McKelvie P A, Wong E Y, Chow L P, Hall A J
Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia.
Clin Exp Ophthalmol. 2001 Oct;29(5):330-4. doi: 10.1046/j.1442-9071.2001.00444.x.
The incidence of disseminated infection with Scedosporium species is increasing in patients with haematological malignancy. Two fatal cases are reported of patients with acute myeloid leukaemia and neutropenia who presented with Scedosporium endophthalmitis. Diagnosis of fungal infection was delayed as blood and vitreous cultures were positive only after 3 days in patient 1 and blood culture was positive at 7 days in patient 2. Despite antifungal therapy with amphotericin B and additional fluconazole in patient 2, both patients died of overwhelming fungal septicaemia. Post-mortem examination of the right globe in patient 1 showed haemorrhagic necrotizing chorioretinitis with numerous fungal hyphae in choroidal vessels, choroid, retina and vitreous. Scedosporium species are often resistant to conventional antifungal therapy including amphotericin B. Diagnosis is difficult and mortality in disseminated infection is high.
在血液系统恶性肿瘤患者中，播散性拟青霉属真菌感染的发生率正在上升。本文报告了两例急性髓系白血病伴中性粒细胞减少症患者发生拟青霉属眼内炎并死亡的病例。两名患者的真菌感染诊断均被延迟，病例1的血液和玻璃体培养仅在3天后呈阳性，病例2的血液培养在7天后呈阳性。尽管病例2接受了两性霉素B抗真菌治疗并加用了氟康唑，但两名患者均死于严重的真菌败血症。病例1右眼球的尸检显示出血性坏死性脉络膜视网膜炎，脉络膜血管、脉络膜、视网膜和玻璃体中有大量真菌菌丝。拟青霉属通常对包括两性霉素B在内的传统抗真菌治疗耐药。诊断困难，播散性感染的死亡率很高。
