Cutaneous Invasive Aspergillosis: Retrospective Multicenter Study of the French Invasive-Aspergillosis Registry and Literature Review.
Cutaneous Invasive Aspergillosis: Retrospective Multicenter Study of the French Invasive-Aspergillosis Registry and Literature Review.
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DOI：
10.1097/md.0000000000001018
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发表时间：
2015-07
期刊：
影响因子：
1.6
通讯作者：
French Mycosis Study Group
中科院分区：
文献类型：
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作者：
Bernardeschi C;Foulet F;Ingen-Housz-Oro S;Ortonne N;Sitbon K;Quereux G;Lortholary O;Chosidow O;Bretagne S;French Mycosis Study Group
侵袭性曲霉病(IA)在免疫功能低下的患者中预后不良。如果出现皮肤表现，应有助于早期诊断。作者的目的是提供一个独特的临床系列中，原发性皮肤IA(PCIA)和继发性CIA(SCIA)的患病率数据和临床及组织学描述，并提供有关CIA的详尽文献综述的结果。从法国巴斯德研究所国家侵袭性真菌病和抗真菌药物参考中心持有的预期多中心曲霉菌病数据库中，对2005至2010年间登记的确诊和可能有皮肤症状的IA病例进行回顾性提取。患者被分为PCIA(即无皮肤外表现的CIA)或SCIA(即播散性IA)。在1,410名确诊或可能患有IA的患者中，15名患者患有CIA(1.06%)，5名患者患有PCIA，10名患者患有SCIA。恶性血液病是主要的基础疾病(12/15)。PCIA表现为各种部位的浸润性和/或化脓性病变，与导管部位无关(4/5)，而SCIA主要表现为播散性丘疹和结节，有时也有孤立结节或蜂窝织炎。11例患者有组织学资料，9例(与PCIA和SCIA相似)显示致密的真皮多形性炎症浸润物，仅PCIA患者的表皮发生改变。高碘酸席夫和Gomori-Grocott亚甲胺硝酸银染色除2例外，其余均显示菌丝与曲霉菌相容。所有PCIA患者均检出黄曲霉，其中以烟曲霉菌最多见(6/10)。5例PCIA患者中有2例手术治疗。PCIA组和SCIA组的3个月生存率分别为100%和30%。我们的研究是最大的成人CIA系列，为该病提供了完整的临床和组织学数据。原发性皮肤IA应及早识别，广泛坏死者应手术治疗；其预后与SCIA明显不同。免疫功能低下患者的任何化脓性、坏死性、丘疹结节或浸润性皮肤损害应立即进行活检，以进行组织学分析和真菌学皮肤直接检查和培养。
Invasive aspergillosis (IA) has poor prognosis in immunocompromised patients. Skin manifestations, when present, should contribute to an early diagnosis. The authors aimed to provide prevalence data and a clinical and histologic description of cutaneous manifestations of primary cutaneous IA (PCIA) and secondary CIA (SCIA) in a unique clinical series of IA and present the results of an exhaustive literature review of CIA. Cases of proven and probable IA with cutaneous manifestations were retrospectively extracted from those registered between 2005 and 2010 in a prospective multicenter aspergillosis database held by the National Reference Center for Invasive Mycoses and Antifungals, Pasteur Institute, France. Patients were classified as having PCIA (i.e., CIA without extracutaneous manifestations) or SCIA (i.e., disseminated IA). Among the 1,410 patients with proven or probable IA, 15 had CIA (1.06%), 5 PCIA, and 10 SCIA. Hematological malignancies were the main underlying condition (12/15). Patients with PCIA presented infiltrated and/or suppurative lesions of various localizations not related to a catheter site (4/5), whereas SCIA was mainly characterized by disseminated papules and nodules but sometimes isolated nodules or cellulitis. Histologic data were available for 11 patients, and for 9, similar for PCIA and SCIA, showed a dense dermal polymorphic inflammatory infiltrate, with the epidermis altered in PCIA only. Periodic acid Schiff and Gomori-Grocott methenamine silver nitrate staining for all but 2 biopsies revealed hyphae compatible with Aspergillus. Aspergillus flavus was isolated in all cases of PCIA, with Aspergillus fumigatus being the most frequent species (6/10) in SCIA. Two out 5 PCIA cases were treated surgically. The 3-month survival rate was 100% and 30% for PCIA and SCIA, respectively. Our study is the largest adult series of CIA and provides complete clinical and histologic data for the disease. Primary cutaneous IA should be recognized early, and cases of extensive necrosis should be treated surgically; its prognosis markedly differs from that for SCIA. Any suppurative, necrotic, papulonodular, or infiltrated skin lesion in an immunocompromised patient should lead to immediate biopsy for histologic analysis and mycological skin direct examination and culture.