Reichenberger F, Habicht J M, Gratwohl A, Tamm M
Division of Pneumology, Dept of Internal Medicine, University Hospital Leipzig, Germany.
Eur Respir J. 2002 Apr;19(4):743-55. doi: 10.1183/09031936.02.00256102.
Invasive pulmonary aspergillosis is a major cause of morbidity and mortality in neutropenic patients. Microbiological and serological tests are of limited value. The diagnosis should be considered in neutropenic patients with fever not responding to antibiotics, and typical findings on thoracic computed tomography scan. Whenever possible, diagnosis should be confirmed by tissue examination. Newer techniques, such as polymerase chain reaction may change the current diagnostic approach. Therapeutic strategies consist of prophylaxis in risk groups and the early application of antifungal agents in suspected or probable disease. Amphotericin B as desoxycholate or lipid formulation is the current standard medication in invasive infection, although it has major side effects. Its role is challenged by the new azole derivates, such as itraconazole and voriconazole, and the new echinocandins. Additional therapies with cytokines, such as granulocyte macrophage colony stimulating factor and interferon-gamma, and with granulocyte transfusions are under evaluation. In selected cases lung resection is of proven diagnostic and therapeutic value. This paper analyses the current understanding of the pathogenesis and epidemiology of invasive aspergillosis and reviews the actual diagnostic and therapeutic strategies for invasive pulmonary aspergillosis in neutropenic patients.
侵袭性肺曲霉病是中性粒细胞减少患者发病和死亡的主要原因。微生物学和血清学检测价值有限。对于使用抗生素治疗无效且胸部计算机断层扫描有典型表现的中性粒细胞减少发热患者，应考虑该病的诊断。只要有可能，诊断应通过组织检查来证实。聚合酶链反应等新技术可能会改变当前的诊断方法。治疗策略包括对高危人群进行预防以及对疑似或可能患病者尽早应用抗真菌药物。两性霉素B的去氧胆酸盐或脂质体制剂是目前侵袭性感染的标准用药，尽管它有严重的副作用。它的地位受到新型唑类衍生物（如伊曲康唑和伏立康唑）以及新型棘白菌素的挑战。使用细胞因子（如粒细胞巨噬细胞集落刺激因子和干扰素-γ）以及粒细胞输注的额外治疗方法正在评估中。在某些特定病例中，肺切除术已被证明具有诊断和治疗价值。本文分析了目前对侵袭性曲霉病发病机制和流行病学的认识，并综述了中性粒细胞减少患者侵袭性肺曲霉病的实际诊断和治疗策略。
