Wang T K F, Chiu W, Chim S, Chan T M, Wong S S Y, Ho P L
Centre of Infection, Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.
Clin Nephrol. 2003 Dec;60(6):415-23. doi: 10.5414/cnp60415.
Ochroconis gallopavum is a potentially fatal dematiaceous fungus causing opportunistic infections in immunocompromised hosts. We report the first case of disseminated O. gallopavum infection in a 13-year-old renal transplant recipient, which involved the brain, lung and spleen. He was treated with amphotericin B, itraconazole and voriconazole, a new antifungal agent first used to treat such an infection. Besides antifungal treatment, all immunosuppressive agents were stopped and automated peritoneal dialysis was resumed. The initial infection was under control with both clinical and radiological improvements after treatment. However, the patient later acquired Acremonium spp. peritonitis; he failed to respond to high-dose amphotericin B, and finally succumbed. A total of 13 reported O. gallopavum human infections, including the one described here, are reviewed. The most common site of involvement is the brain and the crude mortality rate is up to 46%. As the disease is potentially lethal in immunocompromised hosts, empirical antifungal coverage should be considered in post-renal transplant recipients with suspected brain abscess. Early biopsy of lesion for histopathological and microbiological diagnosis would be essential in managing such cases.
家禽赭曲霉是一种潜在致命的暗色真菌，可在免疫功能低下的宿主中引起机会性感染。我们报告了首例13岁肾移植受者播散性家禽赭曲霉感染病例，该感染累及脑、肺和脾脏。患者接受了两性霉素B、伊曲康唑和伏立康唑治疗，伏立康唑是一种首次用于治疗此类感染的新型抗真菌药物。除抗真菌治疗外，停用所有免疫抑制剂并恢复自动腹膜透析。治疗后，初始感染得到控制，临床和影像学均有改善。然而，患者后来发生了枝顶孢属腹膜炎；他对高剂量两性霉素B无反应，最终死亡。本文回顾了包括本病例在内的总共13例已报道的家禽赭曲霉人类感染病例。最常受累部位是脑，粗死亡率高达46%。由于该疾病在免疫功能低下的宿主中具有潜在致命性，对于怀疑有脑脓肿的肾移植后受者应考虑经验性抗真菌治疗。早期对病变进行活检以进行组织病理学和微生物学诊断对于处理此类病例至关重要。
