Burgner D, Eagles G, Burgess M, Procopis P, Rogers M, Muir D, Pritchard R, Hocking A, Priest M
Department of Microbiology, Royal Alexandra Hospital for Children, Westmead, NSW, Australia.
J Clin Microbiol. 1998 Apr;36(4):1146-50. doi: 10.1128/JCM.36.4.1146-1150.1998.
The first reported human case of possible disseminated infection with the insect pathogen Metarrhizium anisopliae var. anisopliae, a fungus which has been used commercially for biocontrol of insects, is described. The patient, a 9-year-old boy, had a 5-year history of pre-B-cell acute lymphoblastic leukemia and had been on chemotherapy throughout this period. After 10 days of profound neutropenia, lesions consistent with ecthyma gangrenosum appeared on his arms and legs. M. anisopliae was grown from specimens from three separate sites, collected at different times over a period of 1 month: a skin biopsy, a swab from the base of a lesion, and the core of another skin lesion which spontaneously discharged. The initial skin biopsy also showed histological evidence of epidermal necrosis and dermal invasion with fungal hyphae. A computed-tomography (CT) scan of the chest demonstrated a lesion in the superior segment of the lower lobe of the left lung. A CT scan of the brain revealed a lesion in the left temporoparietal region of the brain, consistent with an abscess. Despite antifungal treatment including liposomal amphotericin and 5-flucytosine, the patient eventually died. The initial portal of entry is unknown, but hematogenous dissemination to the skin appears likely because of the multiple ecthymic lesions, and the appearances of the brain lesion on the CT scan are consistent with a hematogenous fungal abscess.
本文描述了首例报告的可能由昆虫病原体绿僵菌变种（一种已在商业上用于昆虫生物防治的真菌）引起播散性感染的人类病例。患者为一名9岁男孩，有前B细胞急性淋巴细胞白血病病史5年，在此期间一直在接受化疗。在严重中性粒细胞减少10天后，其手臂和腿部出现了与坏疽性脓皮病相符的皮损。从1个月内不同时间采集的三个不同部位的标本中培养出了绿僵菌：一份皮肤活检标本、一份取自皮损底部的拭子标本，以及另一个自发排出的皮肤损害的核心部位标本。最初的皮肤活检还显示有表皮坏死和真菌菌丝侵入真皮的组织学证据。胸部计算机断层扫描（CT）显示左肺下叶上段有一个病灶。脑部CT扫描显示脑左侧颞顶叶区域有一个病灶，符合脓肿表现。尽管接受了包括脂质体两性霉素和5-氟胞嘧啶在内的抗真菌治疗，患者最终仍死亡。最初的感染途径尚不清楚，但由于多处脓皮病损，血行播散至皮肤似乎很可能，且CT扫描显示的脑部病灶表现符合血行性真菌脓肿。
