "dis"
},
{
"id": 13,
"entity": "抗生素",
"start_offset": 147,
"end_offset": 150,
"label": "dru"
},
{
"id": 14,
"entity": "发热",
"start_offset": 153,
"end_offset": 155,
"label": "sym"
},
{
"id": 15,
"entity": "肌痛",
"start_offset": 158,
"end_offset": 160,
"label": "sym"
},
{
"id": 16,
"entity": "关节痛",
"start_offset": 161,
"end_offset": 164,
"label": "sym"
},
{
"id": 17,
"entity": "内眼炎",
"start_offset": 165,
"end_offset": 168,
"label": "sym"
},
{
"id": 18,
"entity": "心动过速",
"start_offset": 171,
"end_offset": 175,
"label": "sym"
},
{
"id": 19,
"entity": "呼吸困难",
"start_offset": 176,
"end_offset": 180,
"label": "sym"
},
{
"id": 20,
"entity": "皮肤",
"start_offset": 181,
"end_offset": 183,
"label": "bod"
},
{
"id": 21,
"entity": "皮肤有红斑丘疹结节",
"start_offset": 181,
"end_offset": 190,
"label": "sym"
},
{
"id": 22,
"entity": "系统性或播散性念珠菌病",
"start_offset": 196,
"end_offset": 207,
"label": "dis"
}
] |
另外，机体某些特殊部位，如眼的前房和后房、脑膜、关节、心内膜和尿道，对微生物侵袭的抵抗力很低，尤易受条件致病真菌的感染。 | [
{
"id": 0,
"entity": "眼的前房和后房",
"start_offset": 13,
"end_offset": 20,
"label": "bod"
},
{
"id": 1,
"entity": "脑膜",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
},
{
"id": 2,
"entity": "关节",
"start_offset": 24,
"end_offset": 26,
"label": "bod"
},
{
"id": 3,
"entity": "心内膜",
"start_offset": 27,
"end_offset": 30,
"label": "bod"
},
{
"id": 4,
"entity": "尿道",
"start_offset": 31,
"end_offset": 33,
"label": "bod"
},
{
"id": 5,
"entity": "致病真菌",
"start_offset": 52,
"end_offset": 56,
"label": "mic"
}
] |
3.其他因素实施某些使机体抵抗力降低的诊疗措施，如使用抗生素、激素、免疫抑制剂或接受放疗和化疗的肿瘤患者、脾摘除、器官移植及外伤等患者，易受条件致病真菌感染。 | [
{
"id": 0,
"entity": "抗生素",
"start_offset": 27,
"end_offset": 30,
"label": "dru"
},
{
"id": 1,
"entity": "激素",
"start_offset": 31,
"end_offset": 33,
"label": "dru"
},
{
"id": 2,
"entity": "免疫抑制剂",
"start_offset": 34,
"end_offset": 39,
"label": "dru"
},
{
"id": 3,
"entity": "放疗",
"start_offset": 42,
"end_offset": 44,
"label": "pro"
},
{
"id": 4,
"entity": "化疗",
"start_offset": 45,
"end_offset": 47,
"label": "pro"
},
{
"id": 5,
"entity": "肿瘤",
"start_offset": 48,
"end_offset": 50,
"label": "dis"
},
{
"id": 6,
"entity": "脾摘除",
"start_offset": 53,
"end_offset": 56,
"label": "pro"
},
{
"id": 7,
"entity": "器官移植",
"start_offset": 57,
"end_offset": 61,
"label": "pro"
},
{
"id": 8,
"entity": "外伤",
"start_offset": 62,
"end_offset": 64,
"label": "dis"
},
{
"id": 9,
"entity": "致病真菌感染",
"start_offset": 72,
"end_offset": 78,
"label": "dis"
}
] |
手术后异物，缝线和修补手术埋入的材料，以及留置导管等均可引起局部的真菌感染。 | [
{
"id": 0,
"entity": "手术",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
},
{
"id": 1,
"entity": "缝线",
"start_offset": 6,
"end_offset": 8,
"label": "pro"
},
{
"id": 2,
"entity": "修补手术",
"start_offset": 9,
"end_offset": 13,
"label": "pro"
},
{
"id": 3,
"entity": "导管",
"start_offset": 23,
"end_offset": 25,
"label": "equ"
},
{
"id": 4,
"entity": "局部的真菌感染",
"start_offset": 30,
"end_offset": 37,
"label": "sym"
}
] |
（二）真菌感染的来源1.内源性感染是指某些真菌平时就在机体内寄生，成为正常菌群一个组成部分，并不致病，如寄生在口腔、肠道和阴道等处。 | [
{
"id": 0,
"entity": "真菌感染",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "真菌",
"start_offset": 21,
"end_offset": 23,
"label": "mic"
},
{
"id": 2,
"entity": "口腔",
"start_offset": 55,
"end_offset": 57,
"label": "bod"
},
{
"id": 3,
"entity": "肠道",
"start_offset": 58,
"end_offset": 60,
"label": "bod"
},
{
"id": 4,
"entity": "阴道",
"start_offset": 61,
"end_offset": 63,
"label": "bod"
}
] |
