Chakraborty Aabir, Workman Maria Rella, Bullock Peter R
Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, United Kingdom.
J Neurosurg. 2005 Jul;103(1 Suppl):83-7. doi: 10.3171/ped.2005.103.1.0083.
Scedosporium apiospermum is a fungus found in the soil and in contaminated water. Common cutaneous manifestations include Madura foot, a painless swelling on the sole of the foot. Invasive infection is usually associated with immunosuppression. The authors present a 16-month-old immunocompetent boy who had a near-drowning event. Following this, he was severely disabled with spastic quadriparesis. Early computerized tomography scans revealed diffuse hypoxic injury. Magnetic resonance images obtained 3 months after the initial event demonstrated multiple ring-enhancing lesions in the brain. Aspiration of the lesion was performed. Scedosporium apiospermum, the asexual form of Pseudallescheria boydii, was cultured. Conventional antifungal agents were commenced, with minimal effect. The child was subsequently treated with a new antifungal agent, voriconazole, a broad-spectrum triazole antifungal agent with good penetration into the cerebrospinal fluid. The patient improved, with a good radiological outcome and a moderate clinical outcome. The authors review the use of voriconazole for central nervous system infections and review the literature on S. apiospermum associated with near drowning.
尖端赛多孢是一种存在于土壤和受污染水中的真菌。常见的皮肤表现包括马杜拉足，即足底无痛性肿胀。侵袭性感染通常与免疫抑制有关。作者报告了一名16个月大的免疫功能正常男孩，他曾发生过近乎溺水事件。此后，他因痉挛性四肢瘫而严重残疾。早期计算机断层扫描显示弥漫性缺氧损伤。初始事件3个月后获得的磁共振图像显示大脑中有多个环形强化病灶。对病灶进行了穿刺抽吸。培养出了尖端赛多孢，它是博伊德假阿利什霉的无性型。开始使用传统抗真菌药物治疗，但效果甚微。该患儿随后接受了一种新型抗真菌药物伏立康唑的治疗，伏立康唑是一种广谱三唑类抗真菌药物，能很好地穿透脑脊液。患者病情好转，影像学结果良好，临床结果中等。作者回顾了伏立康唑在中枢神经系统感染中的应用，并综述了与近乎溺水相关的尖端赛多孢的文献。
