Dupont B, Richardson M, Verweij P E, Meis J F
Unité de Mycologie, Institut Pasteur, H pital Necker, Paris, France.
Med Mycol. 2000;38 Suppl 1:215-24.
Acute invasive aspergillosis (IA) is a devastating disease. Early diagnosis allowing an early treatment may improve the prognosis. However, this goal remains difficult to achieve. When diagnosis is confirmed it is often already too late. Galactomannan antigen detection and DNA detection are under clinical evaluation to improve early diagnosis and management of treatment. Despite antifungal treatment mortality rate is still high. Clinical resistance is more often due to the intensity of immunodepression than to high minimum inhibitory concentrations to antifungal agents; however, resistance to itraconazole may occur in rare instances. Beside acute IA, a chronic form of this infection may be seen as chronic necrotizing pulmonary aspergillosis or chronic invasive sinusitis. Other sites of infection have been described. The patients are immunocompetent or present minor alteration of their immunity or of anatomic structure of the infected site. Among patients with solid organ transplantation, lung and liver transplant patients are at the highest risk of developing IA. A high degree of awareness and efforts for an early diagnosis may participate to improve the poor prognosis.
急性侵袭性曲霉病（IA）是一种毁灭性疾病。早期诊断并尽早治疗可能会改善预后。然而，这一目标仍难以实现。确诊时往往已为时过晚。半乳甘露聚糖抗原检测和DNA检测正在进行临床评估，以改善IA的早期诊断和治疗管理。尽管进行了抗真菌治疗，死亡率仍然很高。临床耐药性更多是由于免疫抑制的强度，而非抗真菌药物的高最低抑菌浓度；然而，罕见情况下可能会出现对伊曲康唑的耐药性。除了急性IA，这种感染的慢性形式可见于慢性坏死性肺曲霉病或慢性侵袭性鼻窦炎。还描述了其他感染部位。患者具有免疫能力，或其免疫力或感染部位的解剖结构有轻微改变。在实体器官移植患者中，肺和肝移植患者发生IA的风险最高。提高高度警惕并努力进行早期诊断可能有助于改善不良预后。
