The impact of culture isolation of Aspergillus species:: A hospital-based survey of aspergillosis
The impact of culture isolation of Aspergillus species:: A hospital-based survey of aspergillosis
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DOI：
10.1086/323900
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发表时间：
2001-12-01
影响因子：
11.8
通讯作者：
Stevens, DA
中科院分区：
文献类型：
--
作者：
Perfect, JR;Cox, GM;Stevens, DA
术语“曲霉病”包括几类感染：侵袭性曲霉病;慢性坏死性曲霉病;曲霉瘤或真菌球;和过敏性支气管肺炎曲霉病。在24个医疗中心，我们研究了曲霉菌培养阳性对这些疾病的诊断、危险因素、管理和结局的影响。大多数来自非无菌身体部位的曲霉菌培养分离株并不代表疾病。然而，对于高风险患者，如异基因骨髓移植受者（60%），血液癌症患者（50%），以及有中性粒细胞减少症（60%）或营养不良（30%）体征的患者，阳性培养结果与侵袭性疾病相关。当人类免疫缺陷病毒感染（20%），实体器官移植（20%），皮质类固醇使用（20%）或潜在的肺部疾病（10%）等风险因素与阳性培养结果相关时，临床判断和更好的诊断测试是必要的。侵袭性曲霉菌病的治疗仍然不理想：只有38%的患者在诊断后3个月存活。慢性坏死性曲霉病、曲霉瘤和过敏性支气管肺曲霉病有不同的治疗策略和较好的短期预后。
The term "aspergillosis" comprises several categories of infection: invasive aspergillosis; chronic necrotizing aspergillosis; aspergilloma, or fungus ball; and allergic bronchopulmonary aspergillosis. In 24 medical centers, we examined the impact of a culture positive for Aspergillus species on the diagnosis, risk factors, management, and outcome associated with these diseases. Most Aspergillus culture isolates from nonsterile body sites do not represent disease. However, for high-risk patients, such as allogeneic bone marrow transplant recipients (60%), persons with hematologic cancer (50%), and those with signs of neutropenia (60%) or malnutrition (30%), a positive culture result is associated with invasive disease. When such risk factors as human immunodeficiency virus infection (20%), solid-organ transplantation (20%), corticosteroid use (20%), or an underlying pulmonary disease (10%) are associated with a positive culture result, clinical judgment and better diagnostic tests are necessary. The management of invasive aspergillosis remains suboptimal: only 38% of patients are alive 3 months after diagnosis. Chronic necrotizing aspergillosis, aspergilloma, and allergic bronchopulmonary aspergillosis have variable management strategies and better short-term outcomes.