大海捞针：在 FungiScope-全球新兴真菌感染注册中心报告的极为罕见的侵袭性真菌感染。
Needles in a haystack: Extremely rare invasive fungal infections reported in FungiScope-Global Registry for Emerging Fungal Infections.
机构信息
University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), Herderstrasse 52-54, 50931 Cologne, Germany.
University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), Herderstrasse 52-54, 50931 Cologne, Germany; University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.
出版信息
J Infect. 2020 Nov;81(5):802-815. doi: 10.1016/j.jinf.2020.08.015. Epub 2020 Aug 13.
OBJECTIVES
Emerging invasive fungal infections (IFI) have become a notable challenge. Apart from the more frequently described fusariosis, lomentosporiosis, mucormycosis, scedosporiosis, and certain dematiaceae or yeasts, little is known about extremely rare IFI.
METHODS
Extremely rare IFI collected in the FungiScope registry were grouped as Dematiaceae, Hypocreales, Saccharomycetales, Eurotiales, Dermatomycetes, Agaricales, and Mucorales.
RESULTS
Between 2003 and June 2019, 186 extremely rare IFI were documented in FungiScope. Dematiaceae (35.5%), Hypocreales (23.1%), Mucorales (11.8%), and Saccharomycetales (11.3%) caused most IFI. Most patients had an underlying malignancy (38.7%) with acute leukemia accounting for 50% of cancers. Dissemination was observed in 26.9% of the patients. Complete or partial clinical response rate was 68.3%, being highest in Eurotiales (82.4%) and in Agaricales (80.0%). Overall mortality rate was 29.3%, ranging from 11.8% in Eurotiales to 50.0% in Mucorales.
CONCLUSIONS
Physicians are confronted with a complex variety of fungal pathogens, for which treatment recommendations are lacking and successful outcome might be incidental. Through an international consortium of physicians and scientists, these cases of extremely rare IFI can be collected to further investigate their epidemiology and eventually identify effective treatment regimens.
目的
新兴的侵袭性真菌感染（IFI）已成为一个显著的挑战。除了更为常见的镰孢菌病、枝孢霉病、毛霉病、地霉病和某些暗色真菌或酵母外，对于极为罕见的 IFI 知之甚少。
方法
在 FungiScope 登记处收集的极为罕见的 IFI 被分为暗色真菌、腔孢纲、酵母纲、外瓶霉目、皮肤癣菌、伞菌目和毛霉目。
结果
在 2003 年至 2019 年 6 月期间，FungiScope 记录了 186 例极为罕见的 IFI。暗色真菌（35.5%）、腔孢纲（23.1%）、毛霉目（11.8%）和酵母纲（11.3%）引起了大多数 IFI。大多数患者存在基础恶性肿瘤（38.7%），其中急性白血病占癌症的 50%。26.9%的患者发生了播散。完全或部分临床反应率为 68.3%，在外瓶霉目（82.4%）和伞菌目（80.0%）中最高。总死亡率为 29.3%，在外瓶霉目为 11.8%，在毛霉目为 50.0%。
结论
医生面临着多种复杂的真菌病原体，缺乏治疗建议，成功的结果可能是偶然的。通过医生和科学家的国际联盟，可以收集这些极为罕见的 IFI 病例，以进一步研究其流行病学，并最终确定有效的治疗方案。
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