由于某些诱因，机体免疫功能降低时则可引起严重的真菌病。 | [
{
"id": 0,
"entity": "真菌病",
"start_offset": 23,
"end_offset": 26,
"label": "dis"
}
] |
2.外源性感染这类真菌平时在人体内并不存在，而存在于自然界，经呼吸道、胃肠道或有损伤的皮肤侵入人体而发病。 | [
{
"id": 0,
"entity": "真菌",
"start_offset": 9,
"end_offset": 11,
"label": "mic"
},
{
"id": 1,
"entity": "呼吸道",
"start_offset": 31,
"end_offset": 34,
"label": "bod"
},
{
"id": 2,
"entity": "胃肠道",
"start_offset": 35,
"end_offset": 38,
"label": "bod"
},
{
"id": 3,
"entity": "皮肤",
"start_offset": 43,
"end_offset": 45,
"label": "bod"
}
] |
3.条件致病真菌感染条件致病真菌感染可以是内源性的也可以是外源性的。 | [
{
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"entity": "条件致病真菌感染",
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{
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] |
无病原性或病原性极弱的一部分真菌，在机体特异或非特异性免疫功能低下或由于机体内菌群失调时而引起的感染，称为条件致病真菌感染。 | [
{
"id": 0,
"entity": "真菌",
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{
"id": 1,
"entity": "条件致病真菌感染",
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"end_offset": 61,
"label": "dis"
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] |
（三）真菌感染的途径由于病原性真菌的种类和在自然界中的分布，以及患者的年龄、生活环境的不同，其感染途径也是多种多样的。 | [
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"id": 0,
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{
"id": 1,
"entity": "病原性真菌",
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"end_offset": 17,
"label": "mic"
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] |
常见的几种真菌感染途径为：假丝酵母菌（如白色念珠菌）可经常存在于健康人的皮肤、黏膜、肠道等处，多为内源性感染；有时可由接触发生交叉感染。 | [
{
"id": 0,
"entity": "假丝酵母菌",
"start_offset": 13,
"end_offset": 18,
"label": "mic"
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{
"id": 1,
"entity": "白色念珠菌",
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"label": "mic"
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{
"id": 2,
"entity": "皮肤",
"start_offset": 36,
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"label": "bod"
},
{
"id": 3,
"entity": "黏膜",
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"end_offset": 41,
"label": "bod"
},
{
"id": 4,
"entity": "肠道",
"start_offset": 42,
"end_offset": 44,
"label": "bod"
}
] |
隐球菌病为外源性感染，可通过吸入或皮肤接触而引起感染。 | [
{
"id": 0,
"entity": "隐球菌病",
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"label": "dis"
},
{
"id": 1,
"entity": "皮肤",
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"end_offset": 19,
"label": "bod"
}
] |
毛霉菌常因吸入而引起肺部感染或食入含孢子的食物而引起肠道感染。 | [
{
"id": 0,
"entity": "毛霉菌",
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{
"id": 1,
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{
"id": 2,
"entity": "肠道感染",
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] |
例如内脏念珠菌病多为继发性感染，属于内源性，大量广谱抗生素、放疗、化疗和肾上腺皮质激素促进了上皮表面，尤其是口咽部和消化道念珠菌的大量生长和侵入，而肺部感染多由吸入念珠菌引起。 | [
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"entity": "内脏念珠菌病",
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"label": "dis"
},
{
"id": 1,
"entity": "广谱抗生素",
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"end_offset": 29,
"label": "dru"
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{
"id": 2,
"entity": "放疗",
"start_offset": 30,
"end_offset": 32,
"label": "pro"
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{
"id": 3,
"entity": "化疗",
"start_offset": 33,
"end_offset": 35,
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},
{
"id": 4,
"entity": "肾上腺皮质激素",
"start_offset": 36,
"end_offset": 43,
