肿瘤血液学患者毛霉病和曲霉病的对比

Contrasts between mucormycosis and aspergillosis in oncohematological patients.

作者信息

Klimko N, Khostelidi S, Shadrivova O, Volkova A, Popova M, Uspenskaya O, Shneyder T, Bogomolova T, Ignatyeva S, Zubarovskaya L, Afanasyev B

机构信息

I.Mechnikov North-Western State Medical University, 1/28 Santiago de Cuba str., St. Petersburg, Russian Federation, 194291.

I.P.Pavlov First Saint Petersburg State Medical University, 6-8 L'va Tolstogo str., Saint Petersburg, Russian Federation, 197022.

出版信息

Med Mycol. 2019 Apr 1;57(Supplement_2):S138-S144. doi: 10.1093/mmy/myy116.

DOI:10.1093/mmy/myy116

PMID:30816977

Abstract

In retrospective multicenter study from years 2007-2017, we evaluated 59 oncohematological patients with mucormycosis and 541 with invasive aspergillosis (IA). Mucormycosis developed more often in children and adolescents (P = .001), as well as after the emergence of graft versus host disease (P = .0001). Patients with mucormycosis had more severe neutropenia (88% vs 82%), the median duration was 30 versus 14 days (P = .0001) and lymphocytopenia (77% vs 65%), with a median duration (25 vs 14 days, P = .001) as compared to patients with IA. The lung infection was less frequent in patients with mucormycosis than in IA patients (73% vs 97%, P = .02), but more frequent was involvement of 2 or more organs (42% vs 8%, P = .001) and involvement of paranasal sinuses (15% vs 6%, P = .04). Typical clinical features of mucormycosis were localized pain syndrome (53% vs 5%, P = .0001), hemoptysis (32% vs 6%, P = .001), pleural effusion on lung CT scan (53% vs 7%, P = .003), lesions with destruction (38% vs 8%, P = .0001), and a "reverse halo" sign (17% vs 3%). The overall 12-week survival was significantly lower in patients with mucormycosis than for IA patients (49% vs 81%, P = .0001). In both groups unfavorable prognosis factors were ≥2 organs involvement (P = .0009), and concomitant bacterial or viral infection (P = .001, P = .008, respectively). In mucormycosis patients favorable prognosis factor was remission of underlying disease (P = .006).

摘要

在一项针对2007年至2017年的回顾性多中心研究中，我们评估了59例患有毛霉菌病的肿瘤血液科患者和541例患有侵袭性曲霉病（IA）的患者。毛霉菌病在儿童和青少年中更常发生（P = .001），并且在移植物抗宿主病出现后也更常发生（P = .0001）。与IA患者相比，毛霉菌病患者的中性粒细胞减少更严重（88%对82%），中位持续时间为30天对14天（P = .0001），淋巴细胞减少也更严重（77%对65%），中位持续时间为25天对14天（P = .001）。毛霉菌病患者的肺部感染比IA患者少（73%对97%，P = .02），但累及2个或更多器官的情况更常见（42%对8%，P = .001），鼻窦受累也更常见（15%对6%，P = .04）。毛霉菌病的典型临床特征是局部疼痛综合征（53%对5%，P = .0001）、咯血（32%对6%，P = .001）、肺部CT扫描显示胸腔积液（53%对7%，P = .003）、有破坏的病变（38%对8%，P = .0001）以及“反晕征”（17%对3%）。毛霉菌病患者的12周总生存率显著低于IA患者（49%对81%，P = .0001）。在两组中，不良预后因素均为累及≥2个器官（P = .0009）以及合并细菌或病毒感染（分别为P = .001和P = .008）。在毛霉菌病患者中，良好的预后因素是基础疾病缓解（P = .006）。