PRIMARY CUTANEOUS ASPERGILLOSIS ASSOCIATED WITH HICKMAN INTRAVENOUS CATHETERS
PRIMARY CUTANEOUS ASPERGILLOSIS ASSOCIATED WITH HICKMAN INTRAVENOUS CATHETERS
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DOI：
10.1056/nejm198710293171802
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发表时间：
1987-10-29
影响因子：
158.5
通讯作者：
TAN, C
中科院分区：
文献类型：
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作者：
ALLO, MD;MILLER, J;TAN, C
我们描述了9例原发性皮肤曲霉菌病发生在希克曼静脉导管部位的血液系统癌症患者。我们的患者年龄在17至74岁之间，均因原发病或化疗而免疫功能低下，放置希克曼导管为化疗或高营养或两者提供静脉通路。感染的临床体征包括锁骨下静脉入口点、皮下隧道或皮肤出口部位的红斑、硬结和皮肤或皮下坏死。除一名患者外，所有患者的黄曲霉菌伤口培养均呈阳性。治疗包括静脉注射阿替霉素B、口服氟胞嘧啶和局部伤口护理。3例患者完全恢复，无需手术清创;其他3例患者经手术清创和延迟移植后恢复。两名患者死于播散性曲霉菌病，一名患者在从原发性皮肤曲霉菌病恢复期间死于无关原因。成功的治疗需要再生障碍性贫血或白细胞减少症的解决，导管移除，用阿替霉素B进行全身治疗，以及局部伤口护理。我们的结论是原发性皮肤曲霉菌病，一种罕见的感染，可能发生在免疫功能低下的患者希克曼导管的网站，这是一个严重的并发症，需要及时诊断和治疗。
We describe nine patients with underlying hematologic cancer in whom primary cutaneous aspergillosis developed at the sites of Hickman intravenous catheters. Our patients, 17 to 74 years of age, were all immunocompromised either from their primary disease or from chemotherapy, and the Hickman catheters had been placed to provide venous access for chemotherapy or hyperalimentation or both. Clinical signs of infection included erythema, induration, and cutaneous or subcutaneous necrosis at the point of entry into the subclavian vein, in the subcutaneous tunnel, or at the exit site from the skin. Diagnosis was confirmed by positive wound culture for Aspergillus flavus in all but one patient. Treatment consisted of intravenous amphotericin B, oral flucytosine, and local wound care. Three patients recovered completely without operative debridement; three others recovered after operative debridement and delaying grafting. Two patients died of disseminated aspergillosis, and one died of unrelated causes while recovering from primary cutaneous aspergillosis. Successful treatment required resolution of aplasia or leukopenia, catheter removal, systemic treatment with amphotericin B, and local wound care. We conclude that primary cutaneous aspergillosis, a rare infection, may occur at the sites of Hickman catheters in immunocompromised patients, and that it is a serious complication requiring prompt diagnosis and treatment.