Giordano Antonio, Di Landro Francesca, De Carolis Elena, Criscuolo Marianna, Dragonetti Giulia, Fianchi Luana, Pagano Livio
Department of Hematology, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168 Roma, Italy.
Department of Microbiology, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168 Roma, Italy.
J Fungi (Basel). 2021 Sep 19;7(9):778. doi: 10.3390/jof7090778.
Invasive fungal infection (IFI) remains the major complication in patients with either acute leukemia, allogeneic stem cell transplantation setting, or both, especially regarding pulmonary localization. We report an experience of a 74-year-old Caucasian male with a Philadelphia-positive (BCR-ABL p190) Common B-acute lymphoblastic leukemia (ALL) who developed a pulmonary infection due to . Furthermore, we describe the management of this complication and the results of microbiological tests useful to guide the treatment. All cases reported show failure of voriconazole treatment. In the majority of cases a good susceptibility to posaconazole has been reported, which seems to have a good clinical impact; however, only L-AmB shows a clinical effect to produce quick clinical improvement and so it should be a drug of choice. A literature revision shows that only a few papers have thus far described this infection, at present only one case was reported in a hematological setting like a gastrointestinal graft versus host disease in an allogeneic HSCT recipient. The severity of clinical conditions in hematological malignancy settings requires improving the management of this emerging invasive fungal infection. Indeed, a molecular diagnostic approach with a tight laboratory collaboration and targeted therapy should become the gold standard.
侵袭性真菌感染（IFI）仍然是急性白血病、异基因造血干细胞移植患者或两者兼有的患者的主要并发症，尤其是在肺部感染方面。我们报告了一名74岁的费城染色体阳性（BCR-ABL p190）普通B淋巴细胞白血病（ALL）白种男性患者发生肺部感染的病例。此外，我们描述了该并发症的处理方法以及有助于指导治疗的微生物检测结果。所有报告的病例均显示伏立康唑治疗失败。在大多数病例中，已报告对泊沙康唑有良好的敏感性，这似乎具有良好的临床效果；然而，只有脂质体两性霉素B显示出能产生快速临床改善的临床效果，因此它应是首选药物。文献综述表明，迄今为止只有少数论文描述了这种感染，目前在血液学环境中仅报道了1例，如在异基因造血干细胞移植受者中发生的胃肠道移植物抗宿主病。血液系统恶性肿瘤患者临床状况的严重性要求改善对这种新出现的侵袭性真菌感染的管理。事实上，紧密的实验室合作和靶向治疗的分子诊断方法应成为金标准。
