Orth B, Frei R, Itin P H, Rinaldi M G, Speck B, Gratwohl A, Widmer A F
University Hospital, Basel, Switzerland.
Ann Intern Med. 1996 Nov 15;125(10):799-806. doi: 10.7326/0003-4819-125-10-199611150-00003.
Invasive mycoses are an important cause of illness and death in immunocompromised patients. Infections with molds other than aspergilli have been increasingly seen in patients with hematologic cancers, but epidemics of these infections have not yet been reported.
To describe an outbreak of invasive mycoses with Paecilomyces lilacinus in severely neutropenic patients.
An outbreak investigation.
The hematology-oncology isolation and bone marrow transplantation unit of the University Hospital, Basel, Switzerland.
25 consecutive patients admitted between 17 August 1993 (the date of the first manifestation of P. lilacinus infection) and 31 October 1993 (when the unit was closed).
Clinical and microbiological data, including histologic findings; cultures from several patient sites; and environmental examinations of potential airborne, parenteral, enteric, and horizontal routes of transmission. Infections were defined by the isolation of P. lilacinus from clinically evident skin eruptions.
12 of the 25 patients (48%) were infected or colonized. Nine patients (36%), including all bone marrow transplant recipients, had documented invasive P. lilacinus infections. All 9 infected patients had papular, pustular, or necrotic skin eruptions. Two patients with severe graft-versus-host disease died with refractory fungal disease; 1 also had microbiologically documented endophthalmitis and kidney infiltrates. Seven affected patients no longer had P. lilacinus after recovery of bone marrow function. The organism was resistant in vitro to amphotericin B, itraconazole, and fluconazole. Patients did not respond clinically to these agents. The outbreak was ultimately traced to a contaminated, commercially available, pharmaceutically prepared skin lotion. The outbreak ended after the skin lotion was recalled and has not recurred after a follow-up period of 2 years.
Contaminated skin lotion is a potential cause of opportunistic fungal infections in immunocompromised hosts. Paecilomyces lilacinus is a common saprophytic mold that can cause, by direct cutaneous inoculation, invasive infections associated with illness and death.
侵袭性真菌病是免疫功能低下患者发病和死亡的重要原因。除曲霉菌外，霉菌感染在血液系统癌症患者中越来越常见，但尚未有这些感染的流行报告。
描述严重中性粒细胞减少患者中由淡紫拟青霉引起的侵袭性真菌病暴发。
暴发调查。
瑞士巴塞尔大学医院血液肿瘤隔离与骨髓移植科。
1993年8月17日（淡紫拟青霉感染首次出现之日）至1993年10月31日（该科室关闭时）连续收治的25例患者。
临床和微生物学数据，包括组织学检查结果；多个患者部位的培养物；以及对潜在空气传播、胃肠外传播、肠道传播和水平传播途径的环境检查。感染定义为从临床明显的皮肤疹中分离出淡紫拟青霉。
25例患者中有12例（48%）感染或定植。9例患者（36%），包括所有骨髓移植受者，有记录的侵袭性淡紫拟青霉感染。所有9例感染患者均有丘疹、脓疱或坏死性皮肤疹。2例严重移植物抗宿主病患者死于难治性真菌病；1例还患有微生物学证实的眼内炎和肾脏浸润。7例受影响患者骨髓功能恢复后不再有淡紫拟青霉。该菌在体外对两性霉素B、伊曲康唑和氟康唑耐药。患者对这些药物无临床反应。此次暴发最终追溯到一种受污染的市售药用皮肤洗剂。召回皮肤洗剂后暴发结束，随访2年未再发生。
受污染的皮肤洗剂是免疫功能低下宿主机会性真菌感染的潜在原因。淡紫拟青霉是一种常见的腐生霉菌，可通过直接皮肤接种引起与发病和死亡相关的侵袭性感染。
