Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Front Cell Infect Microbiol. 2022 Mar 4;12:851891. doi: 10.3389/fcimb.2022.851891. eCollection 2022.
The limited information available on mixed mycosis involving the lungs makes the understanding of mixed fungal diseases insufficient and affects prognosis. Our study aims to improve understanding by exploring experience in the successful management of mixed fungal infections.
Patients who had two types of mycosis involving the lung at the same disease course were retrospectively enrolled.
Between September 2011 and December 2019, 17 patients with proven mixed mycosis were enrolled. Four patients were immunocompromised, with one case each of lung transplantation, corticosteroid treatment, STAT3 hyper-IgE syndrome, and anti-IFN-γ autoantibody-associated immunodeficiency syndrome. Among 13 patients who were not immunocompromised, 9 had type 2 diabetes mellitus. Eight cases were coinfection with and , 4 cases were and , 2 cases were and , 2 cases were and , and 1 case was and . Seven patients were diagnosed with mixed pulmonary mycosis at almost the same time. Among the remaining 10 patients, the initial treatment was ineffective in four cases, and six patients showed a partial response to the initial antifungal treatment, but the original fungal lesions became re-enlarged. Three patients were admitted to the intensive care unit during hospitalization, and one patient died. Another coinfection patient died due to treatment refusal.
Mixed mycosis involving the lungs is not uncommon in patients without apparent immune deficiency diseases. During the management of mycosis, we recommend keeping mixed mycosis in mind for patients with a poor response to initial antifungal treatment, even in immunocompetent populations, and identifying the cause of illness through a rigorous procedure.
肺部混合真菌感染的相关信息有限，这使得人们对混合真菌感染的认识不足，并影响了预后。本研究旨在通过探索成功治疗混合真菌感染的经验来提高认识。
回顾性纳入同时存在两种肺部真菌感染类型的患者。
2011 年 9 月至 2019 年 12 月，共纳入 17 例确诊为混合真菌感染的患者。其中 4 例为免疫功能低下患者，包括肺移植、皮质类固醇治疗、STAT3 高免疫球蛋白 E 综合征和抗 IFN-γ 自身抗体相关免疫缺陷综合征各 1 例。在 13 例非免疫功能低下患者中，9 例患有 2 型糖尿病。8 例为 和 混合感染，4 例为 和 混合感染，2 例为 和 混合感染，2 例为 和 混合感染，1 例为 和 混合感染。7 例患者几乎同时被诊断为混合性肺部真菌感染。在其余 10 例患者中，4 例初始治疗无效，6 例对初始抗真菌治疗有部分反应，但原有的真菌病变扩大。3 例患者在住院期间入住重症监护病房，1 例患者死亡。另 1 例 混合感染患者因拒绝治疗而死亡。
肺部混合真菌感染在无明显免疫缺陷疾病的患者中并不少见。在管理真菌感染时，我们建议对于初始抗真菌治疗反应不佳的患者，即使在免疫功能正常的人群中，也要考虑混合真菌感染，并通过严格的程序确定病因。
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