Hawkins C, Armstrong D
Clin Haematol. 1984 Oct;13(3):599-630.
Invasive fungal infections cause significant morbidity and mortality in patients with impaired immune defences. Defects in neutrophil function and neutropenia predispose to disseminated Candida, Aspergillus and Mucoraceae infections while altered T-lymphocyte mononuclear phagocyte function predisposes to infection with C. neoformans, Histoplasma and Coccidioides. Fungal infections in the immunocompromised host are difficult to diagnose and difficult to treat successfully. The diagnosis is often missed or delayed because of the non-specific clinical features, the failure to isolate or difficulty in interpreting the presence of the fungus from routine microbiological cultures, and the limited usefulness of available serological tests. The assay for cryptococcal antigen is the only currently available reliable serological test used to diagnose an invasive fungal infection. Definitive diagnosis is made by histopathological demonstration of the fungus in tissue or a positive culture from a sterile body site. Invasive procedures are often necessary to obtain adequate tissue for histology and culture. The treatment of invasive fungal infection in the immunocompromised host is amphotericin B with or without 5FC. The usual recommended dose is 1.5 to 3 g total amphotericin B over 6 to 12 weeks. The optimal dose and duration of therapy for each infection is not known. Treatment failures and relapses are common in patients who do not achieve remission of their underlying disease. Ketoconazole, a new broad-spectrum oral antifungal medication, does not appear to be effective therapy for invasive fungal infection in the immunocompromised patient based on results of small clinical trials. New diagnostic methods and therapeutic approaches are necessary to improve the outcome of these infections. Areas of current research include serological assays for fungal antigens and metabolites which may allow earlier diagnosis, treatment with combinations of antifungal agents, and the development of new antifungal agents.
侵袭性真菌感染在免疫防御功能受损的患者中会导致严重的发病率和死亡率。中性粒细胞功能缺陷和中性粒细胞减少易引发播散性念珠菌、曲霉菌和毛霉科感染，而T淋巴细胞单核吞噬细胞功能改变则易引发新型隐球菌、组织胞浆菌和球孢子菌感染。免疫功能低下宿主的真菌感染难以诊断且难以成功治疗。由于临床特征不具特异性、未能分离出真菌或难以从常规微生物培养中解读真菌的存在，以及现有血清学检测的效用有限，诊断往往会被漏诊或延误。隐球菌抗原检测是目前唯一可用于诊断侵袭性真菌感染的可靠血清学检测。通过组织中真菌的组织病理学证明或无菌身体部位的阳性培养来做出明确诊断。通常需要进行侵入性操作以获取足够的组织用于组织学检查和培养。免疫功能低下宿主侵袭性真菌感染的治疗是使用两性霉素B，可加用或不加用5-氟胞嘧啶（5FC）。通常推荐的总剂量是在6至12周内给予1.5至3克两性霉素B。每种感染的最佳治疗剂量和疗程尚不清楚。在潜在疾病未缓解的患者中，治疗失败和复发很常见。根据小型临床试验的结果，酮康唑这种新型广谱口服抗真菌药物似乎对免疫功能低下患者的侵袭性真菌感染无效。需要新的诊断方法和治疗方法来改善这些感染的治疗效果。当前的研究领域包括针对真菌抗原和代谢产物的血清学检测，这可能有助于早期诊断、联合使用抗真菌药物进行治疗以及开发新的抗真菌药物。
