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[病例报告:镰刀菌血症]

[Case report: a Fusarium fungaemia].

作者信息

Yücesoy Mine, Ergon M Cem, Oren Hale, Gülay Zeynep

机构信息

Dokuz Eylül Universitesi Tip Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Izmir.

出版信息

Mikrobiyol Bul. 2004 Jul;38(3):265-71.

Abstract

In this report, a case of Fusarium fungaemia developed in an acute lymphoblastic leukemia (ALL) patient was presented. A seven year old girl who had weakness, loss of appetite, paleness and ecchymosis on legs applied to Pediatric Hematology Service and cytotoxic chemotherapy was started after she had been diagnosed as ALL-L1. Her chemotherapy was stopped because of increase in fever, leukopenia and neutropenia. Central venous catheter and peripheral blood cultures were obtained. Fusarium thapsinum was recovered from blood cultures, obtained in two consecutive days. Thereupon central venous catheter of the patient was removed and intravenous amphotericin B was added to the therapy. On the fifth day of febrile neutropenia attack, her fever was decreased after the onset of antifungal therapy. Radiological examinations were normal and no fungal growth was observed in the later blood cultures. On the 21st day of amphotericin B therapy, chemotherapy was started again and amphotericin B was changed to peroral itraconazole (200 mg/day) at the fifth week. The patient whose itraconazole therapy was stopped after three months, was still in remission and continued receiving her prolonged therapy. In conclusion, Fusarium infections which manifest with fungaemia and fever as the only symptoms, should be taken into consideration in neutropenic patients receiving immunosuppressive therapy.

摘要

在本报告中,呈现了1例急性淋巴细胞白血病(ALL)患者发生镰刀菌血症的病例。一名7岁女童出现乏力、食欲不振、面色苍白及双下肢瘀斑,就诊于儿科血液科,确诊为ALL-L1后开始进行细胞毒性化疗。由于发热、白细胞减少和中性粒细胞减少加重,她的化疗被中断。采集了中心静脉导管和外周血样本进行培养。连续两天采集的血培养样本均分离出嗜热镰刀菌。随即拔除患者的中心静脉导管,并在治疗中加用静脉注射两性霉素B。在发热性中性粒细胞减少发作的第5天,抗真菌治疗开始后她的体温下降。影像学检查正常,随后的血培养未观察到真菌生长。在两性霉素B治疗的第21天,再次开始化疗,并在第5周将两性霉素B换为口服伊曲康唑(200mg/天)。伊曲康唑治疗3个月后停药的该患者仍处于缓解期,并继续接受延长治疗。总之,对于接受免疫抑制治疗的中性粒细胞减少患者,应考虑到仅以菌血症和发热为表现的镰刀菌感染。

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