Caillot D, Mannone L, Cuisenier B, Couaillier J F
Department of Clinical Hematology, University Hospital of Dijon, France.
Clin Microbiol Infect. 2001;7 Suppl 2:54-61. doi: 10.1111/j.1469-0691.2001.tb00010.x.
Invasive pulmonary aspergillosis (IPA) occurs mostly in immunocompromised hosts and especially in neutropenic patients. Improved prognosis for IPA requires early diagnosis. We report our experience in the management of IPA in patients with hematological malignancies. In prolonged neutropenia (> 10 days), thoracic CT scanning seems to be the best choice for the diagnosis of IPA (with CT halo or air-crescent signs). Its systematic use allows a dramatic reduction in the time to achieve the diagnosis, if there is evidence of a halo sign. The systematic screening for the detection of Aspergillus antigenemia with an ELISA test is helpful for early diagnosis. The detection of Aspergillus antigen (with the less sensitive latex agglutination test) on bronchoalveolar lavage (BAL) fluid may also be as useful. The treatment of IPA relies on amphotericin B (or its lipid formulations) or on azole antifungal agents. Pulmonary surgical resection should be considered either as an emergency procedure (despite persistent neutropenia) to avoid massive hemoptysis, or as an elective or diagnostic procedure. This global strategy for the management of IPA is associated with a 75-80% success rate in hematological patients. Nevertheless, the control of underlying malignancy remains a major prognostic factor.
侵袭性肺曲霉病（IPA）主要发生在免疫功能低下的宿主中，尤其是中性粒细胞减少的患者。改善IPA的预后需要早期诊断。我们报告了我们在血液系统恶性肿瘤患者中管理IPA的经验。在长期中性粒细胞减少（>10天）的情况下，胸部CT扫描似乎是诊断IPA的最佳选择（伴有CT晕征或空气新月征）。如果有晕征的证据，系统地使用它可以显著缩短确诊时间。用ELISA试验系统筛查曲霉抗原血症有助于早期诊断。在支气管肺泡灌洗（BAL）液中检测曲霉抗原（用敏感性较低的乳胶凝集试验）也可能同样有用。IPA的治疗依赖于两性霉素B（或其脂质制剂）或唑类抗真菌药物。肺手术切除应被视为一种紧急手术（尽管存在持续性中性粒细胞减少）以避免大量咯血，或作为一种选择性或诊断性手术。这种IPA的整体管理策略在血液系统疾病患者中的成功率为75%-80%。然而，控制潜在的恶性肿瘤仍然是一个主要的预后因素。
