Pásztor-Bazsó Viktória, Kelemen Ágnes, Varga Ágnes, Farkas Mária, Puskás Noémi, Kassa Csaba, Hauser Péter
1 Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktatókórház, Velkey László Gyermekegészségügyi Központ Miskolc, Szentpéteri kapu 72-76., 3526 Magyarország.
2 Corden Laboratórium Miskolc Magyarország.
Orv Hetil. 2023 Jul 2;164(26):1034-1038. doi: 10.1556/650.2023.32799.
Patients with leukemia may occasionally suffer from rare opportunistic fungal infections with poor prognosis. Fungal infection caused by Geotrichum captitatum has not yet been described in Hungary. With this case report, we would like to draw attention to the fungal infection caused by G. capitatum. The 1.5-year-old girl with acute myeloid leukemia was treated for relapse diagnosed +120 days after a sibling donor bone marrow transplantation. High-grade, fluctuating fever began 11 days after the start of chemotherapy which did not decrease despite combined treatment with broad-spectrum antibiotics and antifungals (posaconasole). Due to worsening respiratory symptoms, a chest CT-scan was performed, raising suspicion of an invasive fungal infection. Blood culture confirmed G. capitatum infection. Initial empiric treatment with liposomal amphotericin B was combined with voriconazole based on international experience. However, we did not observe any improvement, and a few days later the patient passed away due to progression of the underlying disease. G. capitatum (presently known as Saprochaete capitata) is an ubiquitous yeast that can cause an infection with a poor prognosis, mainly in patients with leukemia. Its symptoms primarily appear in the skin and respiratory tract. The accurate identification of this pathogen is essential because the standard diagnostic tests do not give a specific reaction. Based on the limited international experience, the combination of amphotericin B and voriconazole can play a fundamental role in the treatment, however, even with adequate therapy 50% of the cases are fatal. By describing the first Hungarian case caused by G. capitatum, we draw attention to the importance of this rare, opportunistic fungal species with a poor prognosis that develops in immunosuppressed patients. Orv Hetil. 2023; 164(26): 1034-1038.
白血病患者偶尔可能会遭受预后不良的罕见机会性真菌感染。在匈牙利，尚未有关于头状地霉引起的真菌感染的报道。通过本病例报告，我们希望引起对头状地霉引起的真菌感染的关注。这名1.5岁的急性髓系白血病女孩在接受同胞供体骨髓移植120天后复发，接受治疗。化疗开始11天后出现高热、体温波动，尽管联合使用广谱抗生素和抗真菌药（泊沙康唑）治疗，体温仍未下降。由于呼吸道症状恶化，进行了胸部CT扫描，怀疑是侵袭性真菌感染。血培养证实为头状地霉感染。根据国际经验，最初用脂质体两性霉素B进行经验性治疗，并联合伏立康唑。然而，我们未观察到任何改善，几天后患者因基础疾病进展而死亡。头状地霉（目前称为头状腐质霉）是一种普遍存在的酵母菌，可引起预后不良的感染，主要发生在白血病患者中。其症状主要出现在皮肤和呼吸道。准确识别这种病原体至关重要，因为标准诊断测试没有特异性反应。根据有限的国际经验，两性霉素B和伏立康唑联合使用在治疗中可发挥重要作用，然而，即使进行充分治疗，50%的病例仍会死亡。通过描述匈牙利首例由头状地霉引起的病例，我们提请注意这种在免疫抑制患者中发生的、预后不良的罕见机会性真菌物种的重要性。《匈牙利医学周报》。2023年；164(26):1034 - 1038。
