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经支气管内两性霉素 B 灌注成功治疗混合性肺曲霉和毛霉感染:病例报告及文献复习。

Successful treatment of mixed pulmonary Aspergillus and Mucor infection using intrabronchial amphotericin B infusion: a case report and literature review.

机构信息

Department of Respiratory and Critical Care, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, Guangxi, 54100, China.

The 924th Hospital of the PLA Joint Logistics Support Force, Guilin, 54100, China.

出版信息

BMC Pulm Med. 2024 Sep 4;24(1):436. doi: 10.1186/s12890-024-03234-z.

Abstract

BACKGROUND

Reports of pulmonary aspergillosis and mucormycosis co-infections are rare; thus, limited guidance is available on early diagnosis and treatment. We present a case of mixed pulmonary Aspergillus and Mucor infection and review the literature regarding this co-infection. The diagnosis and treatment methods are summarized to improve clinicians' understanding of the disease and to facilitate early diagnosis and treatment.

CASE PRESENTATION

A 60-year-old male farmer with poorly controlled diabetes mellitus was admitted to hospital with a fever of unknown origin that had been present for 15 days and pulmonary aspergillosis complicated by Mucor spp.

INFECTION

Because multiple lobes were involved, the infection worsened despite surgical resection and antifungal therapy. Finally, we treated this patient with a bronchoscopic infusion of amphotericin B. After four courses of bronchoscopic amphotericin B infusion, we observed rapid clinical improvement and subsequent resolution of pulmonary infiltrates.

CONCLUSION

Our case highlights the use of bronchoscopy in the successful clinical treatment of invasive fungal diseases of the lung.

摘要

背景

肺曲霉病和毛霉病合并感染的报告很少见,因此,早期诊断和治疗的指导有限。我们报告了一例混合性肺曲霉和毛霉感染病例,并回顾了关于这种合并感染的文献。总结了诊断和治疗方法,以提高临床医生对该疾病的认识,促进早期诊断和治疗。

病例介绍

一名 60 岁男性农民,患有未控制的糖尿病,因原因不明发热 15 天入院,并发肺曲霉病合并毛霉属感染。

感染

由于多个肺叶受累,尽管进行了手术切除和抗真菌治疗,感染仍恶化。最终,我们对该患者进行了支气管镜下两性霉素 B 灌注治疗。在进行了四个疗程的支气管镜下两性霉素 B 灌注治疗后,我们观察到了快速的临床改善,随后肺部浸润也得到了缓解。

结论

我们的病例强调了支气管镜在成功治疗肺部侵袭性真菌感染中的应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8ff/11373109/a9af676d134f/12890_2024_3234_Fig1_HTML.jpg

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