Denning D W
Department of Infectious Diseases and Tropical Medicine (Monsall Unit), North Manchester General Hospital, Crumpsall.
J Infect. 1994 May;28 Suppl 1:25-33. doi: 10.1016/s0163-4453(94)95941-2.
Invasive aspergillosis is generally a life-threatening invasive opportunistic mycosis affecting principally the upper and lower respiratory tract. Therapeutic response rates vary considerably from one host group to another with particularly high mortality rates in bone marrow transplant, liver transplant and patients with aplastic anaemia or AIDS. Only two drugs are useful for therapy, amphotericin and itraconazole. Recent advances in the formulation of amphoterin B (AmBisome and Amphocil) have resulted in intravenous preparations with lower toxicity, particularly nephrotoxicity, but it has yet to be shown that they have an increased therapeutic index for the treatment of invasive aspergillosis. Itraconazole can only be used orally and in some particularly high-risk or critically ill patients adequate serum concentrations cannot be achieved. The addition of flucytosine or rifampicin to amphotericin B therapy has, at best, only a marginal benefit. Surgery is essential for some manifestations of invasive aspergillosis. This article reviews therapeutic strategies including criteria for initiation of therapy, combination and sequential therapy, duration of therapy and secondary prophylaxis and indications for surgery in invasive aspergillosis.
侵袭性曲霉病通常是一种危及生命的侵袭性机会性真菌病，主要影响上、下呼吸道。不同宿主群体的治疗反应率差异很大，骨髓移植、肝移植以及再生障碍性贫血或艾滋病患者的死亡率尤其高。只有两种药物可用于治疗，即两性霉素和伊曲康唑。两性霉素B制剂（安必素和两性霉素脂质体）的最新进展已产生毒性较低的静脉制剂，尤其是肾毒性，但尚未表明它们对侵袭性曲霉病的治疗具有更高的治疗指数。伊曲康唑只能口服使用，在一些特别高危或重症患者中无法达到足够的血清浓度。在两性霉素B治疗中添加氟胞嘧啶或利福平，充其量只有微不足道的益处。手术对于侵袭性曲霉病的某些表现至关重要。本文综述了治疗策略，包括治疗开始标准、联合和序贯治疗、治疗持续时间和二级预防以及侵袭性曲霉病的手术指征。
