Biddeci Giada, Donà Daniele, Geranio Giulia, Spadini Silvia, Petris Maria Grazia, Pillon Marta, Biffi Alessandra, Putti Maria Caterina
Maternal and Child Health Department, Pediatric Hematology, Oncology and Stem Cell Transplantation Division, Padua University Hospital, 35128 Padua, Italy.
Maternal and Child Health Department, Pediatric Infectious Disease Division, Padua University Hospital, 35128 Padua, Italy.
J Fungi (Basel). 2020 Oct 9;6(4):212. doi: 10.3390/jof6040212.
species are ubiquitous pathogens causing opportunistic infections in immunocompromised patients. Clinical presentation depends on a host's immunity and can be localized or disseminated. Since there are few reports of disseminated fusariosis in children, we described an unusual case of infection in a 9-year-old child with acute lymphoblastic leukemia (ALL). This patient presented a deep wound in the elbow at diagnosis. During the induction phase of chemotherapy, he developed multiple skin lesions and severe pneumonia; was cultured from the skin lesions. He was treated with a high dose of liposomal amphotericin B, followed by voriconazole. Starting from this peculiar case, we collected all patients with acute leukemia affected by infection, treated in the pediatric Onco-Hematology Division of Padua University Hospital during the last 20 years. We identified another six cases: all these patients were affected by acute myeloid leukemia (AML) and five of them presented a relapsed/refractory disease. Two out of seven patients died because of infection; five patients recovered from infection, but three out of seven died because of leukemia. Skin lesions in immunocompromised patients should rise the suspicion of disseminated fusariosis. Furthermore, considering the emergence of filamentous fungi in immunocompromised patients, we all should be aware of infection, reminding us that the diagnosis is important to cure the infection.
该菌属是普遍存在的病原体，可在免疫功能低下的患者中引起机会性感染。临床表现取决于宿主的免疫力，可局限或播散。由于儿童播散性镰刀菌病的报道较少，我们描述了一名9岁急性淋巴细胞白血病（ALL）患儿发生的罕见感染病例。该患者诊断时肘部有一处深部伤口。在化疗诱导期，他出现了多处皮肤病变和严重肺炎；从皮肤病变处培养出了该菌。他接受了高剂量的脂质体两性霉素B治疗，随后使用伏立康唑。从这个特殊病例开始，我们收集了过去20年在帕多瓦大学医院儿科肿瘤血液科接受治疗的所有受该菌感染的急性白血病患者。我们又发现了另外6例：所有这些患者均患有急性髓系白血病（AML），其中5例为复发/难治性疾病。7名患者中有2名因感染死亡；5名患者感染痊愈，但7名中有3名因白血病死亡。免疫功能低下患者出现皮肤病变应怀疑播散性镰刀菌病。此外，考虑到免疫功能低下患者中丝状真菌的出现，我们都应意识到这种感染，这提醒我们诊断对于治愈感染很重要。
