- 期刊
Trichosporon Beigelii Causing Oral Mucositis and Fungemia: Report of One Case
巨毛發芽胞菌引起的口腔粘膜炎和黴菌血症：一病例報告
摘要
二十三個月大男童，為一急性骨髓性白血病(Acute Myelomoncytic leukemia)的患者，住院接受化學治療。住院第八天，接受為期一星期之epirubicin和cytosine arabinoside等化學藥劑治療。病人從第十六天起，發生持續性低中性球血症、腹瀉和間歇性高燒（39℃至41.2℃）。首先使用ceftazidime和amikacin的治療，各每八小時靜脈注射一次。血液培養長出肺炎克雷白氏桿菌(Klebsitella pneumoniae)，病人退燒一天。但先後又出現口腔粘膜炎(mucositis)和注射處發生血管靜脈炎，因而加上口服抗黴菌藥nystatin和靜脈注射oxacillin。經過一陣串的治療後，病人仍處於低中性球血症和逐漸惡化的病況，第二十四天血液和口腔粘膜組織培養初步報告皆長黴菌（後後鑑定皆為巨毛發芽胞菌Trichosporon beigelii），立刻將口服抗黴菌藥改為靜脈注射性抗黴菌藥amphotericin B，第二十五天，病人即已出現敗血性休克和弥漫性管内凝固病變(disseminated imtravascular coagulopathy)，不久便死亡。今提出此一病例報告，強調當病人處於免疫功能失常的情況下，若出現感染的癥候且對抗生素的治療反應不佳時，不能輕易忽視由不常見黴菌所引起感染的可能性，及早使用有效的抗黴菌素，以爭取挽救病人生命的先機。
並列摘要
A 23-month-old boy, a victim of acute myelomonocytic leukemia (AML), was admitted for chemotherapy. On the eighth hospital day, he started a one-week course of chemotherapy with agents of epirubicin and cytosine arabinoside. Unfortunately, persistent neutropenia, deteriorating diarrhea and intermittently spiking fever developed from the sixteenth hospital day. Initially, ceftazidime and amikacin were empirically utilized. Blood culture yielded Klebsiella pneumoniae and the fever subsided for one day. Unfortunately, oral mucositis and catheter-induced phlebitis developed subsequently. Subsequently, oral nystatin and intravenous oxacillin were added. The results of cultures from both blood and oral mucosal tissue yielded a fungus, Trichosporon beigelii. We changed from an oral antifungal agent to intravenous amphotericin B on the twenty-fourth hospital day. He presented signs of septic shock with disseminated intravascular coagulopathy and expired on the twenty-fifth hospital day after failure to respond to aggressive resuscitation. We report this case to emphasize that in cytotoxic chemotherapy-induced granulocytopenic AML patients who have compromised immune systems, and who may manifest some signs or symptoms of infection, and at the same time poorly respond to interventional antibiotic treatment, the possibility of T. beigelii infection can not be neglected.
延伸閱讀
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