Central Laboratory Division, LIM 03, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Laboratory of Medical Mycology (LIM 53), Division of Dermatology Clinic, Hospital das Clínicas da Faculdade de Medicina da Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil.
JAMA Dermatol. 2015 Jun;151(6):642-5. doi: 10.1001/jamadermatol.2014.5462.
To our knowledge, these are the first reports of bloodstream infections by Trichosporon inkin in patients with pemphigus.
Trichosporon inkin, a novel organism causing bloodstream infection, was detected in 2 patients with pemphigus. An elderly man with pemphigus foliaceus died despite treatment with liposomal amphotericin B, 3 mg/kg/d, and a young girl with pemphigus vulgaris responded to treatment with voriconazole, 8 mg/kg/d, for 24 days. One of the T inkin isolates had a minimal inhibitory concentration of 2 mg/L against amphotericin B, suggesting resistance to the drug.
Delayed suspicion of invasive infection by T inkin may result in a poor outcome in patients with severe forms of pemphigus. This opportunistic infection is highly refractory to conventional potent antifungal treatment.
据我们所知，这是棘状外瓶霉引起天疱疮患者血流感染的首次报告。
棘状外瓶霉是一种引起血流感染的新型生物体，在 2 例天疱疮患者中被检出。一位患有落叶型天疱疮的老年男性尽管接受了 3mg/kg/d 的两性霉素 B 脂质体治疗，但最终还是死亡；一位患有寻常型天疱疮的年轻女孩在接受 8mg/kg/d 的伏立康唑治疗 24 天后病情得到缓解。其中一株棘状外瓶霉对两性霉素 B 的最小抑菌浓度为 2mg/L，提示对该药物耐药。
延迟怀疑棘状外瓶霉引起的侵袭性感染可能导致重症天疱疮患者的预后不良。这种机会性感染对传统强效抗真菌治疗高度耐药。
