School of Medicine, National Taiwan University College of Medicine, Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Eur J Clin Microbiol Infect Dis. 2012 Jul;31(7):1319-26. doi: 10.1007/s10096-011-1445-1. Epub 2011 Oct 14.
We reviewed 776 patients who were culture positive for Aspergillus species at the hospital from 2000 to 2009. The isolates were collected for species identification by oligonucleotide hybridization and sequence analysis. A total of 96 cases of proven or probable IA were identified according to published criteria. The incidence of IA has increased significantly during the study period. Aspergillus fumigatus and A. flavus (41.7% each) were equally prevalent causative species. IA due to unusual species including A. nidulans (n=2), A. versicolor (n=2), and A. tubingensis (n=1) were also found. Among patients with IA, 55.2% had hematological disorder, 19.8% had underlying lung disorder, and 10.4% had autoimmune disease. The isolates species (P<0.001) and underlying disease (P<0.001) significantly affect the association of a positive culture with invasive disease. The overall mortality at three months was 62.5%, which remained stable throughout the study period. Multivariate analysis identified prior steroid use (P=0.007) as a significant risk factor for death, while surgery (P=0.030) and voriconazole (P=0.012) had protective effects. In conclusion, autoimmune disorders and underlying pulmonary diseases should also be considered as important predisposing factors of IA. Further emphasis on surgery and voriconazole in the management of IA might be beneficial.
我们回顾了 2000 年至 2009 年期间在医院培养出的 776 株曲霉菌属物种的阳性患者。通过寡核苷酸杂交和序列分析对分离株进行了种属鉴定。根据发表的标准，共确定了 96 例确诊或疑似侵袭性曲霉病病例。在研究期间，IA 的发病率显著增加。烟曲霉和黄曲霉（各占 41.7%）是同样常见的致病物种。由于包括棘孢曲霉（n=2）、杂色曲霉（n=2）和构巢曲霉（n=1）在内的不常见物种引起的 IA 也有发现。在 IA 患者中，55.2%有血液系统疾病，19.8%有肺部基础疾病，10.4%有自身免疫性疾病。分离株的种属（P<0.001）和基础疾病（P<0.001）显著影响阳性培养与侵袭性疾病的关联。三个月时的总体死亡率为 62.5%，在整个研究期间保持稳定。多变量分析确定了先前使用类固醇（P=0.007）是死亡的显著危险因素，而手术（P=0.030）和伏立康唑（P=0.012）具有保护作用。总之，自身免疫性疾病和肺部基础疾病也应被视为 IA 的重要易感因素。在 IA 的治疗中进一步强调手术和伏立康唑可能是有益的。
