Borys Michał, Piwowarczyk Paweł, Sysiak Justyna, Czuczwar Mirosław, Prystupa Andrzej
II Department of Anaesthesiology and Intensive Care, Medical University, Lublin, Poland.
Department of Internal Medicine, Medical University of Lublin.
Ann Agric Environ Med. 2017 Mar 21;24(1):100-103. doi: 10.5604/12321966.1233966.
Although. Aspergillus spp infection is not the major cause of morbidity in Intensive Care Units (ICUs), mortality among patients treated for it is tremendous. Moreover, invasive aspergillosis (IA) is an independent risk factor of hospital costs and length of stay. The prevalence of this disease is inversely correlated with the immunocompetence of individuals; for instance, the incidence of IA among patients with leukemia is estimated as high as 12.7%. Although there is a significant improvement in the antifungal armamentarium, the appropriate treatment is still being given too late, mostly because of late diagnosis. As well as the diagnosis, the criteria for recognition of IA constitute a challenge.
The aim of this review, based on a case report, is to introduce the problem of poor diagnosis and treatment of IA, especially in the critical care settings. The presented scenario is an example which assists in showing the evidence-based medicine (EBM) approach to the treatment of fungal infections. Furthermore, to demonstrate the appropriate approach to diagnosis and treatment of invasive aspergillosis, the guidelines of The European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) are presented.
According to presented literature, Galactomannan assay enables early diagnosis and remains a specific and sensitive tool to diagnose Asppergillosis, both in serum and BAL fluid. The guidelines recommend voriconazole as a first line treatment in IA. Failure to detect and implement proper antifungal treatment may lead to fatal consequences, as in the presented case.
尽管曲霉菌属感染并非重症监护病房（ICU）发病的主要原因，但接受治疗的患者死亡率极高。此外，侵袭性曲霉病（IA）是医院成本和住院时间的独立危险因素。这种疾病的患病率与个体的免疫能力呈负相关；例如，白血病患者中IA的发病率估计高达12.7%。尽管抗真菌药物有了显著改善，但适当的治疗仍给予过晚，主要是因为诊断延迟。除了诊断之外，IA的识别标准也构成了一项挑战。
本综述基于一例病例报告，旨在介绍IA诊断和治疗不佳的问题，尤其是在重症监护环境中。所呈现的病例是一个有助于展示真菌感染循证医学（EBM）治疗方法的实例。此外，为了展示侵袭性曲霉病的诊断和治疗的适当方法，还介绍了欧洲癌症研究与治疗组织/真菌病研究组（EORTC/MSG）的指南。
根据现有文献，半乳甘露聚糖检测能够实现早期诊断，并且仍然是血清和支气管肺泡灌洗液中诊断曲霉病的一种特异且敏感的工具。指南推荐伏立康唑作为IA的一线治疗药物。未能检测并实施适当的抗真菌治疗可能会导致致命后果，如本病例所示。
