- 期刊
Disseminated Fusarial solani Infection with Pulmonary Involvement in an Immunocompromised Patient-A Case Report and Literature Review
免疫功能不全病人發生全身性茄型鐮胞菌感染合併肺部侵犯－病例報告及文獻回顧
摘要
雖然化學治療可以改善血液腫瘤病人的預後，但是化學治療後發生免疫功能抑制卻會使得病人併發感染的機率增加，廣效性抗生素雖然在這些感染的控制上扮演一個重要的角色，但是卻會造成一些伺機性的黴菌感染，例如：麹黴菌、念珠菌這些較常見的黴菌感染，一些以前認為毒性較弱的黴菌，例如：鐮胞菌在臨床上卻越來越常見。我們報告一個急性骨髓白血病的病人，因為化學治療後白血球過低而併發全身性茄型鐮胞菌感染合併肺部和皮膚的侵犯，雖然我們用了lipid-base amphotericin B和voriconazole來治療，但病人最後仍然死亡。此外，我們針對茄型鐮胞菌感染的臨床表現及治療作一文獻回顧發現雖然鐮胞菌和麴黴菌有相似的臨床表現和病理切片結果，可是我們可由臨床上鐮胞菌較會有陽性血液培養結果〈50~70%〉，皮膚病灶〈60~70%〉和對傳統抗黴陽性菌藥如amphotericin B的治療效果不好，來高度懷疑是鐮胞菌的感染，而且在用amphotericin B治療效果不好的病人，可以考慮用voriconazole來治療，並用病人是否退燒、生命徵象是否穩定、血液培養是否轉陰性及皮膚病灶是否消失來評量治療的效果。此外病人的白血球過低現象對存活率有絕對的影響，因此除了給顆粒性白血球群落生長因子(G-CSF)外，顆粒性白血球灌輸也許可以幫助我們爭取時間來等病人白血球恢復正常。
並列摘要
Modern chemotherapy improves outcomes in patients with hematological malignancies. Unfortunately, the incidence of infectious complications increases as a result of the immunosuppression induced by chemotherapy. Broad-spectrum antibiotics have had a major role in the control of these infections, but their use results in the emergence of fungi as opportunistic pathogens. Aspergillus, Candida, and zygomycetous species account for the majority of such infections, but cases due to less virulent molds, including Fusarium species, are being recognized with increasing frequency. A case of disseminated Fusarial solani infection with lung and skin involvement in a patient with acute myeloid leukemia (AML) is reported. The patient died of fusariosis even though lipid-based amphotericin B formulations and voriconazole were administrated. The prognosis of disseminated fusarial infection in the immunocompromised host is usually poor. Profound and prolonged neutropenia appears to be the major predisposing and prognostic factor. The infection seems to respond to newer therapeutic approaches in patients who will ultimately recover from immunosuppression, but the infection may relapse if neutropenia recurs.
延伸閱讀
- Liu, W. L., Ku, S. C., & Yang, P. C. (2006). 肺部轉移性惡性黑色素細胞瘤合併支氣管內侵犯－一病例報告與文獻回顧. 胸腔醫學, 21(2), 182-189. https://doi.org/10.29806/TM.200604.0007
- Lin, S. S., Chen, Y. C., Chen, W. Y., & Kao, S. J. (2014). 以支氣管內病灶為表現的後天免疫缺乏症候群相關之肺內卡波西氏肉瘤－病例報告及文獻回顧. 胸腔醫學, 29(3), 174-181. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201406-201405160018-201405160018-174-181
- Jiang, B. Y., Shieh, W. B., Huang, T. J., Hua, C. C., & Yu, T. R. (2002). 支氣管放線菌症合併肺部非結核性分枝桿菌症：病例報告及文獻回顧. 胸腔醫學, 17(2), 137-142. https://www.airitilibrary.com/Article/Detail?DocID=10239855-200206-17-2-137-142-a
- Kao, C. H., Peng, S. L., & Chang, H. Y. (2014). 阻塞性細支氣管炎合併器質化肺炎－類風濕性關節炎的罕見肺部表現：病例報告及文獻回顧. 胸腔醫學, 29(5), 287-291. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201410-201410010010-201410010010-287-291
- Chen, S. C., Ho, M. W., Tu, C. Y., Pai, P. Y., & Shih, C. M. (2006). 人類後天免疫缺陷病毒感染所導致之肺動脈高壓－病例報告及文獻回顧. 胸腔醫學, 21(3), 261-267. https://doi.org/10.29806/TM.200606.0006