Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Namazi Hospital, Zand Ave, Shiraz, 7193711351, Iran.
Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran.
BMC Infect Dis. 2020 Jul 23;20(1):535. doi: 10.1186/s12879-020-05162-9.
Breakthrough invasive fungal infections (bIFIs) are an area of concern in the scarcity of new antifungals. The mixed form of bIFIs is a rare phenomenon but could be potentially a troublesome challenge when caused by azole-resistant strains or non-Aspergillus fumigatus. To raise awareness and emphasize diagnostic challenges, we present a case of mixed bIFIs in a child with acute lymphoblastic leukemia.
A newly diagnosed 18-month-old boy with acute lymphoblastic leukemia was complicated with prolonged severe neutropenia after induction chemotherapy. He experienced repeated episodes of fever due to extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infection and pulmonary invasive fungal infection with Aspergillus fumigatus (early-type bIFIs) while receiving antifungal prophylaxis. Shortly after pulmonary involvement, his condition aggravated by abnormal focal movement, loss of consciousness and seizure. Cerebral aspergillosis with Aspergillus niger diagnosed after brain tissue biopsy. The patient finally died despite 108-day antifungal therapy.
Mixed bIFIs is a rare condition with high morbidity and mortality in the patients receiving immunosuppressants for hematological malignancies. This case highlights the clinical importance of Aspergillus identification at the species level in invasive fungal infections with multiple site involvement in the patients on antifungal prophylaxis.
突破性侵袭性真菌感染 (bIFIs) 是新抗真菌药物稀缺领域的一个关注点。混合形式的 bIFIs 较为罕见，但如果由唑类耐药菌株或非烟曲霉引起，可能会成为一个潜在的麻烦挑战。为了提高认识并强调诊断挑战，我们报告了一例儿童急性淋巴细胞白血病伴混合 bIFIs 的病例。
一名新诊断为急性淋巴细胞白血病的 18 个月大男孩，在诱导化疗后出现长时间严重中性粒细胞减少症。他在接受抗真菌预防治疗的同时，因产超广谱β-内酰胺酶的大肠杆菌血流感染和曲霉菌（早发型 bIFIs）肺部侵袭性真菌感染而反复出现发热。在肺部受累后不久，他的病情因异常局灶性运动、意识丧失和癫痫发作而恶化。脑组织活检后诊断为脑曲霉病，感染黑曲霉。尽管接受了 108 天的抗真菌治疗，患者最终还是死亡。
混合 bIFIs 在接受免疫抑制治疗血液恶性肿瘤的患者中发病率和死亡率较高，是一种罕见情况。该病例强调了在接受抗真菌预防治疗的患者中，对于多个部位受累的侵袭性真菌感染，进行曲霉属种水平鉴定的临床重要性。
