Sessa A, Meroni M, Battini G, Pitingolo F, Giordano F, Marks M, Casella P
Unità Operativa di Nefrologia e Dialisi, Vimercate, Italy.
Nephrol Dial Transplant. 1996 Jul;11(7):1322-4.
Aspergillus fumigatus is present in the environment worldwide and it is only able to infect debilitated or immunodepressed subjects. Nosocomial outbreaks of A. fumigatus infection have been associated with hospital reconstruction. Spores are released into the environment and are inhaled by immunodepressed patients housed in nearby Medical Units. Specific clinical syndromes are allergic bronchopulmonary aspergillosis and invasive pulmonary aspergillosis with characteristic radiological features. Invasive A. fumigatus infection is commonly fatal, even if promptly diagnosed and treated. Three consecutive cases of A. fumigatus infection occurred in debilitated patients housed in our Renal Unit while building renovation near the Unit was being performed. Two of these patients died and pulmonary and diffuse aspergillosis was found on postmortem examination. The third patient, highly suspected to be infected with Aspergillus, was aggressively and successfully treated with liposomal amphotericin B. Our experience suggests that fungal infections have gained increasing prominence in clinical medicine and they must be considered in chronic debilitated patients including dialysis patients, and that liposomal amphotericin B represents an important advance in the treatment of aspergillosis.
烟曲霉在全球环境中均有存在，且仅能感染身体虚弱或免疫功能低下的个体。医院内烟曲霉感染的暴发与医院重建有关。孢子释放到环境中，被安置在附近医疗单元的免疫功能低下患者吸入。特定的临床综合征为变应性支气管肺曲霉病和具有特征性放射学表现的侵袭性肺曲霉病。侵袭性烟曲霉感染通常是致命的，即便得到及时诊断和治疗。在我们肾科病房对身体虚弱的患者进行病房翻新时，连续发生了3例烟曲霉感染病例。其中2例患者死亡，尸检发现肺部及弥漫性曲霉病。第3例患者高度怀疑感染曲霉，接受了脂质体两性霉素B积极治疗并获成功。我们的经验表明，真菌感染在临床医学中日益突出，在包括透析患者在内的慢性身体虚弱患者中必须考虑到这一点，且脂质体两性霉素B代表了曲霉病治疗方面的一项重要进展。
