Groupe d'Etude des Interactions Hôte-Pathogène, UPRES-EA 3142, Université d'Angers, Angers, France.
J Clin Microbiol. 2010 Jul;48(7):2381-6. doi: 10.1128/JCM.00047-10. Epub 2010 May 12.
We report eight cases of airway colonization by Geosmithia argillacea in patients with cystic fibrosis. This filamentous fungus, resembling members of the genera Penicillium and Paecilomyces, was identified by molecular analysis. All patients carried a mutation on each CFTR (cystic fibrosis transmembrane conductance regulator) allele, with at least one copy of the F508del mutation. The first isolation of this fungus occurred from F508del-homozygous patients at a younger age than in F508del-heterozygous patients. Before recovery of G. argillacea, all patients were treated with itraconazole; two of them had also received voriconazole for an Aspergillus fumigatus infection. However, antifungal susceptibility patterns showed high MICs of voriconazole for all isolates, and high MICs of amphotericin B and itraconazole for the majority of them, but mostly low minimum effective concentrations (MECs) of caspofungin. The appearance and persistence of G. argillacea in the airways were not associated with exacerbation of the disease. However, the clinical implications of G. argillacea, particularly in immunocompromised patients, remain a concern, particularly given recent observations suggesting that this fungus may also cause disseminated infections.
我们报告了 8 例囊性纤维化患者气道中被 Geosmithia argillacea 定植的病例。该丝状真菌通过分子分析鉴定为类似于 Penicillium 和 Paecilomyces 属的成员。所有患者的每个 CFTR（囊性纤维化跨膜电导调节因子）等位基因都携带突变，至少有一个 F508del 突变的拷贝。该真菌的首次分离发生在 F508del 纯合子患者比 F508del 杂合子患者更年轻的时候。在恢复 Geosmithia argillacea 之前，所有患者均接受伊曲康唑治疗；其中 2 人还因烟曲霉感染接受伏立康唑治疗。然而，抗真菌药敏模式显示所有分离株对伏立康唑的 MIC 值较高，对大多数分离株的两性霉素 B 和伊曲康唑的 MIC 值较高，但卡泊芬净的最低有效浓度（MEC）大多较低。Geosmithia argillacea 在气道中的出现和持续与疾病恶化无关。然而，特别是在免疫功能低下的患者中，Geosmithia argillacea 的临床意义仍然令人担忧，特别是最近的观察表明，这种真菌也可能引起播散性感染。
