Nucci Marcio, Anaissie Elias
University Hospital, Universidade Federal do Rio de Janeiro, Brazil.
Clin Infect Dis. 2002 Oct 15;35(8):909-20. doi: 10.1086/342328. Epub 2002 Sep 18.
Infections by Fusarium species frequently involve the skin, either as the primary or the metastatic site. To better understand the pathophysiology of these infections, 43 new patients with fusariosis were evaluated, and the literature was reviewed. A total of 259 patients (232 immunocompromised and 27 immunocompetent) were identified. Skin involvement was present in 70% of patients, particularly in immunocompromised patients (72% vs. 52%; P=.03). In immunocompetent patients, cutaneous infections were characterized by preceding skin breakdown, localized involvement, slow pace of progression, and good response to therapy. In contrast, skin involvement in immunocompromised patients was only occasionally preceded by skin breakdown and typically was presented as rapidly progressive disseminated lesions at various stages of evolution. Metastatic skin lesions were associated with fungemia, neutropenia, and death. Skin was the single source of diagnosis for the majority of immunocompromised and immunocompetent patients. Recommendations for the prevention of fatal fusariosis originating from skin are presented.
镰刀菌属感染常累及皮肤，可为原发部位或转移部位。为更好地理解这些感染的病理生理学，对43例新诊断的镰刀菌病患者进行了评估，并复习了相关文献。共识别出259例患者（232例免疫功能低下者和27例免疫功能正常者）。70%的患者有皮肤受累，尤其在免疫功能低下患者中（72%对52%；P=0.03）。在免疫功能正常患者中，皮肤感染的特征为先前有皮肤破损、局部受累、进展缓慢以及对治疗反应良好。相比之下，免疫功能低下患者的皮肤受累仅偶尔先于皮肤破损，且通常表现为在不同演变阶段迅速进展的播散性病变。转移性皮肤病变与真菌血症、中性粒细胞减少和死亡相关。对于大多数免疫功能低下和免疫功能正常患者，皮肤是诊断的唯一来源。本文提出了预防源自皮肤的致命性镰刀菌病的建议。
