Maartens G, Wood M J
Department of Communicable and Tropical Diseases, East Birmingham Hospital, UK.
J Antimicrob Chemother. 1991 Jul;28 Suppl A:13-22. doi: 10.1093/jac/28.suppl_a.13.
The frequency of invasive fungal infections is increasing owing to the increasing numbers and improved survival of immuno-compromised patients. The fungi responsible for these infections are predominantly opportunistic pathogens. The clinical features and diagnosis of the four commonest infections (invasive candidosis and aspergillosis, cryptococcosis and mucormycosis) are discussed. Particular emphasis is given to the identification of risk factors for these infections, which are different for each disease. As these organisms are common contaminants or commensals, definitive diagnosis requires culture from sites that are normally sterile or histological demonstration of tissue invasion. Definitive diagnosis is not always possible, in part owing to the severe nature of patients' underlying illnesses. A high proportion of cases are diagnosed post mortem because of difficulties in establishing a diagnosis. Clinical diagnoses thus need to be made early in the course of these infections, but a high index of suspicion and knowledge of the clinical manifestations are required.
由于免疫功能低下患者数量的增加及其生存率的提高，侵袭性真菌感染的发生率正在上升。引发这些感染的真菌主要是机会性病原体。本文讨论了四种最常见感染（侵袭性念珠菌病和曲霉病、隐球菌病和毛霉病）的临床特征及诊断方法。特别强调了这些感染的危险因素识别，每种疾病的危险因素各不相同。由于这些微生物通常是污染物或共生菌，因此明确诊断需要从通常无菌的部位进行培养或组织侵袭的组织学证据。明确诊断并非总是可行，部分原因是患者基础疾病的严重性。由于诊断困难，很大一部分病例是在尸检后确诊的。因此，需要在这些感染病程早期做出临床诊断，但这需要高度的怀疑指数和对临床表现的了解。
