Kawamori J, Tsuruta S, Yoshida T
Division of Allergy, Clinical Immunology and Infectious Disease, Shizuoka Children's Hospital.
Kansenshogaku Zasshi. 1991 Sep;65(9):1200-4. doi: 10.11150/kansenshogakuzasshi1970.65.1200.
Aspergillus infection is the most frequent fungal infection associated with chronic granulomatous disease (CGD), and often results in a life-threatening situation. This report describes the use of high-dose fluconazole, a new antifungal agent, for invasive Aspergillus infection in a patient with CGD. A 27-month-old boy was sent to our hospital because of unknown fever in October, 1988. He was then admitted for pneumonia and pleural effusion of the right lung in February, 1989. Treatment with antibiotics was ineffective, and cultures of throat and pleural fluid were negative. In May, 1989, Aspergillus fumigatus was cultured from a subcutaneous abscess at the point of pleural puncture. Therefore we speculated that Aspergillus might have been the cause of pneumonia. The patient was diagnosed as having CGD by NBT test. Treatment with miconazole, flucitocin and amphotericin-B syrup was ineffective. From July, 1989, he was given 100 mg/day fluconazole d.i.v., but the drug did not reach an effective serum concentration to combat Aspergillus. However, an effective concentration of fluconazole was reached at a dose of 250 mg/day, and the chest X-ray findings subsequently improved, despite occasional high fever and continued high CRP. In July, 1990, the route of fluconazole administration was changed from d.i.v. to p.o. at the same dose, resulting in a serum concentration of fluconazole higher than that achieved with d.i.v. treatment. Both the clinical and laboratory findings showed improvement thereafter. Therapy for Aspergillus infection associated with CGD was found to necessitate high doses of anti-fungal drugs over a long period, although treatment with previously employed anti-fungal drugs could not be continued due to their adverse side effects.(ABSTRACT TRUNCATED AT 250 WORDS)
曲霉菌感染是与慢性肉芽肿病（CGD）相关的最常见真菌感染，常导致危及生命的情况。本报告描述了使用新型抗真菌药物大剂量氟康唑治疗CGD患者侵袭性曲霉菌感染的情况。一名27个月大的男孩于1988年10月因不明原因发热被送至我院。1989年2月，他因肺炎和右肺胸腔积液入院。抗生素治疗无效，咽喉和胸腔积液培养均为阴性。1989年5月，在胸腔穿刺部位的皮下脓肿中培养出烟曲霉菌。因此，我们推测曲霉菌可能是肺炎的病因。通过NBT试验诊断该患者患有CGD。咪康唑、氟胞嘧啶和两性霉素B糖浆治疗均无效。从1989年7月起，他每天接受100毫克氟康唑静脉滴注，但该药物未达到有效血清浓度以对抗曲霉菌。然而，每天250毫克的剂量达到了氟康唑的有效浓度，尽管偶尔仍有高热且CRP持续升高，但胸部X线检查结果随后有所改善。1990年7月，氟康唑给药途径从静脉滴注改为口服，剂量相同，导致氟康唑血清浓度高于静脉滴注治疗时的浓度。此后临床和实验室检查结果均显示有所改善。尽管由于先前使用的抗真菌药物有不良反应而无法继续使用，但发现治疗与CGD相关的曲霉菌感染需要长期使用高剂量抗真菌药物。（摘要截取自250字）
