Crees Zachary D, Patel Dilan A, Dram Alexandra, Kim Miriam, Bern Michael D, Eberly Allison R, Augustin Kristan, Hotchkiss Richard S, DiPersio John F
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO.
Department of Anesthesiology and Critical Care Medicine, Washington University School of Medicine, St Louis, MO.
Crit Care Explor. 2023 Oct 19;5(10):e0990. doi: 10.1097/CCE.0000000000000990. eCollection 2023 Oct.
We report the case of a patient with aplastic anemia and pancytopenia on immune-suppressive therapy who developed invasive pulmonary infection with mucormycosis and was treated with immune adjuvant therapy.
Given the patient's profound lymphopenia and progressive invasive mucor despite dual antifungal drug therapy, interleukin (IL)-7, a cytokine that induces lymphocyte activation and proliferation, was instituted and resulted in normalization of absolute lymphocyte counts and was temporally associated with clearance of fungal pathogens and resolution of clinical symptoms.
Patients with life-threatening fungal infections are frequently immune suppressed and immune adjuvant therapies should be considered in patients who are not responding to antifungal drugs and source control. Well-designed, double-blind, placebo-controlled trials are needed to advance the field. Although a number of immune adjuvants may be beneficial in fungal sepsis, IL-7 is a particularly attractive immune adjuvant because of its broad immunologic effects on key immunologic pathways that mediate enhanced antifungal immune system activity.
我们报告了一例再生障碍性贫血和全血细胞减少症患者，该患者接受免疫抑制治疗，发生了毛霉菌病侵袭性肺部感染，并接受了免疫辅助治疗。
鉴于患者严重淋巴细胞减少且尽管接受双重抗真菌药物治疗仍有进行性侵袭性毛霉菌感染，于是使用白细胞介素（IL）-7，一种诱导淋巴细胞活化和增殖的细胞因子，这导致绝对淋巴细胞计数恢复正常，并且在时间上与真菌病原体清除和临床症状缓解相关。
患有危及生命的真菌感染的患者通常免疫功能受到抑制，对于对抗真菌药物和源头控制无反应的患者应考虑免疫辅助治疗。需要设计良好的双盲、安慰剂对照试验来推动该领域的发展。尽管许多免疫佐剂可能对真菌败血症有益，但IL-7是一种特别有吸引力的免疫佐剂，因为它对介导增强抗真菌免疫系统活性的关键免疫途径具有广泛的免疫作用。
