尖端赛多孢子菌致免疫正常者肺部感染一例并文献复习_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

冯小艺 ,  欧雪梅

四川大学华西医院呼吸与危重症医学科（四川成都 610041）;

Corresponding author：

欧雪梅, Email: ouxuemei@163.com

Keywords：

尖端赛多孢子菌; 肺部感染; 免疫功能正常宿主

DOI：

10.7507/1671-6205.202010011

Video：

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目的探讨尖端赛多孢子菌致免疫正常宿主肺部感染的病因及发病机制、临床表现、诊断及治疗，通过对相关文献的复习，提高临床对此病的认识，减少误诊、漏诊。方法对 1 例尖端赛多孢子菌致肺部感染患者的临床表现、实验室检查、影像学检查及治疗进行报道并结合相关文献分析。结果患者女性，47 岁，因“痰中带血 1⁺个月”入院。胸部 CT 提示右肺下叶背段支气管扩张伴周围少许感染，扩张支气管腔内结节影。肺泡灌洗液病原微生物高通量基因检测结果提示尖端赛多孢子菌。结合患者临床表现拟诊为肺尖端赛多孢子菌病，予伏立康唑抗真菌感染治疗后患者症状缓解。文献复习共检索到尖端赛多孢子菌病病例报道 1000 余例，其中致免疫功能正常者肺部感染仅 40 余例。多为散发报道或小样本报道。结论尖端赛多孢子菌致免疫正常宿主肺部感染相对罕见，此真菌侵袭力强，感染部位广，预后差，临床上应提高警惕，尽早诊断。治疗上依赖于抗真菌治疗、免疫调节治疗和在某些情况下手术切除的联合治疗。

Citation： 冯小艺, 欧雪梅. 尖端赛多孢子菌致免疫正常者肺部感染一例并文献复习. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(4): 266-269. doi: 10.7507/1671-6205.202010011 Copy

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2.	Caston JJ, Linares MJ, Rivero A, et al. Clinical differences between invasive pulmonary infection by Scedosporium apiospermum and invasive pulmonary aspergillosis. Mycoses, 2011, 54(5): e468-473.
3.	Rodriguez-Tudela JL, Berenguer J, Guarro J, et al. Epidemiology and outcome of Scedosporium prolificans infection, a review of 162 cases. Med Mycol, 2009, 47(4): 359-370.
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5.	Noni M, Katelari A, Kapi A, et al. Scedosporium apiospermum complex in cystic fibrosis: should we treat?. Mycoses, 2017, 60(9): 594-599.
6.	Hedayati MT, Tavakoli M, Maleki M, et al. Fungal epidemiology in cystic fibrosis patients with a special focus on Scedosporium species complex. Microb Pathog, 2019, 129: 168-175.
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8.	Wiederhold NP. The antifungal arsenal: alternative drugs and future targets. Int J Antimicrob Agents, 2018, 51: 333-339.
9.	McCarthy MW, Katragkou A, Iosifidis E, et al. Recent advances in the treatment of Scedosporiosis and Fusariosis. J Fungi (Basel), 2018, 4(2): 73.
10.	Solé A. Scedosporium apiospermum disseminated infection in a single lung transplant recipient. Rev Iberoam Micol, 2011, 28(3): 139-142.
11.	Liu W, Feng RZ, Jiang HL. Scedosporium spp lung infection in immunocompetent patients: A systematic review and MOOSE-compliant meta-analysis. Medicine (Baltimore), 2019, 98(41): e17535.
12.	He XH, Wu JY, Wu CJ, et al. Scedosporium Apiospermum infection after near-drowning. Chin Med J (Engl), 2015, 128: 2119-2123.
13.	Husain S, Muñoz P, Forrest G, et al. Infections due to Scedosporium apiospermum and Scedosporium prolificans in transplant recipients: clinical characteristics and impact of antifungal agent therapy on outcome. Clin Infect Dis, 2005, 40(1): 89-99.

1. Cortez KJ, Roilides E, Quiroz-Telles F, et al. Infections caused by Scedosporium spp. Clin Microbiol Rev, 2008, 21(1): 157-197.
2. Caston JJ, Linares MJ, Rivero A, et al. Clinical differences between invasive pulmonary infection by Scedosporium apiospermum and invasive pulmonary aspergillosis. Mycoses, 2011, 54(5): e468-473.
3. Rodriguez-Tudela JL, Berenguer J, Guarro J, et al. Epidemiology and outcome of Scedosporium prolificans infection, a review of 162 cases. Med Mycol, 2009, 47(4): 359-370.
4. Severo LC, Oliveira Fde M, Irion K. Respiratory tract intracavitary colonization due to Scedosporium apiospermum: report of four cases. Rev Inst Med Trop Sao Paulo, 2004, 46(1): 43-46.
5. Noni M, Katelari A, Kapi A, et al. Scedosporium apiospermum complex in cystic fibrosis: should we treat?. Mycoses, 2017, 60(9): 594-599.
6. Hedayati MT, Tavakoli M, Maleki M, et al. Fungal epidemiology in cystic fibrosis patients with a special focus on Scedosporium species complex. Microb Pathog, 2019, 129: 168-175.
7. Seidel D, Meißner A, Lackner M, et al. Prognostic factors in 264 adults with invasive Scedosporium spp. and Lomentospora prolificans infection reported in the literature and FungiScope®. Crit Rev Microbiol, 2019, 45(1): 1-21.
8. Wiederhold NP. The antifungal arsenal: alternative drugs and future targets. Int J Antimicrob Agents, 2018, 51: 333-339.
9. McCarthy MW, Katragkou A, Iosifidis E, et al. Recent advances in the treatment of Scedosporiosis and Fusariosis. J Fungi (Basel), 2018, 4(2): 73.
10. Solé A. Scedosporium apiospermum disseminated infection in a single lung transplant recipient. Rev Iberoam Micol, 2011, 28(3): 139-142.
11. Liu W, Feng RZ, Jiang HL. Scedosporium spp lung infection in immunocompetent patients: A systematic review and MOOSE-compliant meta-analysis. Medicine (Baltimore), 2019, 98(41): e17535.
12. He XH, Wu JY, Wu CJ, et al. Scedosporium Apiospermum infection after near-drowning. Chin Med J (Engl), 2015, 128: 2119-2123.
13. Husain S, Muñoz P, Forrest G, et al. Infections due to Scedosporium apiospermum and Scedosporium prolificans in transplant recipients: clinical characteristics and impact of antifungal agent therapy on outcome. Clin Infect Dis, 2005, 40(1): 89-99.

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尖端赛多孢子菌致免疫正常者肺部感染一例并文献复习

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