Torres H A, Bodey G P, Tarrand J J, Kontoyiannis D P
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Clin Microbiol Infect. 2003 Aug;9(8):786-92. doi: 10.1046/j.1469-0691.2003.00600.x.
To review our recent experience with protothecosis in patients with cancer at The University of Texas MD Anderson Cancer Center, and compare these cases with others reported in the literature.
We report on three patients with protothecosis and cancer who were seen at The University of Texas MD Anderson Cancer Center from January 1979 to May 2002, and reviewed all cases of protothecosis in patients with cancer reported in the literature since 1966.
Overall, 13 cases of protothecosis complicating cancer were evaluated. The median age of the patients was 41 years (range, 7-73 years). Seven patients (54%) had an underlying hematologic malignancy, and one infection occurred after bone marrow transplantation. Neutropenia was uncommon in these patients (14%). Prototheca wickerhamii was the most common Prototheca species identified as the causative agent of infection. Skin infection was the most common presentation of protothecosis, occurring in five patients (38%), followed by disseminated disease in three patients (23%), algaemia in three patients (23%), pulmonary infection in one patient (8%), and olecranon bursitis in one patient (8%). Information on the use of antifungal therapy was available for ten patients. Seven of the ten patients received amphotericin B, while three received triazoles (fluconazole in two, itraconazole in one). Breakthrough protothecosis occurred during the administration of systemic antifungal therapy with itraconazole in one patient. All seven patients who received amphotericin B showed a response, as did one of the three patients given triazoles. Seven (58%) of the patients died during the study period, only one (17%) of protothecosis.
Protothecosis is an uncommon infection in cancer patients, implying that Prototheca spp. have a low pathogenic potential in this population. Pulmonary involvement in particular is uncommon in these patients. Amphotericin B appears to be the most effective antifungal agent; the role of triazoles in treating protothecosis is uncertain, but they may be less effective.
回顾德克萨斯大学MD安德森癌症中心癌症患者原壁菌病的近期诊疗经验，并将这些病例与文献中报道的其他病例进行比较。
我们报告了1979年1月至2002年5月在德克萨斯大学MD安德森癌症中心就诊的3例患有原壁菌病和癌症的患者，并回顾了自1966年以来文献中报道的所有癌症患者原壁菌病病例。
总体而言，共评估了13例并发癌症的原壁菌病病例。患者的中位年龄为41岁（范围7 - 73岁）。7例患者（54%）患有潜在的血液系统恶性肿瘤，1例感染发生在骨髓移植后。这些患者中性粒细胞减少并不常见（14%）。威克汉姆原壁菌是最常被鉴定为感染病原体的原壁菌属物种。皮肤感染是原壁菌病最常见的表现形式，5例患者（38%）出现，其次是3例患者（23%）出现播散性疾病，3例患者（23%）出现藻血症，1例患者（8%）出现肺部感染，1例患者（8%）出现鹰嘴滑囊炎。有10例患者有抗真菌治疗的相关信息。10例患者中有7例接受了两性霉素B治疗，3例接受了三唑类药物治疗（2例使用氟康唑，1例使用伊曲康唑）。1例患者在接受伊曲康唑全身抗真菌治疗期间发生了突破性原壁菌病。接受两性霉素B治疗的7例患者均有反应，接受三唑类药物治疗的3例患者中有1例有反应。7例患者（58%）在研究期间死亡，仅1例（17%）死于原壁菌病。
原壁菌病在癌症患者中是一种罕见感染，这意味着原壁菌属在该人群中的致病潜力较低。特别是肺部受累在这些患者中并不常见。两性霉素B似乎是最有效的抗真菌药物；三唑类药物在治疗原壁菌病中的作用尚不确定，但可能效果较差。
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