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侵袭性镰刀菌病的临床特征与转归:单中心病例系列并文献复习

Clinical Features and Outcomes of Invasive Fusariosis: A Case Series in a Single Center with Literature Review.

作者信息

Kim Ji-Yeon, Kang Cheol-In, Lee Ji Hye, Lee Woo Joo, Huh Kyungmin, Cho Sun Young, Chung Doo Ryeon, Peck Kyong Ran

机构信息

Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Division of Infectious Diseases, Seongnam Citizens Medical Center, Seongnam, Korea.

出版信息

Infect Chemother. 2023 Jun;55(2):290-294. doi: 10.3947/ic.2018.0717. Epub 2021 Feb 3.

Abstract

species, which are commonly found in soil, water, and organic substrates, can cause serious infections especially in immunocompromised patients. Fusarium infection is notoriously difficult to treat, because of their inherently high minimum inhibitory concentrations (MICs) to most antifungal agents. There have been limited data on invasive fusariosis in Korea. We identified 57 patients with culture-proven fusariosis at Samsung Medical Center, Seoul, Korea, from September 2003 through January 2017. Invasive fusariosis was defined as any case with at least one positive blood culture or with concurrent involvement of 2 or more non-contiguous sites. Superficial infections such as keratitis and onychomycosis were excluded. We reported 14 cases of invasive fusariosis categorized according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria, of which 6 cases were fusarium fungemia. Hematologic malignancies (7/14, 50%), solid organ transplantation (2/14, 14.2%), or immunosuppressive therapy (2/14, 14.2%), were the predominant underlying conditions. The overall mortality rate was 37%, however, that of disseminated fusariosis was up to 83%. Antifungal treatment with voriconazole or liposomal amphotericin B was commonly administered. In this report, we described the clinical characteristics and treatment outcomes of invasive fusariosis in Korea. Given the high mortality in disseminated cases, invasive fusariosis is becoming a therapeutic challenge to clinicians treating immunocompromised patients.

摘要

常见于土壤、水和有机基质中的某些物种,尤其在免疫功能低下的患者中可引起严重感染。镰刀菌感染 notoriously 难以治疗,因为它们对大多数抗真菌药物的固有最低抑菌浓度(MIC)很高。韩国关于侵袭性镰刀菌病的数据有限。我们在韩国首尔三星医疗中心确定了2003年9月至2017年1月期间57例经培养证实为镰刀菌病的患者。侵袭性镰刀菌病定义为至少有一次血培养阳性或同时累及2个或更多非连续部位的任何病例。排除角膜炎和甲癣等浅表感染。我们报告了14例根据欧洲癌症研究与治疗组织/真菌病研究组标准分类的侵袭性镰刀菌病病例,其中6例为镰刀菌血症。血液系统恶性肿瘤(7/14,50%)、实体器官移植(2/14,14.2%)或免疫抑制治疗(2/14,14.2%)是主要的基础疾病。总体死亡率为37%,然而,播散性镰刀菌病的死亡率高达83%。常用伏立康唑或脂质体两性霉素B进行抗真菌治疗。在本报告中,我们描述了韩国侵袭性镰刀菌病的临床特征和治疗结果。鉴于播散性病例的高死亡率,侵袭性镰刀菌病正成为治疗免疫功能低下患者的临床医生面临的治疗挑战。

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