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[肝移植患者中由头状马格努斯菌引起的播散性真菌感染]

[Disseminated fungal infection due to Magnusiomyces capitatus in a liver graft patient].

作者信息

Yapo-Kouadio C G, Hasseine L, Goubaux B, Gari-Toussaint M

机构信息

Laboratoire de parasitologie-mycologie, hôpital de l'Archet 2, centre hospitalier universitaire de Nice, 151, route Saint-Antoine-de-Ginestière, CS 23079, 06202 Nice cedex 3, France.

Laboratoire de parasitologie-mycologie, hôpital de l'Archet 2, centre hospitalier universitaire de Nice, 151, route Saint-Antoine-de-Ginestière, CS 23079, 06202 Nice cedex 3, France.

出版信息

J Mycol Med. 2016 Sep;26(3):261-4. doi: 10.1016/j.mycmed.2016.05.002. Epub 2016 Jun 8.

Abstract

Disseminated fungal infections due to Magnusiomyces capitatus are rare, occurring exclusively in immunocompromised patients. We report the first case in a liver transplant patient with chronic rejection and portal thrombosis who had a M. capitatus fungemia with a refractory septic shock. Despite an antibacterial and antifungal treatment with caspofungin empirical treatment, the patient died from multiple organ failure. Subsequently, mycological examinations of blood cultures, bronchoalveolar lavage fluid and urine were positive to M. capitatus identified by mass spectrometry and confirmed by sequencing respectively. The stain was resistant to caspofungin and fluconazole. The best treatment appears to be the combination of amphotericin B and voriconazole or amphotericin B and 5 fluorocytosine.

摘要

由头状麦格努斯菌引起的播散性真菌感染较为罕见,仅发生于免疫功能低下的患者。我们报告了首例发生在肝移植患者中的病例,该患者伴有慢性排斥反应和门静脉血栓形成,出现了头状麦格努斯菌血症并伴有难治性感染性休克。尽管给予了卡泊芬净经验性抗菌和抗真菌治疗,但患者仍死于多器官功能衰竭。随后,对血培养、支气管肺泡灌洗液和尿液进行的真菌学检查对头状麦格努斯菌呈阳性,分别通过质谱鉴定并经测序确认。该菌株对卡泊芬净和氟康唑耐药。最佳治疗方案似乎是两性霉素B与伏立康唑联合使用或两性霉素B与5-氟胞嘧啶联合使用。

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