"label": "dru"
},
{
"id": 5,
"entity": "上皮表面",
"start_offset": 46,
"end_offset": 50,
"label": "bod"
},
{
"id": 6,
"entity": "口咽部",
"start_offset": 54,
"end_offset": 57,
"label": "bod"
},
{
"id": 7,
"entity": "消化道",
"start_offset": 58,
"end_offset": 61,
"label": "bod"
},
{
"id": 8,
"entity": "念珠菌",
"start_offset": 61,
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"label": "mic"
},
{
"id": 9,
"entity": "肺部感染",
"start_offset": 74,
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"label": "dis"
},
{
"id": 10,
"entity": "念珠菌",
"start_offset": 82,
"end_offset": 85,
"label": "mic"
}
] |
（四）真菌感染的类型根据侵犯部位及范围分为以下几种：1.浅部真菌病主要侵犯皮肤及其附属器官（也就是癣菌病，简称“癣”），一般症状较轻，90%以上的真菌属此类。 | [
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"entity": "真菌感染",
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{
"id": 1,
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{
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"entity": "皮肤",
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{
"id": 3,
"entity": "癣菌病",
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},
{
"id": 4,
"entity": "癣",
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"label": "dis"
},
{
"id": 5,
"entity": "真菌",
"start_offset": 73,
"end_offset": 75,
"label": "mic"
}
] |
2.深部真菌病主要侵犯皮下组织、黏膜深处，内脏器官，骨骼，中枢神经系统等。 | [
{
"id": 0,
"entity": "深部真菌病",
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{
"id": 1,
"entity": "皮下组织",
"start_offset": 11,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "黏膜深处",
"start_offset": 16,
"end_offset": 20,
"label": "bod"
},
{
"id": 3,
"entity": "内脏器官",
"start_offset": 21,
"end_offset": 25,
"label": "bod"
},
{
"id": 4,
"entity": "骨骼",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 5,
"entity": "中枢神经系统",
"start_offset": 29,
"end_offset": 35,
"label": "bod"
}
] |
局限性真菌病，是指真菌侵犯特定的器官、组织，如头癣、甲癣等。 | [
{
"id": 0,
"entity": "局限性真菌病",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "真菌",
"start_offset": 9,
"end_offset": 11,
"label": "mic"
},
{
"id": 2,
"entity": "头癣",
"start_offset": 23,
"end_offset": 25,
"label": "dis"
},
{
"id": 3,
"entity": "甲癣",
"start_offset": 26,
"end_offset": 28,
"label": "dis"
}
] |
全身性真菌感染，如疾病一开始就侵犯深部组织器官或病变从局部开始进一步发展侵犯各脏器、组织形成感染灶，则为全身侵袭性或系统性真菌感染。 | [
{
"id": 0,
"entity": "全身性真菌感染",
"start_offset": 0,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "脏器",
"start_offset": 39,
"end_offset": 41,
"label": "bod"
},
{
"id": 2,
"entity": "全身侵袭性或系统性真菌感染",
"start_offset": 52,
"end_offset": 65,
"label": "dis"
}
] |
真菌也可引起败血症，称为真菌败血症。 | [
{
"id": 0,
"entity": "真菌",
"start_offset": 0,
"end_offset": 2,
"label": "mic"
},
{
"id": 1,
"entity": "败血症",
"start_offset": 6,
"end_offset": 9,
"label": "dis"
},
{
"id": 2,
"entity": "真菌败血症",
"start_offset": 12,
"end_offset": 17,
"label": "dis"
}
] |
（五）真菌感染性疾病的免疫学特点正常情况下人对真菌具有高度的非特异性抵抗力。 | [
{
"id": 0,
"entity": "真菌感染性疾病",
"start_offset": 3,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "真菌",
"start_offset": 23,
"end_offset": 25,
"label": "mic"
}
] |
这些非特异性抵抗力主要表现为：机体的屏障作用、吞噬细胞对真菌的吞噬功能、正常体液中非特异性抗真菌因素、内分泌因素和微生态环境。 | [
{
"id": 0,
"entity": "吞噬细胞",
"start_offset": 23,
"end_offset": 27,
"label": "bod"
},
{
"id": 1,
"entity": "真菌",
"start_offset": 28,
"end_offset": 30,
"label": "mic"
},
{
"id": 2,
"entity": "体液",
"start_offset": 38,
"end_offset": 40,
"label": "bod"
}
] |
