Marr Kieren A, Carter Rachel A, Crippa Fulvio, Wald Anna, Corey Lawrence
Program in Infectious Diseases, Fred Hutchinson Cancer Research Center; and Department of Medicine, University of Washington, Seattle, WA, USA.
Clin Infect Dis. 2002 Apr 1;34(7):909-17. doi: 10.1086/339202. Epub 2002 Feb 26.
Reports have focused on the emergence of moulds as pathogens in recipients of hematopoietic stem cell transplants. To review the incidence of and risks for mould infections, we examined the records of 5589 patients who underwent hematopoietic stem cell transplantation at the Fred Hutchinson Cancer Research Center (Seattle) from 1985 through 1999. After 1992, the incidence of invasive aspergillosis increased in allograft recipients and remained high through the 1990s. Infections with non-fumigatus Aspergillus species, Fusarium species, and Zygomycetes increased during the late 1990s, especially in patients who received multiple transplants. Although infection caused by Scedosporium species was common in patients who had neutropenia, infection caused by Zygomycetes typically occurred later after transplantation, when patients had graft-versus-host disease. The overall 1-year survival rate was equally poor (similar20%) for all patients with mould infections. The results of the present study demonstrate the changing epidemiology of mould infections, emphasizing the increasing importance of amphotericin B--resistant organisms and the differences in risks and outcome of infection with different filamentous fungi.
已有报告聚焦于霉菌在造血干细胞移植受者中作为病原体的出现情况。为了回顾霉菌感染的发生率及风险，我们查阅了1985年至1999年在弗雷德·哈钦森癌症研究中心（西雅图）接受造血干细胞移植的5589例患者的记录。1992年后，同种异体移植受者侵袭性曲霉病的发生率增加，并且在整个20世纪90年代一直居高不下。非烟曲霉属物种、镰刀菌属物种和接合菌的感染在20世纪90年代后期增加，尤其是在接受多次移植的患者中。虽然头孢霉属物种引起的感染在中性粒细胞减少的患者中很常见，但接合菌引起的感染通常在移植后较晚发生，此时患者患有移植物抗宿主病。所有霉菌感染患者的总体1年生存率同样很低（约20%）。本研究结果表明了霉菌感染流行病学的变化，强调了对两性霉素B耐药的生物体的重要性日益增加，以及不同丝状真菌感染的风险和结果的差异。
