Tong S Y C, Peleg A Y, Yoong J, Handke R, Szer J, Slavin M
Victorian Infectious Diseases Service, Department of Microbiology, Royal Melbourne Hospital, Melbourne, Australia.
Transpl Infect Dis. 2007 Sep;9(3):241-3. doi: 10.1111/j.1399-3062.2007.00203.x. Epub 2007 Jul 1.
Breakthrough invasive fungal infections among patients with hematologic malignancies receiving voriconazole are being reported with increasing frequency, with zygomycete infections predominating. We report a case of disseminated Scedosporium prolificans infection in a patient receiving voriconazole prophylaxis. Despite poor in vitro activity of voriconazole for this organism, synergy studies using the checkerboard method demonstrated synergy with the combination of voriconazole and terbinafine. This regimen, in conjunction with central venous line removal and intravitreal voriconazole, contributed to the recovery of the patient. S. prolificans is a life-threatening mold that should be considered in patients with breakthrough invasive fungal infections while on voriconazole prophylaxis.
接受伏立康唑治疗的血液系统恶性肿瘤患者中，突破性侵袭性真菌感染的报告频率越来越高，其中接合菌感染占主导。我们报告1例接受伏立康唑预防治疗的患者发生播散性多育赛多孢菌感染。尽管伏立康唑对该菌的体外活性不佳，但采用棋盘法进行的协同研究表明，伏立康唑与特比萘芬联合具有协同作用。该治疗方案，再加上拔除中心静脉导管和玻璃体内注射伏立康唑，促使患者康复。多育赛多孢菌是一种危及生命的霉菌，对于接受伏立康唑预防治疗时发生突破性侵袭性真菌感染的患者应予以考虑。
