Kumar L, Singh S, Aggarwal S, Mathur M, Bijlani L, Kochupillai V
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi.
J Assoc Physicians India. 1990 Oct;38(10):787-9.
Fungal infections are increasingly being reported in patients with acute leukaemia on intensive induction chemotherapy protocols. The common fungi seen are candida, aspergillus and mucormycosis. We have seen 3 cases of mucormycosis over the last 4 years. All 3 patients had acute leukaemia-two had acute lymphoblastic and one acute myeloid leukaemia. All patients were in neutropenic phase after induction chemotherapy. Features suggestive of fungal infection were fever and development or progression of pulmonary infiltrates despite antibiotic therapy. Repeated body fluid cultures were negative in two patients. In the first patient, the diagnosis was confirmed after biopsy of a palatal mass; he was treated successfully with amphotericin-B. In two patients the diagnosis was confirmed at autopsy. A high degree of suspicion in febrile, neutropenic cancer patients on chemotherapy and early administration of amphotericin-B may improve the outcome. With dissemination, the prognosis is poor.
在接受强化诱导化疗方案的急性白血病患者中，真菌感染的报道日益增多。常见的真菌有念珠菌、曲霉菌和毛霉菌病。在过去4年里，我们共诊治了3例毛霉菌病患者。所有3例患者均患有急性白血病，其中2例为急性淋巴细胞白血病，1例为急性髓细胞白血病。所有患者在诱导化疗后均处于中性粒细胞减少期。提示真菌感染的特征为发热以及尽管接受了抗生素治疗，但肺部浸润仍出现或进展。两名患者的反复体液培养均为阴性。首例患者经腭部肿物活检确诊，接受两性霉素B治疗后成功治愈。另外两名患者在尸检时确诊。对于接受化疗的发热、中性粒细胞减少的癌症患者，高度怀疑并早期给予两性霉素B可能会改善预后。若发生播散，预后较差。
