Disseminated aspergillosis in intensive care unit patients:: An autopsy study
Disseminated aspergillosis in intensive care unit patients:: An autopsy study
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DOI：
10.1179/joc.2003.15.1.71
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发表时间：
2003-02-01
影响因子：
1.8
通讯作者：
Vincent, JL
中科院分区：
文献类型：
--
作者：
Dimopoulos, G;Piagnerelli, M;Vincent, JL
播散性曲霉菌病是一种罕见但在危重人群中常常致命的疾病。研究表明这种疾病的发病率正在增加，并且该人群中可用的流行病学数据相对较少，我们对一所学术大学医院的 31 个床位混合内外科重症监护病房 (ICU) 一年内尸检发现的播散性曲霉病病例进行了评估。 1999年，2984人入住ICU，其中489人死亡，并进行了222人尸检。尸检显示，6 例（2.7%）尸检患者患有累及非邻近器官的播散性曲霉菌病，其中 5 名患者（占总数的 2.3%）患有慢性阻塞性肺疾病 (COPD)，并因肺部感染接受了皮质类固醇和机械通气治疗。一名患者还患有粒细胞减少症。每名患者入住 ICU 后，痰液和支气管肺泡灌洗 (BAL) 培养物均呈烟曲霉阳性，但这被认为是定植，因此患者因疑似念珠菌感染而接受了氟康唑治疗。总之，接受皮质类固醇治疗并出现肺部感染的慢性阻塞性肺病患者应被视为患有播散性曲霉菌病的风险。入住 ICU 后迅速致命的结果表明曲霉定植可能发生在入住 ICU 之前。
Disseminated aspergillosis is an uncommon but frequently fatal disease in critically ill populations. With studies suggesting that the incidence of this disease is increasing, and with relatively few epidemiological data available in this population, we evaluated cases of disseminated aspergillosis identified at autopsy over a one-year period on a 31-bed mixed medico-surgical intensive care unit (ICU) of an academic university hospital. In 1999, there were 489 deaths out of 2984 ICU admissions, and 222 autopsies were performed. Post-mortem examination demonstrated disseminated aspergillosis involving non-contiguous organs in 6 (2.7%) autopsies and, of these, five patients (2.3% of total) had had chronic obstructive pulmonary disease (COPD) and had been treated with corticosteroids and mechanical ventilation for pulmonary infection. One patient also had granulocytopenia. In each patient, sputum and bronchoalveolar lavage (BAL) cultures had been positive for Aspergillus fumigatus after ICU admission but this was considered as colonization and the patients were given fluconazole for suspected candidal infection. In conclusion, COPD patients treated with corticosteroids and presenting with pulmonary infection should be considered at risk for disseminated aspergillosis. The rapidly fatal outcome after ICU admission suggests that colonization with Aspergillus can occur before ICU admission.