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三级护理癌症中心的暗色丝孢霉病

Phaeohyphomycosis in a tertiary care cancer center.

作者信息

Ben-Ami Ronen, Lewis Russell E, Raad Issam I, Kontoyiannis Dimitrios P

机构信息

Department of Infectious Diseases, Infection Control and Employee Health, the University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.

出版信息

Clin Infect Dis. 2009 Apr 15;48(8):1033-41. doi: 10.1086/597400.

Abstract

BACKGROUND

Phaeohyphomycosis is a rare opportunistic fungal infection. To assess the range of clinical presentations and outcomes of phaeohyphomycosis in patients with cancer, we reviewed cases diagnosed at the M. D. Anderson Cancer Center (Houston, TX).

METHODS

We searched the microbiology laboratory records for dematiaceous molds that had been isolated during the period from January 1989 through March 2008. Demographic and clinical data were abstracted from patients' medical records. Invasive phaeohyphomycosis was defined according to the criteria of the European Organization for Research and Treatment of Cancer Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycosis Study Group for proven or probable invasive fungal disease. Archived dematiaceous mold isolates were tested for antifungal drug susceptibility.

RESULTS

Of 348 isolates of dematiaceous fungi recovered, only 39 isolates (11%), recovered from 39 patients, were associated with proven or probable invasive fungal disease (33 proven and 6 probable). The incidence rate of phaeohyphomycosis increased from 1.0 to 3.1 cases per 100,000 patient-days during the study period (P = .006). Of these 39 patients, 14 (36%) had a breakthrough infection while receiving prophylactic or empirical antifungal therapy. Sites of infection were the lungs (15 [38%] of 39 patients), skin (15 [38%]), sinuses (14 [36%]), and bloodstream (7 [18%]). Thirteen patients (33%) had a disseminated infection. Values of the serum galactomannan index were measured for 11 (28%) of 39 patients. The galactomannan index value was elevated (>0.5) in 5 (45%) of these 11 patients. The mortality rate at 12 weeks was 33%. Cox regression analysis revealed a significantly higher risk of death for patients with disseminated infection (hazard ratio, 5.7; P = .03) and a lower risk for patients who recovered from neutropenia within 30 days (hazard ratio, 0.2; P = .04). Isolates were frequently not susceptible to voriconazole and caspofungin.

CONCLUSIONS

Although rare, dematiaceous molds are increasingly encountered in immunosuppressed patients with cancer. The propensity of these fungi for dissemination and for resistance to antifungal drugs presents management challenges.

摘要

背景

暗色丝孢霉病是一种罕见的机会性真菌感染。为评估癌症患者中暗色丝孢霉病的临床表现范围和预后,我们回顾了在德克萨斯州休斯顿市MD安德森癌症中心诊断的病例。

方法

我们检索了微生物实验室记录,查找1989年1月至2008年3月期间分离出的暗色霉菌。从患者病历中提取人口统计学和临床数据。侵袭性暗色丝孢霉病根据欧洲癌症研究与治疗组织侵袭性真菌感染协作组以及美国国立过敏与传染病研究所真菌病研究组关于确诊或疑似侵袭性真菌病的标准来定义。对存档的暗色霉菌分离株进行抗真菌药敏试验。

结果

在回收的348株暗色真菌分离株中,只有从39例患者中回收的39株分离株(11%)与确诊或疑似侵袭性真菌病相关(33例确诊,6例疑似)。在研究期间,暗色丝孢霉病的发病率从每100,000患者日1.0例增加到3.1例(P = 0.006)。在这39例患者中,14例(36%)在接受预防性或经验性抗真菌治疗期间发生了突破性感染。感染部位为肺部(39例患者中的15例[38%])、皮肤(15例[38%])、鼻窦(14例[36%])和血流(7例[18%])。13例患者(33%)发生了播散性感染。对39例患者中的11例(28%)测量了血清半乳甘露聚糖指数值。在这11例患者中,5例(45%)的半乳甘露聚糖指数值升高(>0.5)。12周时的死亡率为33%。Cox回归分析显示,播散性感染患者的死亡风险显著更高(风险比,5.7;P = 0.03),而在30天内从中性粒细胞减少症中恢复的患者死亡风险较低(风险比,0.2;P = 0.04)。分离株对伏立康唑和卡泊芬净常常不敏感。

结论

尽管罕见,但在免疫抑制的癌症患者中越来越多地遇到暗色霉菌。这些真菌的播散倾向和对抗真菌药物的耐药性带来了管理挑战。

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