Nucci Marcio, Anaissie Elias
University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Clin Microbiol Rev. 2007 Oct;20(4):695-704. doi: 10.1128/CMR.00014-07.
Fusarium species cause a broad spectrum of infections in humans, including superficial, locally invasive, and disseminated infections. The clinical form of fusariosis depends largely on the immune status of the host and the portal of entry, with superficial and localized disease occurring mostly in immunocompetent patients and invasive and disseminated disease affecting immunocompromised patients. Risk factors for severe fusariosis include prolonged neutropenia and T-cell immunodeficiency, especially in hematopoietic stem cell transplant recipients with severe graft-versus-host disease. The most frequent presentation of disseminated fusariosis is a combination of characteristic cutaneous lesions and positive blood cultures, with or without lung or sinus involvement. The prognosis is poor and is determined largely by degree of immunosuppression and extent of infection, with virtually a 100% death rate among persistently neutropenic patients with disseminated disease. These infections may be clinically suspected on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy. Treatment options include the lipid formulations of amphotericin B, voriconazole, and posaconazole. Prevention of fusarial infection among high-risk patients should be considered.
镰刀菌属可引起人类广泛的感染，包括浅表感染、局部侵袭性感染和播散性感染。镰刀菌病的临床形式很大程度上取决于宿主的免疫状态和感染途径，浅表和局限性疾病大多发生在免疫功能正常的患者中，而侵袭性和播散性疾病则影响免疫功能低下的患者。严重镰刀菌病的危险因素包括长期中性粒细胞减少和T细胞免疫缺陷，尤其是在患有严重移植物抗宿主病的造血干细胞移植受者中。播散性镰刀菌病最常见的表现是特征性皮肤病变和血培养阳性的组合，伴有或不伴有肺部或鼻窦受累。预后很差，主要取决于免疫抑制程度和感染范围，患有播散性疾病的持续性中性粒细胞减少患者的死亡率几乎为100%。这些感染可根据一系列临床和实验室检查结果在临床上怀疑，应及时进行治疗。治疗选择包括两性霉素B脂质体、伏立康唑和泊沙康唑。应考虑对高危患者预防镰刀菌感染。