但免疫功能基本正常的儿童，由于吸入大量真菌孢子，如空调污染、密切接触鸽类以及接触有真菌存在的环境等，超过机体抵抗力而发病，多见于肺隐球菌病，其次是侵袭性肺曲霉菌病。 | [
{
"id": 0,
"entity": "肺隐球菌病",
"start_offset": 64,
"end_offset": 69,
"label": "dis"
},
{
"id": 1,
"entity": "侵袭性肺曲霉菌病",
"start_offset": 73,
"end_offset": 81,
"label": "dis"
}
] |
在严重的免疫缺陷患者，合并机会性感染常无明显的感染灶，组织反应和炎细胞浸润也比较轻微。 | [
{
"id": 0,
"entity": "免疫缺陷",
"start_offset": 4,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "炎细胞",
"start_offset": 32,
"end_offset": 35,
"label": "bod"
},
{
"id": 2,
"entity": "组织反应和炎细胞浸润也比较轻微",
"start_offset": 27,
"end_offset": 42,
"label": "sym"
}
] |
（六）真菌的检测真菌的检测包括直接镜检、培养检查、特殊染色检查、生化试验、动物接种和免疫学检查等。 | [
{
"id": 0,
"entity": "真菌",
"start_offset": 3,
"end_offset": 5,
"label": "mic"
},
{
"id": 1,
"entity": "真菌",
"start_offset": 8,
"end_offset": 10,
"label": "mic"
},
{
"id": 2,
"entity": "直接镜检",
"start_offset": 15,
"end_offset": 19,
"label": "pro"
},
{
"id": 3,
"entity": "培养检查",
"start_offset": 20,
"end_offset": 24,
"label": "pro"
},
{
"id": 4,
"entity": "特殊染色检查",
"start_offset": 25,
"end_offset": 31,
"label": "pro"
},
{
"id": 5,
"entity": "生化试验",
"start_offset": 32,
"end_offset": 36,
"label": "pro"
},
{
"id": 6,
"entity": "动物接种",
"start_offset": 37,
"end_offset": 41,
"label": "pro"
},
{
"id": 7,
"entity": "免疫学检查",
"start_offset": 42,
"end_offset": 47,
"label": "pro"
}
] |
1.病原学检查（1）直接镜检：从病损部位直接采取标本，进行镜检。 | [
{
"id": 0,
"entity": "直接镜检",
"start_offset": 10,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "镜检",
"start_offset": 29,
"end_offset": 31,
"label": "pro"
}
] |
将标本置于玻片上，加一滴5%～10%氢氧化钾溶液，覆以盖玻片，轻微加热后于显微镜下检查。 | [
{
"id": 0,
"entity": "玻片",
"start_offset": 5,
"end_offset": 7,
"label": "equ"
},
{
"id": 1,
"entity": "氢氧化钾",
"start_offset": 18,
"end_offset": 22,
"label": "dru"
},
{
"id": 2,
"entity": "盖玻片",
"start_offset": 27,
"end_offset": 30,
"label": "equ"
},
{
"id": 3,
"entity": "显微镜",
"start_offset": 37,
"end_offset": 40,
"label": "equ"
}
] |
（2）真菌培养：根据真菌感染部位确定采取标本。 | [
{
"id": 0,
"entity": "真菌",
"start_offset": 3,
"end_offset": 5,
"label": "mic"
},
{
"id": 1,
"entity": "真菌感染",
"start_offset": 10,
"end_offset": 14,
"label": "sym"
}
] |
理想的培养标本是通过无菌技术采取的血液、骨髓、胸水、腹水和脑脊液，检出真菌时的临床意义较大。 | [
{
"id": 0,
"entity": "血液",
"start_offset": 17,
"end_offset": 19,
"label": "bod"
},
{
"id": 1,
"entity": "骨髓",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
},
{
"id": 2,
"entity": "胸水",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 3,
"entity": "腹水",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 4,
"entity": "脑脊液",
"start_offset": 29,
"end_offset": 32,
"label": "bod"
},
{
"id": 5,
"entity": "真菌",
"start_offset": 35,
"end_offset": 37,
"label": "mic"
}
] |
从脑脊液、血液中培养出致病性真菌，如新型隐球菌，一次培养阳性即有诊断意义。 | [
{
"id": 0,
"entity": "脑脊液",
"start_offset": 1,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "血液",
"start_offset": 5,
"end_offset": 7,
"label": "bod"
},
{
"id": 2,
"entity": "致病性真菌",
"start_offset": 11,
"end_offset": 16,
"label": "mic"
},
{
"id": 3,
"entity": "新型隐球菌",
"start_offset": 18,
"end_offset": 23,
"label": "mic"
}
] |
从痰、尿、大便致病菌，如念珠菌、曲霉菌、毛霉菌则有可能是标本污染，或是正常寄生菌，必须多次培养阳性且为同一种菌，并结合临床、内镜和病理检查方可确诊。 | [
{
"id": 0,
"entity": "痰",
"start_offset": 1,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "尿",
"start_offset": 3,
"end_offset": 4,
"label": "bod"
},
{
"id": 2,
"entity": "大",
"start_offset": 5,
"end_offset": 6,
"label": "ite"
},
{
"id": 3,
"entity": "大",
"start_offset": 5,
"end_offset": 6,
