Division of Colon and Rectal Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, New York, USA.
Surg Infect (Larchmt). 2021 Apr;22(3):326-333. doi: 10.1089/sur.2020.157. Epub 2020 Jul 30.
Intestinal aspergillosis (IA) is a rare entity primarily discovered in immunocompromised patients. Because of its low incidence, IA is not considered routinely in the differential of abdominal pain, distension, and diarrhea. A systematic characterization of demographics, comorbidities, clinical presentations, and outcomes can help surgeons recognize and manage IA in critically ill patients. Two independent authors carried out the literature search using PubMed, MEDLINE, and Scopus databases. The Mesh terms utilized were: 'intestinal' and 'aspergillosis' combined with the Boolean operator 'AND' (synonyms were combined with the Boolean operator 'OR'). Intestinal aspergillosis was defined as inflammation of the gastrointestinal tract (duodenum to rectum) caused by spp. All articles reporting IA were included. Articles describing aspergillosis of the esophagus or stomach were excluded. Statistical analysis was performed using SPSS software (version 18; SPSS Inc., Chicago, IL). Forty-two articles reporting 56 cases were included in the study. Mean age was 44.9 ± 20.5 years. Male to female ratio was 29:27. The most common condition in patients who developed IA was transplantation (19 patients; 34%). The most common clinical presentations of IA were abdominal pain (21 patients; 38%) and diarrhea 12 patients; 21%). Sixty-six percent of patients had primary IA whereas 34% developed IA secondarily to systemic infection. Diagnostic modalities included exploratory laparotomy (35 patients; 63%) and endoscopy (7 patients; 13%). Mean time to diagnosis was 8.6 ± 11.3 days. Intestinal aspergillosis was limited to the small bowel in 61% of patients. In 43 (77%) patients, bowel resection is the definitive treatment, whereas 13 (23%) patients underwent antifungal therapy alone. Mortality rate was 39%. Sixty-three percent of patients treated with surgery survived, compared with 46% treated with antifungal therapy alone (p = 0.34). Intestinal aspergillosis is a life-threatening condition with a mortality rate of 39%. Extrapulmonary IA is seen in patients with neutropenia, sepsis, inflammatory conditions, and immunosuppression. Patients who undergo surgery are more likely to survive this infection.
肠曲霉病（IA）是一种罕见的疾病，主要发生在免疫功能低下的患者中。由于其发病率较低，IA 通常不会被认为是腹痛、腹胀和腹泻的鉴别诊断之一。对人口统计学、合并症、临床表现和结局进行系统描述，可以帮助外科医生识别和处理重症患者的 IA。两位独立的作者使用 PubMed、MEDLINE 和 Scopus 数据库进行文献检索。使用的 Mesh 术语是：“肠”和“曲霉病”，并结合布尔运算符“AND”（同义词结合布尔运算符“OR”）。肠曲霉病被定义为由 spp 引起的胃肠道（十二指肠至直肠）炎症。所有报告 IA 的文章都被包括在内。描述食管或胃曲霉病的文章被排除在外。使用 SPSS 软件（版本 18；SPSS Inc.，芝加哥，IL）进行统计分析。报告 56 例的 42 篇文章被纳入研究。平均年龄为 44.9±20.5 岁。男女比例为 29:27。发生 IA 的患者最常见的情况是移植（19 例；34%）。IA 最常见的临床表现是腹痛（21 例；38%）和腹泻（12 例；21%）。66%的患者为原发性 IA，34%的患者继发于全身感染。诊断方法包括剖腹探查术（35 例；63%）和内镜检查（7 例；13%）。平均诊断时间为 8.6±11.3 天。肠曲霉病仅累及小肠的患者占 61%。43 例（77%）患者行肠切除术为确定性治疗，13 例（23%）患者仅行抗真菌治疗。死亡率为 39%。接受手术治疗的患者中有 63%存活，而仅接受抗真菌治疗的患者中有 46%存活（p=0.34）。肠曲霉病是一种危及生命的疾病，死亡率为 39%。肺外 IA 见于中性粒细胞减少、脓毒症、炎症性疾病和免疫抑制的患者。接受手术治疗的患者更有可能存活。
