Tashiro T, Nagai H, Nagaoka H, Goto Y, Kamberi P, Nasu M
Second Department of Internal Medicine, Oita Medical University, Japan.
Chest. 1995 Jul;108(1):190-5. doi: 10.1378/chest.108.1.190.
Trichosporon beigelii is a causative agent of hypersensitivity pneumonia in immunocompetent individuals and of invasive pneumonia in immunocompromised patients. The actual incidence and clinical manifestations of T beigelii pneumonia are obscure because the diagnosis is sometimes difficult. We studied eight patients with T beigelii pneumonia diagnosed by immunohistochemical investigation of lung tissue sections and/or isolation of the organism from the lung, sputum, or blood. All patients had underlying hematologic malignancies for which they had received cytotoxic chemotherapy, resulting in profound neutropenia. The clinical manifestations were persistent fever unresponsive to broad-spectrum antibiotic therapy, cough, bloody sputum, and rapidly progressive dyspnea. The chest radiographs showed diffuse alveolar infiltrates in four patients, diffuse interstitial infiltrates in one, patchy reticulonodular infiltrates in one, and focal alveolar infiltrates in two. Histopathologic examination demonstrated numerous centrally necrotic foci with minimal cellular inflammatory reaction, intra-alveolar hemorrhage, and edema. Trichosporon beigelii consisting of both yeast and hyphal forms was located predominantly in the alveolar vessels. In neutropenic patients with hematologic malignancies, this fungus appears to enter the lung not only through the airways but also via the hematogenous route. In vitro susceptibility testing indicated borderline susceptibility to amphotericin B and showed that some azoles were active against T beigelii at safely achievable serum concentrations.
白吉利丝孢酵母是免疫功能正常个体发生超敏性肺炎以及免疫功能低下患者发生侵袭性肺炎的病原体。由于诊断有时困难，白吉利丝孢酵母肺炎的实际发病率和临床表现尚不明确。我们研究了8例经肺组织切片免疫组化检查和/或从肺、痰液或血液中分离出该病原体而确诊为白吉利丝孢酵母肺炎的患者。所有患者均有潜在血液系统恶性肿瘤，并因此接受了细胞毒性化疗，导致严重中性粒细胞减少。临床表现为对广谱抗生素治疗无反应的持续发热、咳嗽、血痰和迅速进展的呼吸困难。胸部X线片显示，4例患者为弥漫性肺泡浸润，1例为弥漫性间质浸润，1例为斑片状网状结节浸润，2例为局灶性肺泡浸润。组织病理学检查显示有许多中央坏死灶，伴有轻微的细胞炎症反应、肺泡内出血和水肿。同时含有酵母型和菌丝型的白吉利丝孢酵母主要位于肺泡血管中。在患有血液系统恶性肿瘤的中性粒细胞减少患者中，这种真菌似乎不仅通过气道进入肺部，还通过血行途径进入。体外药敏试验表明对两性霉素B的敏感性处于临界水平，并显示一些唑类药物在安全可达到的血清浓度下对白吉利丝孢酵母有活性。
