Kaya Abdurrahman, Kaya Sibel Yıldız, Balkan İlker İnanç, Alkan Sena, Kurt Ahmet Furkan, Elverdi Tuğrul, Ürkmez Seval, Öngören Şeniz, Aygün Gökhan
Department of Infectious Diseases, İstanbul Training and Research Hospital, İstanbul, Türkiye.
Department of Infectious Diseases and Clinical Microbiology, İstanbul University-Cerrahpaşa Cerrahpaşa School of Medicine, İstanbul, Türkiye.
Infect Dis Clin Microbiol. 2024 Dec 19;6(4):343-348. doi: 10.36519/idcm.2024.371. eCollection 2024 Dec.
spp. are ubiquitous, and people are frequently exposed to their spores in the environment and hospital settings. Despite frequent inhalation of the spores, infection is infrequent in humans, except in immunosuppressed hosts. Although amphotericin B (AmB) has been a first-line antifungal for invasive infections for 50 years, its success rate in these patients remains unsatisfactory. Resistance to AmB is sporadic, but the fungus can acquire resistance. Herein, we report two patients unresponsive to AmB, and eventually, we found that the fungi were resistant to AmB. The species complex was recovered from endotracheal aspirate in one case. In the other case, the species complex was recovered from a skin biopsy on liposomal amphotericin B (L-AmB) treatment. We used conventional methods for both spp. Initially, serum galactomannan tests were negative in the patients. The radiological results of two patients were compatible with invasive pulmonary aspergillosis, and later, the serum galactomannan levels in the cases increased rapidly during routine blood screening. Eventually, both patients died in intensive care.
曲霉属无处不在，人们在环境和医院环境中经常接触到其孢子。尽管经常吸入孢子，但除免疫抑制宿主外，人类感染并不常见。尽管两性霉素B（AmB）50年来一直是侵袭性感染的一线抗真菌药物，但其在这些患者中的成功率仍不尽人意。对AmB的耐药性是散发性的，但真菌可获得耐药性。在此，我们报告两例对AmB无反应的患者，最终我们发现这些真菌对AmB耐药。在一例中，该曲霉属复合体从气管内吸出物中分离出来。在另一例中，该曲霉属复合体在脂质体两性霉素B（L-AmB）治疗期间从皮肤活检中分离出来。我们对这两种曲霉属均采用传统方法。最初，患者的血清半乳甘露聚糖检测呈阴性。两名患者的放射学结果与侵袭性肺曲霉病相符，后来，在常规血液筛查期间，病例中的血清半乳甘露聚糖水平迅速升高。最终，两名患者均在重症监护室死亡。