"label": "bod"
},
{
"id": 4,
"entity": "病菌，",
"start_offset": 8,
"end_offset": 11,
"label": "mic"
},
{
"id": 5,
"entity": "念珠菌",
"start_offset": 12,
"end_offset": 15,
"label": "mic"
},
{
"id": 6,
"entity": "曲霉菌",
"start_offset": 16,
"end_offset": 19,
"label": "mic"
},
{
"id": 7,
"entity": "合临",
"start_offset": 58,
"end_offset": 60,
"label": "pro"
}
] |
（3）动物接种：将真菌感染的标本，如脑脊液、血液等，接种于敏感动物，如小白鼠等，饲养数周后处死，相应的动物组织中可见到大量的真菌，可以确诊。 | [
{
"id": 0,
"entity": "动物接种",
"start_offset": 3,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "真菌感染",
"start_offset": 9,
"end_offset": 13,
"label": "sym"
},
{
"id": 2,
"entity": "脑脊液",
"start_offset": 18,
"end_offset": 21,
"label": "bod"
},
{
"id": 3,
"entity": "血液",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
},
{
"id": 4,
"entity": "真菌",
"start_offset": 62,
"end_offset": 64,
"label": "mic"
}
] |
2.病理检查真菌感染的组织病理变化与感染的菌种和感染的部位有关，也随病程的不同程度而改变。 | [
{
"id": 0,
"entity": "病理检查",
"start_offset": 2,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "真菌感染",
"start_offset": 6,
"end_offset": 10,
"label": "dis"
}
] |
一般病变早期多为化脓性改变，而在晚期多为肉芽肿性改变。 | [
{
"id": 0,
"entity": "化脓性改变",
"start_offset": 8,
"end_offset": 13,
"label": "sym"
},
{
"id": 1,
"entity": "肉芽肿性改变",
"start_offset": 20,
"end_offset": 26,
"label": "sym"
}
] |
但是，真菌组织反应不具特异性，所以病理上的组织反应只对真菌感染的诊断具有参考意义。 | [
{
"id": 0,
"entity": "真菌",
"start_offset": 3,
"end_offset": 5,
"label": "mic"
}
] |
只有在病变组织中发现有真菌才能确诊为真菌感染。 | [
{
"id": 0,
"entity": "真菌",
"start_offset": 11,
"end_offset": 13,
"label": "mic"
},
{
"id": 1,
"entity": "真菌感染",
"start_offset": 18,
"end_offset": 22,
"label": "dis"
}
] |
3.其他检查（1）血液标本真菌细胞壁成分1，3-β-D葡聚糖抗原（G试验）：1，3-β-D葡聚糖广泛存在于真菌细胞壁中，但不包括隐球菌和接合菌，而其他微生物、动物及人体细胞均无此成分。 | [
{
"id": 0,
"entity": "血液标本真菌细胞壁成分1，3-β-D葡聚糖抗原（G试验）",
"start_offset": 9,
"end_offset": 37,
"label": "pro"
},
{
"id": 1,
"entity": "真菌细胞壁",
"start_offset": 53,
"end_offset": 58,
"label": "mic"
},
{
"id": 2,
"entity": "隐球菌",
"start_offset": 64,
"end_offset": 67,
"label": "mic"
},
{
"id": 3,
"entity": "接合菌",
"start_offset": 68,
"end_offset": 71,
"label": "mic"
}
] |
（2）血液标本曲霉半乳甘露聚糖抗原（GM）检测（ELISA）：连续2次吸光度值（I）＞0.8或单次I＞1.5；GM检测患儿的假阳性率比成年患者高，因为儿童会比成年人食用更多含有GM的食物，特别是牛奶，而哌拉西林钠他/唑巴坦钠等青霉素类药物的使用也可能引起GM水平增高，产生假阳性结果；相反，接受抗真菌预防性或经验性治疗则会产生假阴性结果。 | [
{
"id": 0,
"entity": "血液标本曲霉半乳甘露聚糖抗原（GM）检测（ELISA）",
"start_offset": 3,
"end_offset": 30,
"label": "pro"
},
{
"id": 1,
"entity": "GM检测",
"start_offset": 55,
"end_offset": 59,
"label": "pro"
},
{
"id": 2,
"entity": "哌拉西林钠他",
"start_offset": 101,
"end_offset": 107,
"label": "dru"
},
{
"id": 3,
"entity": "唑巴坦钠",
"start_offset": 108,
"end_offset": 112,
"label": "dru"
},
{
"id": 4,
"entity": "青霉素",
"start_offset": 113,
"end_offset": 116,
"label": "dru"
},
{
"id": 5,
"entity": "GM水平",
"start_offset": 127,
"end_offset": 131,
"label": "ite"
},
{
"id": 6,
"entity": "抗真菌预防性或经验性治疗",
"start_offset": 147,
"end_offset": 159,
"label": "pro"
}
] |
（3）血液、脑脊液或支气管肺泡灌洗液乳胶凝集法检测隐球菌荚膜多糖抗原：目前临床上诊断隐球菌感染的最重要方法之一，不仅可有助于早期诊断，尚可用于疗效和预后的评估，敏感性和特异性均达到90%以上。 | [
{
"id": 0,
"entity": "血液、脑脊液或支气管肺泡灌洗液乳胶凝集法",
"start_offset": 3,
"end_offset": 23,
"label": "pro"
},
{
"id": 1,
"entity": "隐球菌荚膜多糖抗原",
"start_offset": 25,
"end_offset": 34,
"label": "mic"
},
{
"id": 2,
"entity": "隐球菌感染",
"start_offset": 42,
"end_offset": 47,
"label": "dis"
}
] |
（七）侵袭性肺部真菌感染的诊断侵袭性肺部真菌感染（invasivepulmonaryfungalinfections，IPFIs）指真菌侵入气管支气管及肺组织引起的感染，不包括真菌寄生和过敏引起的肺部病变。 | [
