Mu Xiangdong, Yu Jin, Nie Ligong, Cheng Yuan, Wang Guangfa
Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China. Email:
Zhonghua Jie He He Hu Xi Za Zhi. 2014 Sep;37(9):677-81.
To describe the clinical features of mixed types of pulmonary aspergillosis (MTPA), and therefore to improve the diagnosis and treatment of MTPA.
This study retrospectively analyzed 3 patients with MTPA in Peking University First Hospital from November 2010 to 2012. "Invasive pulmonary aspergillosis (IPA), pulmonary aspergilloma, allergic bronchopulmonary aspergillosis (ABPA)" were used as the Chinese and English keywords, to search the literatures from Wanfang database and Pubmed database until to May 2014.
There were 3 patients with MTPA, respectively with aspergilloma and IPA (patient 1), ABPA and IPA (patient 2), aspergilloma and IPA (patient 3). The cultures of respiratory secretions of the patients all yielded A.fumigatus. Patient 1 was treated by amphotericin B; Patient 2 was treated by intravenous itraconazole and glucocorticoid; Patient 3 was treated by oral voriconazole and inhaled corticosteroid, and the aspergilloma was surgically removed at the same time. Eventually, patients 1 and 2 died, while the symptoms of patient 3 were significantly improved. Drug sensitivity test of A. fumigatus showed resistance to amphotericin B or itraconazole. By far there was no concept of MTPA in the literatures and there were only 3 relevant case reports.
MTPA is a new subtype of pulmonary aspergillosis, which is more complicated and severe, and perhaps with drug resistance. MTPA should be treated by comprehensive therapies on the basis of sensitive and effective antifungal drugs.
描述混合型肺曲霉病（MTPA）的临床特征，以提高MTPA的诊断与治疗水平。
本研究回顾性分析了2010年11月至2012年期间北京大学第一医院的3例MTPA患者。以“侵袭性肺曲霉病（IPA）、肺曲霉菌球、变应性支气管肺曲霉病（ABPA）”作为中英文关键词，检索万方数据库和Pubmed数据库至2014年5月的文献。
3例MTPA患者，分别为曲霉菌球合并IPA（患者1）、ABPA合并IPA（患者2）、曲霉菌球合并IPA（患者3）。患者呼吸道分泌物培养均为烟曲霉。患者1接受两性霉素B治疗；患者2接受静脉注射伊曲康唑和糖皮质激素治疗；患者3接受口服伏立康唑和吸入糖皮质激素治疗，同时手术切除曲霉菌球。最终，患者1和2死亡，而患者3的症状明显改善。烟曲霉药敏试验显示对两性霉素B或伊曲康唑耐药。目前文献中尚无MTPA的概念，仅有3篇相关病例报道。
MTPA是肺曲霉病的一种新亚型，病情更复杂、严重，可能存在耐药情况。MTPA应在敏感有效的抗真菌药物基础上进行综合治疗。
