Groll A H, Jaeger G, Allendorf A, Herrmann G, Schloesser R, von Loewenich V
Department of Pediatrics, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany.
Clin Infect Dis. 1998 Sep;27(3):437-52. doi: 10.1086/514717.
We report a fatal case of invasive pulmonary aspergillosis in a severely ill neonate and review 43 additional cases of invasive aspergillosis reported from 1955 through 1996 that occurred during the first 3 months of life. Eleven of the 44 patients had primary cutaneous aspergillosis, 10 had invasive pulmonary aspergillosis, and 14 had disseminated disease. Most infections were nosocomial in origin. Prematurity (43%); proven chronic granulomatous disease (14%); and a complex of diarrhea, dehydration, malnutrition, and invasive bacterial infections (23%) accounted for the majority of underlying conditions. At least 41% of the patients had received corticosteroid therapy before diagnosis, but only one patient had been neutropenic. Among patients who received medical and/or surgical treatment, outcome was relatively favorable, with an overall survival rate of 73%. Invasive aspergillosis may occur in neonates and young infants and warrants consideration under certain circumstances. Current therapeutic approaches consist of high-dose amphotericin B and appropriate surgical interventions.
我们报告了1例重症新生儿侵袭性肺曲霉病致死病例，并回顾了1955年至1996年间报告的另外43例在出生后前3个月发生的侵袭性曲霉病病例。44例患者中，11例有原发性皮肤曲霉病，10例有侵袭性肺曲霉病，14例有播散性疾病。大多数感染起源于医院。早产（43%）、确诊的慢性肉芽肿病（14%）以及腹泻、脱水、营养不良和侵袭性细菌感染综合征（23%）占大多数基础疾病。至少41%的患者在诊断前接受过皮质类固醇治疗，但只有1例患者存在中性粒细胞减少。在接受药物和/或手术治疗的患者中，预后相对良好，总生存率为73%。侵袭性曲霉病可能发生在新生儿和幼儿中，在某些情况下值得考虑。目前的治疗方法包括大剂量两性霉素B和适当的手术干预。
