Chen C-Y, Chen Y-C, Tang J-L, Yao M, Huang S-Y, Tsai W, Chen Yao-Chang, Shen M-C, Wang C-H, Tien H-F
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Laboratory Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, 100, Taipei, Taiwan.
Ann Hematol. 2003 Feb;82(2):93-97. doi: 10.1007/s00277-002-0588-7. Epub 2003 Jan 8.
Nosocomial fungal infection increases gradually and has become the leading pathogen at National Taiwan University Hospital since 1993. From January 1995 through May 2002, hepatosplenic fungal infection (HSF) was diagnosed in 37 (7.4%) of the 500 adult patients with acute leukemia who received chemotherapy at this hospital. There was no significant difference in the incidence of HSF between the patients with acute myeloid leukemia and those with acute lymphoblastic leukemia, or between the patients treated with high-dose chemotherapy and those with conventional or low-dose chemotherapy. Candida tropicalis was the leading pathogen, followed by Candida albicans. The computed tomography scan showed multiple hypodense lesions in the liver (89%), spleen (70%), and kidney (27%). Eighteen patients were initially treated with fluconazole and 19 with amphotericin B. Nineteen patients received the planned chemotherapy after the diagnosis of HSF. Among them, eight patients underwent hematopoietic stem cell transplantation and seven patients survived more than 100 days post-transplantation; none of these patients had relapse of prior HSF. Twenty-three patients (62%) died during a median follow up of 10 months, but only seven died due to HSF. In conclusion, a substantial percentage of patients with acute leukemia acquired HSF after chemotherapy and carried high mortality. However, HSF itself is not a contraindication for subsequent chemotherapy and hematopoietic stem cell transplantation.
医院内真菌感染呈逐渐上升趋势，自1993年以来已成为台湾大学附属医院的主要病原体。1995年1月至2002年5月，在本院接受化疗的500例成年急性白血病患者中，有37例（7.4%）被诊断为肝脾真菌感染（HSF）。急性髓细胞白血病患者与急性淋巴细胞白血病患者之间，或接受大剂量化疗的患者与接受常规或小剂量化疗的患者之间，HSF的发生率无显著差异。热带念珠菌是主要病原体，其次是白色念珠菌。计算机断层扫描显示肝脏（89%）、脾脏（70%）和肾脏（27%）有多个低密度病变。18例患者最初接受氟康唑治疗，19例接受两性霉素B治疗。19例患者在诊断HSF后接受了计划中的化疗。其中，8例患者接受了造血干细胞移植术，7例患者移植后存活超过100天；这些患者均无先前HSF复发。23例患者（62%）在中位随访10个月期间死亡，但仅7例死于HSF。总之，相当一部分急性白血病患者在化疗后发生HSF，且死亡率很高。然而，HSF本身并非后续化疗和造血干细胞移植的禁忌证。
