Richardson S E, Bannatyne R M, Summerbell R C, Milliken J, Gold R, Weitzman S S
Department of Bacteriology, Hospital for Sick Children, Toronto, Ontario, Canada.
Rev Infect Dis. 1988 Nov-Dec;10(6):1171-81. doi: 10.1093/clinids/10.6.1171.
A report of the species Fusarium proliferatum causing systemic infection in a child with acute lymphoblastic leukemia is presented, with a review of the clinical and laboratory features relating to outcome in disseminated fusarial infections. Thirteen cases of disseminated infection due to Fusarium species have been reported, all but one of which were fatal. Hematologic malignancy is the commonest underlying illness. The frequent occurrence of multiple skin lesions, orbitofacial involvement, and fungemia is in contrast to the otherwise similar disseminated aspergillosis or mucormycosis. Fungemia in disseminated fusariosis may reflect a capacity for invasion of intravascular catheters by Fusarium species. Fusarium isolates from disseminated infections are variably sensitive to amphotericin B, ketoconazole, and miconazole and uniformly resistant to 5-fluorocytosine. The correlation between antifungal susceptibility status and clinical outcome is poor, reflecting problems in susceptibility testing, marginally effective chemotherapy, and serious impairment of host defenses. Attention to early diagnosis and the care of indwelling prosthetic devices may enhance survival until more effective chemotherapy is available.
本文报告了1例急性淋巴细胞白血病患儿发生系统性感染的病例，病原体为轮枝镰刀菌，并对播散性镰刀菌感染的临床及实验室特征与预后的相关性进行了综述。已报告13例由镰刀菌属引起的播散性感染病例，除1例存活外，其余均死亡。血液系统恶性肿瘤是最常见的基础疾病。与其他类似的播散性曲霉病或毛霉病不同，播散性镰刀菌感染常出现多发皮肤损害、眶面部受累及真菌血症。播散性镰刀菌病中的真菌血症可能反映了镰刀菌属侵入血管内导管的能力。从播散性感染中分离出的镰刀菌对两性霉素B、酮康唑和咪康唑的敏感性各异，对5-氟胞嘧啶均耐药。抗真菌药敏状态与临床预后之间的相关性较差，这反映出药敏试验存在问题、化疗效果欠佳以及宿主防御功能严重受损。在有更有效的化疗方法之前，重视早期诊断及对留置假体装置的护理可能会提高生存率。
