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新出现的霉菌感染:准备好应对患者体内意想不到的真菌。

Emerging mould infections: Get prepared to meet unexpected fungi in your patient.

作者信息

Dellière Sarah, Rivero-Menendez Olga, Gautier Cécile, Garcia-Hermoso Dea, Alastruey-Izquierdo Ana, Alanio Alexandre

机构信息

Université de Paris, Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France.

Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.

出版信息

Med Mycol. 2020 Feb 1;58(2):156-162. doi: 10.1093/mmy/myz039.

Abstract

Invasive fungal diseases are increasing issues in modern medicine, where the human immunodeficiency virus (HIV) pandemic and the wider use of immunosuppressive drugs generate an ever-growing number of immunocompromised patients with an increased susceptibility to uncommon fungal pathogens. In the past decade, new species have been reported as being responsible for disseminated and invasive fungal diseases in humans. Among them, the following genera are rare but seem emerging issues: Scopulariopsis, Hormographiella, Emergomyces, Westerdykella, Trametes, Actinomucor, Saksenaea, Apophysomyces, and Rhytidhysteron. Delay in diagnosis, which is often the case in these infections, jeopardizes patients' prognosis and leads to increased mortality. Here we summarize the clinical and biological presentation and the key features to identify these emerging pathogens and we discuss the available antifungal classes to treat them. We focused on Pubmed to recover extensively reported human invasive cases and articles regarding the nine previously cited fungal organisms. Information concerning patient background, macroscopic and microscopic description and pictures of these fungal organisms, histological features in tissues, findings with commonly used antigen tests in practice, and hints on potential efficient antifungal classes were gathered. This review's purpose is to help clinical microbiologists and physicians to suspect, identify, diagnose, and treat newly encountered fungi in hospital settings.

摘要

侵袭性真菌病在现代医学中是日益严重的问题,人类免疫缺陷病毒(HIV)大流行以及免疫抑制药物的广泛使用导致免疫功能低下的患者数量不断增加,他们对不常见的真菌病原体易感性增强。在过去十年中,已有新物种被报告可导致人类播散性和侵袭性真菌病。其中,以下属较为罕见但似乎正成为新问题:帚霉属、嗜热子囊菌属、新兴隐球菌属、韦斯特德氏菌属、栓菌属、放射毛霉属、异孢根霉属、犁头霉属和缝裂壳属。这些感染常常出现诊断延迟的情况,这会危及患者的预后并导致死亡率上升。在此,我们总结了这些新兴病原体的临床和生物学表现以及识别它们的关键特征,并讨论了可用于治疗它们的抗真菌药物类别。我们重点检索了PubMed,以获取大量报道的人类侵袭性病例以及关于上述九种真菌生物体的文章。收集了有关患者背景、这些真菌生物体的宏观和微观描述及图片、组织中的组织学特征、实际常用抗原检测的结果以及潜在有效抗真菌药物类别的相关信息。本综述的目的是帮助临床微生物学家和医生在医院环境中怀疑、识别、诊断和治疗新遇到的真菌。

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