ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others
ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others
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DOI：
10.1111/1469-0691.12465
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发表时间：
2014-04-01
影响因子：
14.2
通讯作者：
Lass-Floerl, C.
中科院分区：
文献类型：
--
作者：
Tortorano, A. M.;Richardson, M.;Lass-Floerl, C.
在透明丝酵母菌群中总结的真菌病是异质性的，由透明（非真菌）菌丝的存在来定义。与透明丝酵菌病有关的生物数量正在增加，临床上最重要的物种属于镰刀菌属，Scedosporium, Acremonium, Scopulariopsis， Purpureocillium和Paecilomyces。严重免疫功能低下的患者特别容易受到感染，其临床表现从定植到慢性局部病变到急性侵袭性和/或播散性疾病不等。诊断通常需要分离和鉴定感染病原体。镰状螺旋体病预后不良，早期治疗局部疾病对于防止进展为更具侵袭性或播散性感染很重要。治疗应包括伏立康唑和手术清创，如果可能或泊沙康唑作为挽救治疗。伏立康唑是由塞多孢子属成员引起的感染的一线治疗方法。对于顶孢菌、Scopulariopsis、紫毛霉和拟青霉的最佳抗真菌处理尚未确定。治疗通常包括手术和抗真菌治疗，这取决于临床表现。
Mycoses summarized in the hyalohyphomycosis group are heterogeneous, defined by the presence of hyaline (non-dematiaceous) hyphae. The number of organisms implicated in hyalohyphomycosis is increasing and the most clinically important species belong to the genera Fusarium, Scedosporium, Acremonium, Scopulariopsis, Purpureocillium and Paecilomyces. Severely immunocompromised patients are particularly vulnerable to infection, and clinical manifestations range from colonization to chronic localized lesions to acute invasive and/or disseminated diseases. Diagnosis usually requires isolation and identification of the infecting pathogen. A poor prognosis is associated with fusariosis and early therapy of localized disease is important to prevent progression to a more aggressive or disseminated infection. Therapy should include voriconazole and surgical debridement where possible or posaconazole as salvage treatment. Voriconazole represents the first-line treatment of infections due to members of the genus Scedosporium. For Acremonium spp., Scopulariopsis spp., Purpureocillium spp. and Paecilomyces spp. the optimal antifungal treatment has not been established. Management usually consists of surgery and antifungal treatment, depending on the clinical presentation.