McWhinney P H, Kibbler C C, Hamon M D, Smith O P, Gandhi L, Berger L A, Walesby R K, Hoffbrand A V, Prentice H G
Academic Department of Haematology, Royal Free Hospital School of Medicine, London, United Kingdom.
Clin Infect Dis. 1993 Sep;17(3):397-404. doi: 10.1093/clinids/17.3.397.
Over 13 years, we have seen 16 cases of proven invasive aspergillosis in 446 bone marrow transplant recipients, an incidence of 3.6%. The incidence of infection is low in patients with uncomplicated allogeneic or autologous bone-marrow transplants (< 2% and 0, respectively). Of the 16 episodes following transplantation, 10 occurred in patients with late transplant complications who were no longer in protective isolation. In patients who had focal pulmonary lesions (as diagnosed by computed tomographic scanning), culture of bronchoalveolar lavage (BAL) fluid was not an effective diagnostic procedure. In diffuse pulmonary disease due to Aspergillus, culture of BAL fluid had a sensitivity of 100%. Aspergillus species were isolated from an additional six patients who had no evidence of invasive aspergillosis. Graft rejection was a significant predisposing factor for the development of invasive aspergillosis (P < .001, log-rank test), and in our hospital, these patients now receive intravenous amphotericin B as prophylaxis. None of the six patients whose chest roentgenograms showed abnormalities before transplantation and who underwent surgical resection as part of the treatment for invasive aspergillosis developed recurrent infection.
在13年的时间里，我们在446例骨髓移植受者中发现了16例经证实的侵袭性曲霉病病例，发病率为3.6%。在无并发症的异基因或自体骨髓移植患者中，感染发生率较低（分别<2%和0）。在移植后的16次发病中，10例发生在不再处于保护性隔离状态的移植后期并发症患者中。对于有局灶性肺部病变（通过计算机断层扫描诊断）的患者，支气管肺泡灌洗（BAL）液培养不是一种有效的诊断方法。在曲霉引起的弥漫性肺部疾病中，BAL液培养的敏感性为100%。另外6例无侵袭性曲霉病证据的患者也分离出了曲霉菌种。移植物排斥是侵袭性曲霉病发生的一个重要易感因素（P<.001，对数秩检验），在我们医院，这些患者现在接受静脉注射两性霉素B作为预防措施。6例移植前胸部X线片显示异常并作为侵袭性曲霉病治疗一部分接受手术切除的患者均未发生复发性感染。
