Invasive mould disease in haematologic patients: comparison between fusariosis and aspergillosis
Invasive mould disease in haematologic patients: comparison between fusariosis and aspergillosis
复制标题
DOI：
10.1016/j.cmi.2018.05.006
复制
发表时间：
2018-10-01
影响因子：
14.2
通讯作者：
Nucci, M.
中科院分区：
文献类型：
--
作者：
Nucci, F.;Nouer, S. A.;Nucci, M.
目的：比较侵袭性曲霉菌病（IA）和侵袭性镰刀菌病（IF）血液病患者的流行病学、临床表现、诊断、治疗和预后。我们回顾性分析了2006年至2017年期间诊断为IA的36例患者和诊断为IF的26例血液病患者的病历，并比较了基线特征、共存暴露、临床表现、治疗，结果：发热在IF中更常见（96.2% vs. 63.9%，p 0.003），而肺炎（88.9% vs. 50.0%，p 0.001）和鼻窦炎（63.9% vs. 38.5%，p 0.048）在IA中更常见。皮肤病变和阳性血培养仅发生在IF患者中。在肺炎患者中，晕轮征在IA中更常见（62.5% vs. 23.1%，p 0.02）。88.6%的IA患者和73.3%的IF患者血清半乳甘露聚糖阳性（p 0.18），阳性检测的中位数和半乳甘露聚糖值无差异。阳性血清半乳甘露聚糖加肺浸润是IA的主要临床表现，发生在13例IF和肺受累患者中的4例。IA和IF的30天生存率分别为77.7%和46.1%（p 0.01）。结论：IA和IF具有相同的流行病学背景，但大多数病例的临床表现不同，IA的气道疾病，IF的发热、转移性皮肤病变和血培养阳性。然而，相当一部分IF患者的临床表现与IA相似，包括发热、肺浸润和血清半乳甘露聚糖阳性。(C)2018年欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: To compare the epidemiology, clinical presentation, diagnosis, treatment, and outcome of haematologic patients with invasive aspergillosis (IA) or invasive fusariosis (IF).Methods: We retrospectively reviewed the charts of 36 patients with IA and 26 with IF diagnosed between 2006 and 2017 in haematologic patients, and compared baseline characteristics, coexisting exposures, clinical manifestations, treatment, and the outcome.Results: Fever was more frequent in IF (96.2% vs. 63.9%, p 0.003), whereas pneumonia (88.9% vs. 50.0%, p 0.001) and sinusitis (63.9% vs. 38.5%, p 0.048) were more frequent in IA. Skin lesions and positive blood cultures occurred exclusively in patients with IF. Among patients with pneumonia, the halo sign was more frequent in IA (62.5% vs. 23.1%, p 0.02). Serum galactomannan was positive in 88.6% of patients with IA and in 73.3% with IF (p 0.18), with no differences in the median number of positive tests and galactomannan values. Positive serum galactomannan plus lung infiltrates was the predominant clinical presentation in IA and occurred in four of 13 patients with IF and lung involvement. The 30-day survival was 77.7% in IA and 46.1% in IF (p 0.01).Conclusions: IA and IF share the same epidemiologic scenario but different clinical presentations in the majority of cases, with disease in the airways in IA, and fever, metastatic skin lesions, and positive blood cultures in IF. However, a substantial proportion of patients with IF present with a clinical picture similar to IA, with fever, lung infiltrates, and positive serum galactomannan. (C) 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.