Jabado N, Casanova J L, Haddad E, Dulieu F, Fournet J C, Dupont B, Fischer A, Hennequin C, Blanche S
Unité d'Immuno-Hèmatologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France.
Clin Infect Dis. 1998 Dec;27(6):1437-41. doi: 10.1086/515015.
Scedosporium apiospermum is an opportunistic fungus in humans. The incidence of S. apiospermum infection in patients with acquired neutropenia (e.g., patients receiving chemotherapy and bone marrow transplant recipients) is steadily increasing. S. apiospermum has poor in vitro susceptibility to "conventional" antifungal agents, rendering the management of infections complex. Patients with chronic granulomatous disease (CGD) are highly susceptible to fungal infections, which are mostly due to Aspergillus species. We describe two children with CGD and invasive pulmonary infection due to S. apiospermum. Both patients were treated with antifungal therapy including azole derivatives (itraconazole or voriconazole) and surgical resection of infected tissues. These cases highlight that scedosporium infection can closely mimic aspergillus infection and should be considered in any case in which there is a failure to respond to appropriate "conventional" antifungal therapy. We also suggest that the emergence of this pathogen may have been favored by long-term use of amphotericin B in both patients.
尖端赛多孢是人类中的一种机会性真菌。获得性中性粒细胞减少症患者（如接受化疗的患者和骨髓移植受者）中尖端赛多孢感染的发生率正在稳步上升。尖端赛多孢对“传统”抗真菌药物的体外敏感性较差，使得感染的管理变得复杂。慢性肉芽肿病（CGD）患者极易发生真菌感染，主要是由曲霉菌种引起。我们描述了两名患有CGD且因尖端赛多孢导致侵袭性肺部感染的儿童。两名患者均接受了包括唑类衍生物（伊曲康唑或伏立康唑）在内的抗真菌治疗以及感染组织的手术切除。这些病例突出表明，赛多孢感染可酷似曲霉菌感染，在对适当的“传统”抗真菌治疗无反应的任何情况下都应予以考虑。我们还认为，长期使用两性霉素B可能促成了这两名患者体内该病原体的出现。
