Camps Isabel Ruiz
Infectious Diseases Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Int J Antimicrob Agents. 2008 Nov;32 Suppl 2:S119-23. doi: 10.1016/S0924-8579(08)70012-8.
Invasive fungal infections (IFIs) continue to cause considerable morbidity and mortality in haematopoietic stem cell transplant recipients. The epidemiology of IFI has changed since the late 1980s, with a trend towards a reduction in invasive infection due to opportunistic yeasts and an increase in invasive mould infections, particularly by Aspergillus spp. Since the introduction of fluconazole for prophylaxis, the incidence rate of invasive candidiasis is close to 5% and the risk factors related to invasive candidiasis are gastrointestinal tract colonisation, cytomegalovirus disease and a prior episode of bacteraemia. The highest risk for invasive aspergillosis was observed in older patients and patients with graft-versus-host disease and immunosuppressive therapy, steroid use (>1-2 mg/kg/day), persistent neutropenia and certain types of transplantation (cord blood transplant, allogeneic mismatched or T-cell depletion). In those cases, rational preventive measures must be implemented and vigilance is necessary in order to diagnose infection as soon as possible.
侵袭性真菌感染（IFI）在造血干细胞移植受者中仍会导致相当高的发病率和死亡率。自20世纪80年代末以来，IFI的流行病学发生了变化，机会性酵母菌引起的侵袭性感染呈减少趋势，而侵袭性霉菌感染，尤其是曲霉属感染呈增加趋势。自引入氟康唑进行预防以来，侵袭性念珠菌病的发病率接近5%，与侵袭性念珠菌病相关的危险因素包括胃肠道定植、巨细胞病毒病和既往菌血症发作。侵袭性曲霉病的最高风险见于老年患者、移植物抗宿主病患者以及接受免疫抑制治疗的患者、使用类固醇（>1-2mg/kg/天）、持续性中性粒细胞减少症患者以及某些类型的移植（脐血移植、异基因不匹配或T细胞去除）患者。在这些情况下，必须实施合理的预防措施，并且有必要保持警惕以便尽快诊断感染。
