Service d'Hygiène Hospitalière, CHU Farhat Hached, Sousse, Tunisie.
Mycopathologia. 2014 Jun;177(5-6):281-9. doi: 10.1007/s11046-014-9742-8. Epub 2014 Apr 12.
Although scarce, available data suggest that the epidemiology of invasive aspergillosis (IA) in North Africa differs from northern countries, where more than 80 % is caused by Aspergillus fumigatus. This study aimed at describing the epidemiology of IA in the region of Sousse, Tunisia, and at assessing the usefulness of the available diagnostic tools. For 2 years, clinical and mycological data were prospectively collected from 175 neutropenia episodes of 91 patients hospitalised in the haematology department at the Farhat Hached hospital in Sousse (Tunisia). Screening for galactomannan antigen was positive in 40 % of neutropenia episodes; Aspergillus PCR was positive in 42 % of the tested sera. Nine patients were classified as probable and two as possible IA according to the EORTC/MSG criteria. Twelve patients who prematurely died, had no CT scan and could not be classified. Fifty-six Aspergillus spp. were isolated in 53 (6.5 %) sputa collected from 35 (20 %) patients. The following species were identified with MALDI-TOF mass spectrometry and DNA sequencing: A. niger, 35 %; A. flavus, 38 %; A. tubingensis, 19 %; A. fumigatus, 4 %; A. westerdijkiae, 2 % and A. ochraceus, 2 %. Our findings highlight the epidemiological features of IA in Tunisia, which is characterised by the predominance of Aspergillus spp. from sections Nigri and Flavi.
尽管数据稀缺，但现有数据表明，北非侵袭性曲霉病（IA）的流行病学与北方国家不同，北方国家超过 80%的病例由烟曲霉引起。本研究旨在描述突尼斯苏塞地区的 IA 流行病学，并评估现有诊断工具的实用性。在 2 年的时间里，从苏塞法哈特·哈切德医院血液科住院的 91 名患者的 175 例中性粒细胞减少症发作中前瞻性收集了临床和真菌学数据。40%的中性粒细胞减少症发作中检测到半乳甘露聚糖抗原呈阳性；42%的检测血清中曲霉 PCR 呈阳性。根据 EORTC/MSG 标准，9 名患者被归类为可能和 2 名可能的 IA。12 名过早死亡的患者没有进行 CT 扫描，无法进行分类。从 35 名患者（20%）采集的 53 份痰液中分离出 56 株 Aspergillus spp.。使用 MALDI-TOF 质谱和 DNA 测序鉴定出以下物种：黑曲霉，35%；黄曲霉，38%；烟曲霉，19%；烟曲霉，4%；西地西曲霉，2%和桔青霉，2%。我们的研究结果强调了突尼斯 IA 的流行病学特征，其特征是黑曲霉和黄曲霉节的 Aspergillus spp.占优势。
