Aspergillus niger: an unusual cause of invasive pulmonary aspergillosis.
Aspergillus niger: an unusual cause of invasive pulmonary aspergillosis.
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尼日尔曲霉：浸润性肺曲霉病的异常原因。
DOI：
10.1099/jmm.0.018309-0
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发表时间：
2010-07
影响因子：
3
通讯作者：
Stout JE
中科院分区：
文献类型：
--
作者：
Person AK;Chudgar SM;Norton BL;Tong BC;Stout JE
由曲霉菌引起的感染会引起显著的发病率和死亡率。大多数是烟曲霉，其次是黄曲霉和地曲霉。黑曲霉是一种很少被报道为引起肺炎的霉菌。一个72岁的女性慢性阻塞性肺疾病和颞动脉炎长期类固醇治疗出现咯血和胸膜炎胸痛。胸片显示右肺上叶非均匀实变区伴空化。诱导细菌痰培养、抗酸涂片和培养均为阴性。真菌痰培养生长黑曲霉。患者经经验性抗菌药物与伏立康唑联合治疗后临床好转，随后采用伏立康唑单药治疗。然而，伏立康唑治疗4周后，重复胸部计算机断层扫描显示感染明显进展，右肺上叶几乎完全坏死。血清伏立康唑水平低正常（1.0 μg ml−1，正常范围0.5 ~ 6.0 μg ml−1）。支气管肺泡灌洗标本中再次检出黑曲霉。行右上肺叶切除术，肺组织培养生长黑曲霉。肺组织病理学表现为急性组织性肺炎，真菌菌丝和草酸盐结晶，证实侵袭性黑曲霉感染。黑曲霉，不像烟曲霉和黄曲霉，不常被认为是侵袭性曲霉病（IA）的原因。在组织病理学标本中发现草酸钙晶体是典型的黑曲霉感染，即使在没有分生孢子的情况下也有助于诊断。鉴于伏立康唑的口服生物利用度差异很大，治疗药物监测可能有助于优化IA的治疗。
Infections due to Aspergillus species cause significant morbidity and mortality. Most are attributed to Aspergillus fumigatus, followed by Aspergillus flavus and Aspergillus terreus. Aspergillus niger is a mould that is rarely reported as a cause of pneumonia. A 72-year-old female with chronic obstructive pulmonary disease and temporal arteritis being treated with steroids long term presented with haemoptysis and pleuritic chest pain. Chest radiography revealed areas of heterogeneous consolidation with cavitation in the right upper lobe of the lung. Induced bacterial sputum cultures, and acid-fast smears and cultures were negative. Fungal sputum cultures grew A. niger. The patient clinically improved on a combination therapy of empiric antibacterials and voriconazole, followed by voriconazole monotherapy. After 4 weeks of voriconazole therapy, however, repeat chest computed tomography scanning showed a significant progression of the infection and near-complete necrosis of the right upper lobe of the lung. Serum voriconazole levels were low–normal (1.0 μg ml−1, normal range for the assay 0.5–6.0 μg ml−1). A. niger was again recovered from bronchoalveolar lavage specimens. A right upper lobectomy was performed, and lung tissue cultures grew A. niger. Furthermore, the lung histopathology showed acute and organizing pneumonia, fungal hyphae and oxalate crystallosis, confirming the diagnosis of invasive A. niger infection. A. niger, unlike A. fumigatus and A. flavus, is less commonly considered a cause of invasive aspergillosis (IA). The finding of calcium oxalate crystals in histopathology specimens is classic for A. niger infection and can be helpful in making a diagnosis even in the absence of conidia. Therapeutic drug monitoring may be useful in optimizing the treatment of IA given the wide variations in the oral bioavailability of voriconazole.
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影响因子：
4.9
作者：
Smith, J;Safdar, N;Andes, D
通讯作者：
Andes, D
DOI：
10.1056/nejmoa0802629
发表时间：
2008-10-23
期刊：
The New England journal of medicine
影响因子：
--
作者：
Bochud PY;Chien JW;Marr KA;Leisenring WM;Upton A;Janer M;Rodrigues SD;Li S;Hansen JA;Zhao LP;Aderem A;Boeckh M
通讯作者：
Boeckh M
DOI：
10.1016/s0022-5223(98)70443-x
发表时间：
1998-01-01
影响因子：
6
作者：
Baron, O;Guillaumé, B;Michaud, JL
通讯作者：
Michaud, JL
影响因子：
--
作者：
Danner, Bernhard C;Didilis, Vassilios;Schondube, Friedrich A
通讯作者：
Schondube, Friedrich A
影响因子：
6.9
作者：
Loudon, KW;Coke, AP;Morris, CQ
通讯作者：
Morris, CQ