Pediatric Intensive Care Unit, Hippokration Hospital, Thessaloniki, Greece.
Mycoses. 2011 Nov;54(6):e686-96. doi: 10.1111/j.1439-0507.2010.02001.x. Epub 2011 May 25.
Chronic granulomatous disease (CGD) is a rare inherited disorder characterised by inability of phagocytes to kill catalase-positive organisms including certain fungi. Aspergillus species are the most frequent fungal pathogens. This study is a systematic review of the reported cases of osteomyelitis due to Aspergillus species in CGD patients. Retrospective analysis of 46 osteomyelitis cases caused by Aspergillus species in 43 CGD patients (three females) published in the English literature (PubMed) was performed. Twenty-three cases were due to Aspergillus fumigatus (50%), 20 to Aspergillus nidulans (43.5%), one to Aspergillus flavus and two to unspecified Aspergillus species. The median age was 8 years (range 1.5-21). Osteomyelitis due to A. nidulans was associated with pulmonary infection and involved 'small bones' more frequently than A. fumigatus osteomyelitis (P = 0.001). Amphotericin B was used in 91.3% and surgical debridement in 67.4% of all cases. The overall mortality of osteomyelitis due to Aspergillus species in CGD patients was 37%; 55% for A. nidulans compared to 13% for A. fumigatus (P = 0.008). Aspergillus fumigatus causes osteomyelitis in CGD patients almost as frequently as A. nidulans and much more frequently than A. flavus. Osteomyelitis due to A. nidulans is associated with higher mortality than A. fumigatus.
慢性肉芽肿病（CGD）是一种罕见的遗传性疾病，其特征是吞噬细胞无法杀死包括某些真菌在内的过氧化氢酶阳性的生物体。曲霉菌是最常见的真菌病原体。本研究对 CGD 患者曲霉菌引起的骨髓炎的报道病例进行了系统回顾。对在英文文献（PubMed）上发表的 43 例 CGD 患者（3 例女性）的 46 例由曲霉菌引起的骨髓炎病例进行了回顾性分析。23 例由烟曲霉引起（50%），20 例由构巢曲霉引起（43.5%），1 例由黄曲霉引起，2 例由未特指的曲霉引起。中位年龄为 8 岁（范围 1.5-21）。与烟曲霉骨髓炎相比，A. nidulans 引起的骨髓炎与肺部感染有关，且更常累及“小骨”（P = 0.001）。91.3%的病例使用两性霉素 B，67.4%的病例进行手术清创。CGD 患者曲霉菌引起的骨髓炎的总体死亡率为 37%；A. nidulans 为 55%，而 A. fumigatus 为 13%（P = 0.008）。烟曲霉在 CGD 患者中引起骨髓炎的频率几乎与构巢曲霉相同，且比黄曲霉更为常见。A. nidulans 引起的骨髓炎的死亡率高于 A. fumigatus。
