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血液系统疾病患者中培养阳性的侵袭性肺曲霉病的特征:烟曲霉与非烟曲霉菌种之间的比较。

Characteristics of culture-positive invasive pulmonary aspergillosis in patients with hematologic diseases: Comparison between Aspergillus fumigatus and non-fumigatus Aspergillus species.

作者信息

Cho Sung-Yeon, Lee Dong-Gun, Choi Jae-Ki, Lee Hyo-Jin, Kim Si-Hyun, Park Sun Hee, Choi Su-Mi, Choi Jung-Hyun, Yoo Jin-Hong, Park Yeon-Joon, Lee Jong-Wook

机构信息

Division of Infectious Diseases, Department of Internal Medicine Vaccine Bio Research Institute The Catholic Blood and Marrow Transplantation Centre Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

出版信息

Medicine (Baltimore). 2017 Dec;96(49):e8841. doi: 10.1097/MD.0000000000008841.

Abstract

While the epidemiology and clinical differences of various Candida spp. has been relatively well-identified, data regarding invasive aspergillosis (IA) caused by different Aspergillus spp. are insufficient.We aimed to determine the epidemiology of culture-positive invasive pulmonary aspergillosis (IPA) and to compare the characteristics and outcomes of Aspergillus fumigatus IPA with those of non-fumigatus IPA in patients with hematologic diseases. All consecutive cases of IPA from 2011 to 2015 were reviewed retrospectively.There were 430 proven/probable IPA and 76 culture-positive proven/probable IPA. Excluding cases of multiple species of fungi or cases having difficulties in species-level identification, 41 A fumigatus and 22 non-fumigatus IPA (Aspergillus flavus [n = 11], Aspergillus niger [n = 6], and Aspergillus terreus [n = 5]) were compared. There were no significant differences in baseline characteristics between the 2 groups. However, disseminated IA was more common in non-fumigatus IPA (2.4% vs 18.2%; P = .046). Paranasal sinus (PNS) involvement was more common in non-fumigatus IPA. There was a trend towards higher peak serum galactomannan values in non-fumigatus IPA than in A fumigatus IPA group (median 1.33 [interquartile 0.98-3.29] vs 0.97 [0.66-1.97]; P = .084). Clinical response and mortality did not differ between groups.The culture-positive rate of proven/probable IPA was 17.7%, of which non-fumigatus Aspergillus accounted for about one-third. Disseminated IA, especially involving the PNS, was more frequent in non-fumigatus IPA than in A fumigatus IPA.

摘要

虽然各种念珠菌属的流行病学和临床差异已得到相对充分的认识,但关于不同曲霉菌属引起的侵袭性曲霉病(IA)的数据却并不充分。我们旨在确定培养阳性的侵袭性肺曲霉病(IPA)的流行病学情况,并比较血液系统疾病患者中烟曲霉IPA与非烟曲霉IPA的特征及转归。对2011年至2015年所有连续性IPA病例进行回顾性分析。共有430例确诊/疑似IPA,其中76例为培养阳性的确诊/疑似IPA。排除多种真菌病例或菌种水平鉴定存在困难的病例后,对41例烟曲霉IPA和22例非烟曲霉IPA(黄曲霉[n = 11]、黑曲霉[n = 6]和土曲霉[n = 5])进行比较。两组患者的基线特征无显著差异。然而,播散性IA在非烟曲霉IPA中更为常见(2.4%对18.2%;P = 0.046)。鼻旁窦(PNS)受累在非烟曲霉IPA中更为常见。非烟曲霉IPA组血清半乳甘露聚糖峰值有高于烟曲霉IPA组的趋势(中位数1.33[四分位间距0.98 - 3.29]对0.97[0.66 - 1.97];P = 0.084)。两组间临床反应和死亡率无差异。确诊/疑似IPA的培养阳性率为17.7%,其中非烟曲霉约占三分之一。非烟曲霉IPA中播散性IA,尤其是累及PNS的情况,比烟曲霉IPA更为频繁。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb9b/5728864/f2b83b453187/medi-96-e8841-g001.jpg

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