Section of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston.
Section of Hematology-Oncology, Baylor College of Medicine and Texas Children's Hospital, Houston.
J Pediatric Infect Dis Soc. 2018 Aug 17;7(3):199-204. doi: 10.1093/jpids/pix031.
Trichosporonosis is an emerging and often fatal opportunistic fungal infection in immunocompromised patients, particularly those with hematologic malignancy, but data in children are lacking.
We report here 3 cases of invasive infection caused by Trichosporon asahii in pediatric patients with acute lymphoblastic leukemia at Texas Children's Hospital in Houston, Texas. We also conducted a literature review and identified 16 additional reports of pediatric patients with invasive T asahii infection and an underlying malignant or nonmalignant hematologic disorder.
Of the 19 cases of invasive T asahii infection, the most commonly reported underlying hematologic disorder was acute lymphoblastic leukenia (47%), followed by acute myelogenous leukemia (21%). Most of the patients (94%) had neutropenia, defined as an absolute neutrophil count of <500 cells/mm3. Antifungal prophylaxis information was available in 6 of the 19 cases, and micafungin use was reported in 5 cases. Treatment regimens frequently included voriconazole monotherapy (47%) or the combination of an azole antifungal with amphotericin B (35%). The mortality rate was 58%.
Recognizing that echinocandins, which are increasingly used for prophylaxis in patients with a hematologic malignancy, are not active against Trichosporon species is of critical importance. The recommended first-line therapy for trichosporonosis is voriconazole, but successful outcome depends largely on the underlying immune status of the host.
芽生菌病是一种在免疫功能低下的患者中出现的、常常致命的机会性真菌感染，尤其是血液恶性肿瘤患者，但在儿童中的数据缺乏。
我们在此报告了德克萨斯州休斯顿市德克萨斯儿童医疗中心的 3 例儿童急性淋巴细胞白血病患者感染 Trichosporon asahii 的侵袭性感染病例。我们还进行了文献回顾，确定了另外 16 例患有侵袭性 T asahii 感染和恶性或非恶性血液系统疾病的儿科患者的报告。
在 19 例侵袭性 T asahii 感染病例中，最常报道的基础血液病是急性淋巴细胞白血病（47%），其次是急性髓系白血病（21%）。大多数患者（94%）有中性粒细胞减少症，定义为绝对中性粒细胞计数<500 个/mm3。19 例中有 6 例有抗真菌预防信息，5 例报告使用米卡芬净。治疗方案常包括伏立康唑单药治疗（47%）或唑类抗真菌药物联合两性霉素 B（35%）。死亡率为 58%。
认识到棘白菌素类药物越来越多地用于血液恶性肿瘤患者的预防，但对 Trichosporon 种无效，这一点至关重要。治疗芽生菌病的推荐一线治疗药物是伏立康唑，但治疗结果在很大程度上取决于宿主的基础免疫状态。