{
"id": 0,
"entity": "侵袭性肺部真菌感染",
"start_offset": 3,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "侵袭性肺部真菌感染",
"start_offset": 15,
"end_offset": 24,
"label": "dis"
},
{
"id": 2,
"entity": "invasivepulmonaryfungalinfections",
"start_offset": 25,
"end_offset": 58,
"label": "dis"
},
{
"id": 3,
"entity": "IPFIs",
"start_offset": 59,
"end_offset": 64,
"label": "dis"
},
{
"id": 4,
"entity": "真菌",
"start_offset": 66,
"end_offset": 68,
"label": "mic"
},
{
"id": 5,
"entity": "气管",
"start_offset": 70,
"end_offset": 72,
"label": "bod"
},
{
"id": 6,
"entity": "支气管",
"start_offset": 72,
"end_offset": 75,
"label": "bod"
},
{
"id": 7,
"entity": "肺组织",
"start_offset": 76,
"end_offset": 79,
"label": "bod"
},
{
"id": 8,
"entity": "真菌",
"start_offset": 88,
"end_offset": 90,
"label": "mic"
},
{
"id": 9,
"entity": "过敏",
"start_offset": 93,
"end_offset": 95,
"label": "dis"
},
{
"id": 10,
"entity": "肺部",
"start_offset": 98,
"end_offset": 100,
"label": "bod"
},
{
"id": 11,
"entity": "肺部病变",
"start_offset": 98,
"end_offset": 102,
"label": "sym"
}
] |
【IPFIs的诊断】IPFIs的诊断采用分级诊断模式，诊断依据由宿主（危险）因素、临床证据、微生物学证据和组织病理学4部分组成，分为确诊、临床诊断和拟诊三个级别。 | [
{
"id": 0,
"entity": "IPFIs",
"start_offset": 1,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "IPFIs",
"start_offset": 10,
"end_offset": 15,
"label": "dis"
}
] |
诊断依据：1.宿主和（或）环境（危险）因素（1）基础疾病：早产儿、低出生体重儿、先天发育异常、慢性疾病和重度营养不良等。 | [
{
"id": 0,
"entity": "早产",
"start_offset": 29,
"end_offset": 31,
"label": "sym"
},
{
"id": 1,
"entity": "低出生体重",
"start_offset": 33,
"end_offset": 38,
"label": "sym"
},
{
"id": 2,
"entity": "先天发育异常",
"start_offset": 40,
"end_offset": 46,
"label": "sym"
},
{
"id": 3,
"entity": "慢性疾病",
"start_offset": 47,
"end_offset": 51,
"label": "dis"
},
{
"id": 4,
"entity": "重度营养不良",
"start_offset": 52,
"end_offset": 58,
"label": "sym"
}
] |
（2）原发性免疫缺陷病：各类原发性免疫缺陷病，尤其是联合免疫缺陷病、细胞免疫缺陷病和慢性肉芽肿病（CGD）等。 | [
{
"id": 0,
"entity": "原发性免疫缺陷病",
"start_offset": 3,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "原发性免疫缺陷病",
"start_offset": 14,
"end_offset": 22,
"label": "dis"
},
{
"id": 2,
"entity": "联合免疫缺陷病",
"start_offset": 26,
"end_offset": 33,
"label": "dis"
},
{
"id": 3,
"entity": "细胞免疫缺陷病",
"start_offset": 34,
"end_offset": 41,
"label": "dis"
},
{
"id": 4,
"entity": "慢性肉芽肿病",
"start_offset": 42,
"end_offset": 48,
"label": "dis"
},
{
"id": 5,
"entity": "CGD",
"start_offset": 49,
"end_offset": 52,
"label": "dis"
}
] |
（3）继发性免疫功能低下：抗肿瘤药物导致外周血中性粒细胞减少；长期应用广谱抗菌药物、糖皮质激素以及其他免疫抑制剂；骨髓移植和器官移植后以及HIV感染和其他严重病毒感染等。 | [
{
"id": 0,
"entity": "继发性免疫功能低下",
"start_offset": 3,
"end_offset": 12,
"label": "sym"
},
{
"id": 1,
"entity": "抗肿瘤药物",
"start_offset": 13,
"end_offset": 18,
"label": "dru"
},
{
"id": 2,
"entity": "外周血中性粒细胞",
"start_offset": 20,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "外周血中性粒细胞减少",
"start_offset": 20,
"end_offset": 30,
"label": "sym"
},
{
"id": 4,
"entity": "广谱抗菌药物",
"start_offset": 35,
"end_offset": 41,
"label": "dru"
},
{
"id": 5,
"entity": "糖皮质激素",
"start_offset": 42,
"end_offset": 47,
"label": "dru"
},
{
"id": 6,
"entity": "免疫抑制剂",
"start_offset": 51,
"end_offset": 56,
"label": "dru"
},
{
"id": 7,
"entity": "骨髓移植",
"start_offset": 57,
"end_offset": 61,
"label": "pro"
},
{
"id": 8,
"entity": "器官移植",
"start_offset": 62,
"end_offset": 66,
"label": "pro"
},
{
"id": 9,
"entity": "HIV感染",
"start_offset": 69,
