Gamis A S, Gudnason T, Giebink G S, Ramsay N K
Department of Pediatrics, University of Minnesota Hospital and Clinic, Minneapolis.
Rev Infect Dis. 1991 Nov-Dec;13(6):1077-88. doi: 10.1093/clinids/13.6.1077.
Clinical data from 10 episodes of disseminated infection with Fusarium among eight recipients of bone marrow transplants and from 31 cases reported previously in the literature were analyzed in an effort to characterize the natural history of this rare infection and its response to therapy. The characteristic signs of fusarial infection--disseminated skin nodules, fungemia, and multiple-organ involvement--are results of its propensity for early spread. From a review of the literature and our own experience, it appears that recovery of phagocytic mechanisms (the primary immunologic defenses against Fusarium) in the form of rising neutrophil counts is mandatory for clinical resolution. Even after a graft begins to function adequately, Fusarium may not be completely eradicated, as evidenced by the high incidence of recurrence among patients with subsequent neutropenic episodes. Fusarium is highly resistant to conventional antifungal drugs in vitro, but its progression may be slowed by intensive antifungal therapy until the recovery of adequate neutrophil levels.
分析了8例骨髓移植受者发生的10次播散性镰刀菌感染的临床数据以及文献中先前报道的31例病例，以试图描述这种罕见感染的自然病程及其对治疗的反应。镰刀菌感染的特征性体征——播散性皮肤结节、真菌血症和多器官受累——是其早期扩散倾向的结果。从文献回顾和我们自己的经验来看，以中性粒细胞计数升高形式出现的吞噬机制（针对镰刀菌的主要免疫防御）恢复对于临床缓解是必不可少的。即使移植物开始充分发挥功能，镰刀菌也可能不会被完全根除，后续出现中性粒细胞减少发作的患者复发率很高就证明了这一点。镰刀菌在体外对传统抗真菌药物高度耐药，但强化抗真菌治疗可能会减缓其进展，直到中性粒细胞水平恢复正常。
