Le Conte P, Blanloeil Y, Germaud P, Morin O, Moreau P
Service des Urgences, CHU, Nantes.
Ann Fr Anesth Reanim. 1995;14(2):198-208.
Invasive pulmonary aspergilloses occur in patients with antineoplasic chemotherapy, mainly when associated with a prolonged neutropenia, in transplanted patients with continuous corticotherapy and less frequently in immunocompetent surgical patients. The clinical features are those of an acute infective pneumonia, not responding to antibiotherapy. Radiologic signs are often non specific. Diagnosis is obtained with bronchoalveolar lavage in which Aspergillus is found both at direct examination and in culture. Serological tests are of little interest for the diagnosis of invasive aspergillosis. Extrapulmonary locations such as sinusitis, cutaneous or brain abscesses occur in 20% of cases. The gold standard of treatment is intravenous amphotericin B which elicits an acute reaction often followed by a nephrotoxic effect which can be decreased by fluid loading with saline. Oral itraconazole administration can follow the initial treatment with amphotericin B. The mortality rate remains high and an early diagnosis and an appropriate treatment are essential.
侵袭性肺曲霉病发生于接受抗肿瘤化疗的患者，主要与长期中性粒细胞减少相关，也见于接受持续皮质激素治疗的移植患者，在免疫功能正常的外科手术患者中较少见。其临床特征为急性感染性肺炎，对抗生素治疗无反应。影像学表现通常不具特异性。通过支气管肺泡灌洗进行诊断，直接检查和培养均可发现曲霉菌。血清学检测对侵袭性曲霉病的诊断价值不大。20%的病例会出现肺外病变，如鼻窦炎、皮肤或脑脓肿。治疗的金标准是静脉注射两性霉素B，但会引发急性反应，常伴有肾毒性作用，可通过生理盐水补液来减轻。初始使用两性霉素B治疗后可继以口服伊曲康唑。死亡率仍然很高，早期诊断和恰当治疗至关重要。
