Shao Qing, Shen Ding-Xia
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2009 Dec;17(6):1619-23.
Invasive fungal infections (IFI) are a kind of the most severe complications after hematopoietic stem cell transplantation (HSCT), Candida and Aspergillus are common causes. Because of immunosuppressive therapy, ablative conditioning regimen, acute or chronic graft-versus-host disease, long-term treatment of broad-spectrum antibiotics and cytomegalovirus infection, IFI has increased in the past few years. Invasive mould infection is a major cause of morbidity and mortality in HSCT recipients. Methods for early diagnosis of IFI include clinical and laboratory examinations, as well as characteristic radiography. Voriconazole is the first-line antifungal agent for prevention of IFI. Combination therapy of two antifungal compounds such as azoles or amphotericin B with echinocandins have shown a good effectiveness and may be a promising future strategy for antifungal treatment. In this review, the early diagnosis and treatment of IFI in HSCT recipients are summarized. As for early diagnosis of IFI, the laboratory diagnosis techniques such as GM test, G test and PCR techniques are discussed. As for prophylaxis and treatment of IFI, the prophylaxis treatment, empirical treatment, preemptive treatment, targeted treatment, combined treatment and immunologic treatment are discussed.
侵袭性真菌感染(IFI)是造血干细胞移植(HSCT)后最严重的并发症之一,念珠菌和曲霉菌是常见病因。由于免疫抑制治疗、清髓性预处理方案、急性或慢性移植物抗宿主病、长期使用广谱抗生素以及巨细胞病毒感染,IFI在过去几年中有所增加。侵袭性霉菌感染是HSCT受者发病和死亡的主要原因。IFI的早期诊断方法包括临床和实验室检查以及特征性影像学检查。伏立康唑是预防IFI的一线抗真菌药物。两种抗真菌化合物如唑类或两性霉素B与棘白菌素的联合治疗已显示出良好的疗效,可能是未来抗真菌治疗的一个有前景的策略。在这篇综述中,总结了HSCT受者IFI的早期诊断和治疗。关于IFI的早期诊断,讨论了GM试验、G试验和PCR技术等实验室诊断技术。关于IFI的预防和治疗,讨论了预防性治疗、经验性治疗、抢先治疗、靶向治疗、联合治疗和免疫治疗。