"end_offset": 74,
"label": "dis"
},
{
"id": 10,
"entity": "严重病毒感染",
"start_offset": 77,
"end_offset": 83,
"label": "dis"
}
] |
（4）侵入性操作：包括血管内留置导管、留置导尿管、气管插管或气管切开、机械通气、腹膜透析、血液净化和胃肠外营养等。 | [
{
"id": 0,
"entity": "血管",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 1,
"entity": "导管",
"start_offset": 16,
"end_offset": 18,
"label": "equ"
},
{
"id": 2,
"entity": "导尿管",
"start_offset": 21,
"end_offset": 24,
"label": "equ"
},
{
"id": 3,
"entity": "气管插管",
"start_offset": 25,
"end_offset": 29,
"label": "pro"
},
{
"id": 4,
"entity": "气管切开",
"start_offset": 30,
"end_offset": 34,
"label": "pro"
},
{
"id": 5,
"entity": "机械通气",
"start_offset": 35,
"end_offset": 39,
"label": "pro"
},
{
"id": 6,
"entity": "腹膜透析",
"start_offset": 40,
"end_offset": 44,
"label": "pro"
},
{
"id": 7,
"entity": "血液净化",
"start_offset": 45,
"end_offset": 49,
"label": "pro"
},
{
"id": 8,
"entity": "胃肠外营养",
"start_offset": 50,
"end_offset": 55,
"label": "pro"
}
] |
（5）环境危险因素：免疫功能基本正常的儿童，由于吸入大量真菌孢子，如空调污染、密切接触鸽类以及接触有真菌存在的环境等，超过机体抵抗力而发病，多见于肺隐球菌病，其次是侵袭性肺曲霉菌病。 | [
{
"id": 0,
"entity": "真菌孢子",
"start_offset": 28,
"end_offset": 32,
"label": "mic"
},
{
"id": 1,
"entity": "肺隐球菌病",
"start_offset": 73,
"end_offset": 78,
"label": "dis"
},
{
"id": 2,
"entity": "侵袭性肺曲霉菌病",
"start_offset": 82,
"end_offset": 90,
"label": "dis"
}
] |
2.临床证据（1）发热、咳嗽和肺部体征经抗菌药物治疗无好转，或好转后再次出现发热、咳嗽和肺部体征。 | [
{
"id": 0,
"entity": "发热",
"start_offset": 9,
"end_offset": 11,
"label": "sym"
},
{
"id": 1,
"entity": "咳嗽",
"start_offset": 12,
"end_offset": 14,
"label": "sym"
},
{
"id": 2,
"entity": "肺部",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "发热",
"start_offset": 38,
"end_offset": 40,
"label": "sym"
},
{
"id": 4,
"entity": "咳嗽",
"start_offset": 41,
"end_offset": 43,
"label": "sym"
},
{
"id": 5,
"entity": "肺部",
"start_offset": 44,
"end_offset": 46,
"label": "bod"
},
{
"id": 6,
"entity": "肺部体征",
"start_offset": 44,
"end_offset": 48,
"label": "sym"
}
] |
（2）影像学提示肺部病变经抗菌药物治疗无好转或肺部出现新的非原发病的浸润影。 | [
{
"id": 0,
"entity": "肺部",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "肺部病变",
"start_offset": 8,
"end_offset": 12,
"label": "sym"
},
{
"id": 2,
"entity": "肺部",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 3,
"entity": "肺部出现新的非原发病的浸润影",
"start_offset": 23,
"end_offset": 37,
"label": "sym"
}
] |
3.微生物学证据有临床诊断意义的微生物学证据：（1）合格痰标本直接镜检发现菌丝，且培养连续2次以上分离到同种真菌。 | [
{
"id": 0,
"entity": "痰",
"start_offset": 28,
"end_offset": 29,
"label": "bod"
},
{
"id": 1,
"entity": "直接镜检",
"start_offset": 31,
"end_offset": 35,
"label": "pro"
},
{
"id": 2,
"entity": "真菌",
"start_offset": 54,
"end_offset": 56,
"label": "mic"
}
] |
（2）支气管肺泡灌洗液经直接镜检发现菌丝，真菌培养阳性。 | [
{
"id": 0,
"entity": "支气管肺泡灌洗液",
"start_offset": 3,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "直接镜检",
"start_offset": 12,
"end_offset": 16,
"label": "pro"
},
{
"id": 2,
"entity": "真菌",
"start_offset": 21,
"end_offset": 23,
"label": "mic"
}
] |
（3）合格痰液或支气管肺泡灌洗液直接镜检或培养发现新生隐球菌。 | [
{
"id": 0,
"entity": "痰液",
"start_offset": 5,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "支气管肺泡灌洗液",
"start_offset": 8,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "直接镜检",
"start_offset": 16,
"end_offset": 20,
"label": "pro"
},
{
"id": 3,
"entity": "隐球菌",
"start_offset": 27,
"end_offset": 30,
"label": "mic"
}
] |
（4）血液标本曲霉半乳甘露聚糖抗原（GM）检测（ELISA）连续2次吸光度值（I）＞0.8或单次I＞1.5。 | [
{
"id": 0,
"entity": "血液标本曲霉半乳甘露聚糖抗原（GM）检测",
