Yamazaki T, Kume H, Murase S, Yamashita E, Arisawa M
Nippon Roche Research Center, Kamakura, Kanagawa 247-8530, University Hospital, School of Medicine, Kitasato University, Kanagawa 228-8550, Japan.
J Clin Microbiol. 1999 Jun;37(6):1732-8. doi: 10.1128/JCM.37.6.1732-1738.1999.
The data on visceral mycoses that had been reported in the Annual of the Pathological Autopsy Cases in Japan from 1969 to 1994 by the Japanese Society of Pathology were analyzed epidemiologically. The frequency of visceral mycoses among the annual total number of pathological autopsy cases increased noticeably from 1.60% in 1969 to a peak of 4.66% in 1990. Among them, the incidences of candidiasis and aspergillosis increased the most. After 1990, however, the frequency of visceral mycoses decreased gradually. Until 1989, the predominant causative agent was Candida, followed in order by Aspergillus and Cryptococcus. Although the rate of candidiasis decreased by degrees from 1990, the rate of aspergillosis increased up to and then surpassed that of candidiasis in 1991. Leukemia was the major disease underlying the visceral mycoses, followed by solid cancers and other blood and hematopoietic system diseases. Severe mycotic infection has increased over the reported 25-year period, from 6.6% of the total visceral mycosis cases in 1969 to 71% in 1994. The reasons for this decrease of candidiasis combined with an increase of aspergillosis or of severe mycotic infection might be that (i) nonsevere (not disseminated) infections were excluded from the case totals, since they have become controllable by antifungal drugs such as fluconazole, but (ii) the available antifungal drugs were not efficacious against severe infections such as pulmonary aspergillosis, and (iii) the number of patients living longer in an immunocompromised state had increased because of developments in chemotherapy and progress in medical care.
对日本病理学会在《日本病理尸检病例年报》中报告的1969年至1994年期间内脏真菌病的数据进行了流行病学分析。在内脏真菌病在年度病理尸检病例总数中的占比方面，从1969年的1.60%显著增加到1990年的峰值4.66%。其中，念珠菌病和曲霉病的发病率增长最为明显。然而，1990年之后，内脏真菌病的占比逐渐下降。直到1989年，主要病原体是念珠菌，其次依次是曲霉和隐球菌。尽管念珠菌病的发病率自1990年起逐渐下降，但曲霉病的发病率持续上升，并在1991年超过了念珠菌病。白血病是内脏真菌病的主要基础疾病，其次是实体癌以及其他血液和造血系统疾病。在报告的25年期间，严重真菌感染有所增加，从1969年占内脏真菌病病例总数的6.6%增至1994年的71%。念珠菌病减少而曲霉病或严重真菌感染增加的原因可能是：(i) 非严重（未播散）感染已从病例总数中排除，因为它们已可通过氟康唑等抗真菌药物得到控制；(ii) 现有的抗真菌药物对肺曲霉病等严重感染无效；(iii) 由于化疗的发展和医疗护理的进步，免疫功能低下状态下存活时间更长的患者数量有所增加。
