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在淋巴肿瘤患者中:宿主与真菌进化性相互作用的例证

in Patients with Lymphoid Neoplasms: An Illustration of Evolutive Host-Fungus Interactions.

作者信息

Paccoud Olivier, Bougnoux Marie-Elisabeth, Desnos-Ollivier Marie, Varet Bruno, Lortholary Olivier, Lanternier Fanny

机构信息

University of Paris, Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75015 Paris, France.

University of Paris, Department of Mycology, Necker-Enfants Malades University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75015 Paris, France.

出版信息

J Fungi (Basel). 2021 Mar 16;7(3):212. doi: 10.3390/jof7030212.

Abstract

Recent outbreaks of (CG) infections in North America have sparked renewed interest in the pathogenic potential of CG, and have underscored notable differences with in terms of geographic distribution, pathogen virulence, and host susceptibility. While cases of CG are increasingly reported in patients with a wide variety of underlying conditions, only very few have been reported in patients with lymphoid neoplasms. Herein, we report a case of autochthonous CG meningitis in a patient receiving ibrutinib for chronic lymphocytic leukemia in France, and review available data on the clinical epidemiology of CG infections in patients with lymphoid neoplasms. We also summarise recent data on the host responses to CG infection, as well as the potential management pitfalls associated with its treatment in the haematological setting. The clinical epidemiology, clinical presentation, and course of disease during infections caused by CG involve complex interactions between environmental exposure to CG, infecting genotype, pathogen virulence factors, host susceptibility, and host immune responses. Future treatment guidelines should address the challenges associated with the management of antifungal treatments in the onco-haematological setting and the potential drug-drug interactions.

摘要

近期北美地区曲霉属(CG)感染的爆发引发了人们对CG致病潜力的新关注,并凸显了其在地理分布、病原体毒力和宿主易感性方面与其他病原体的显著差异。虽然越来越多患有各种基础疾病的患者被报告感染CG,但仅有极少数患有淋巴肿瘤的患者有相关报告。在此,我们报告了法国一名接受依鲁替尼治疗慢性淋巴细胞白血病的患者发生原发性CG脑膜炎的病例,并回顾了淋巴肿瘤患者CG感染临床流行病学的现有数据。我们还总结了近期关于宿主对CG感染反应的数据,以及血液学环境中其治疗相关的潜在管理陷阱。CG感染的临床流行病学、临床表现和病程涉及环境暴露于CG、感染基因型、病原体毒力因子、宿主易感性和宿主免疫反应之间的复杂相互作用。未来的治疗指南应应对肿瘤血液学环境中抗真菌治疗管理相关的挑战以及潜在的药物相互作用。

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