"start_offset": 3,
"end_offset": 23,
"label": "pro"
},
{
"id": 1,
"entity": "ELISA",
"start_offset": 24,
"end_offset": 29,
"label": "pro"
},
{
"id": 2,
"entity": "吸光度值",
"start_offset": 34,
"end_offset": 38,
"label": "ite"
}
] |
（5）血液标本真菌细胞壁成分1，3-β-D葡聚糖抗原（G试验）连续2次阳性。 | [
{
"id": 0,
"entity": "血液标本真菌细胞壁成分1，3-β-D葡聚糖抗原",
"start_offset": 3,
"end_offset": 26,
"label": "pro"
},
{
"id": 1,
"entity": "G试验",
"start_offset": 27,
"end_offset": 30,
"label": "pro"
}
] |
（6）血液隐球菌抗原阳性有确诊意义的微生物学证据：（1）肺组织真菌培养阳性（2）胸腔积液真菌培养阳性（3）血液真菌培养阳性（曲霉和除马尼菲青霉以外的青霉需除外污染）。 | [
{
"id": 0,
"entity": "血液",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "隐球菌抗原",
"start_offset": 5,
"end_offset": 10,
"label": "mic"
},
{
"id": 2,
"entity": "血液隐球菌抗原阳性",
"start_offset": 3,
"end_offset": 12,
"label": "sym"
},
{
"id": 3,
"entity": "肺组织",
"start_offset": 28,
"end_offset": 31,
"label": "bod"
},
{
"id": 4,
"entity": "肺组织真菌培养阳性",
"start_offset": 28,
"end_offset": 37,
"label": "sym"
},
{
"id": 5,
"entity": "胸腔积液",
"start_offset": 40,
"end_offset": 44,
"label": "bod"
},
{
"id": 6,
"entity": "胸腔积液真菌培养阳性",
"start_offset": 40,
"end_offset": 50,
"label": "sym"
},
{
"id": 7,
"entity": "血液",
"start_offset": 53,
"end_offset": 55,
"label": "bod"
},
{
"id": 8,
"entity": "血液真菌培养阳性",
"start_offset": 53,
"end_offset": 61,
"label": "sym"
}
] |
（4）合格痰液或支气管肺泡灌洗液发现肺孢子菌包囊、滋养体或囊内小体。 | [
{
"id": 0,
"entity": "痰液",
"start_offset": 5,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "支气管肺泡灌洗液",
"start_offset": 8,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "痰液或支气管肺泡灌洗液发现肺孢子菌包囊、滋养体或囊内小体",
"start_offset": 5,
"end_offset": 33,
"label": "sym"
}
] |
（5）胸腔积液和血液直接镜检发现新生隐球菌。 | [
{
"id": 0,
"entity": "胸腔积液",
"start_offset": 3,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "血液",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 2,
"entity": "直接镜检",
"start_offset": 10,
"end_offset": 14,
"label": "pro"
},
{
"id": 3,
"entity": "新生隐球菌",
"start_offset": 16,
"end_offset": 21,
"label": "mic"
},
{
"id": 4,
"entity": "胸腔积液和血液直接镜检发现新生隐球菌",
"start_offset": 3,
"end_offset": 21,
"label": "sym"
}
] |
4.组织病理学证据肺组织标本进行组织病理学检查发现真菌感染的病理改变以及菌丝或孢子等真菌成分。 | [
{
"id": 0,
"entity": "肺组织",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 1,
"entity": "菌丝",
"start_offset": 36,
"end_offset": 38,
"label": "mic"
},
{
"id": 2,
"entity": "孢子",
"start_offset": 39,
"end_offset": 41,
"label": "mic"
},
{
"id": 3,
"entity": "真菌",
"start_offset": 42,
"end_offset": 44,
"label": "mic"
},
{
"id": 4,
"entity": "肺组织标本进行组织病理学检查发现真菌感染的病理改变以及菌丝或孢子等真菌成分",
"start_offset": 9,
"end_offset": 46,
"label": "sym"
}
] |
诊断标准为：确诊（proven）：宿主因素+临床证据+肺组织病理学和（或）有确诊意义的微生物学证据。 | [
{
"id": 0,
"entity": "肺组织",
"start_offset": 27,
"end_offset": 30,
"label": "bod"
}
] |
（八）抗真菌药物治疗包括多烯类、唑类、嘧啶类、棘白菌素类等药物。 | [
{
"id": 0,
"entity": "抗真菌药物治疗",
"start_offset": 3,
"end_offset": 10,
"label": "pro"
}
] |
前两类较常用，嘧啶类中的氟胞嘧啶，抗真菌谱窄，仅对酵母菌有较高的抗菌活性，但与其他抗真菌药有协同作用，生物利用度较高。 | [
{
"id": 0,
"entity": "氟胞嘧啶",
"start_offset": 12,
"end_offset": 16,
"label": "dru"
},
{
"id": 1,
"entity": "酵母菌",
"start_offset": 25,
"end_offset": 28,
"label": "mic"
}
] |
此外，还有抗真菌中草药，如大蒜素注射液等。 | [
{
"id": 0,
"entity": "抗真菌中草药",
"start_offset": 5,
"end_offset": 11,
"label": "dru"
},
{
"id": 1,
"entity": "大蒜素注射液",
"start_offset": 13,
"end_offset": 19,
"label": "dru"
}
] |
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