Management of pulmonaryScedosporium apiospermuminfection by thoracoscopic surgery in an immunocompetent woman
Management of pulmonaryScedosporium apiospermuminfection by thoracoscopic surgery in an immunocompetent woman
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通过胸腔镜手术治疗免疫功能正常女性的肺部尖端足孢子菌感染
DOI：
10.1177/0300060520931620
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发表时间：
2020-07-01
影响因子：
1.6
通讯作者：
Jiang，Hongli
中科院分区：
文献类型：
--
作者：
Liu，Wei;Feng，Ruizhi;Jiang，Hongli
顶精子隐孢子菌复合体是一组新兴的机会性真菌病原体，可影响免疫功能低下和免疫功能正常的个体，最常见的是通过肺部感染。虽然它们对许多抗真菌药物具有耐药性，但这组病原体对唑类药物，特别是伏立康唑具有良好的敏感性。在这里，我们描述了一个健康的44岁妇女的管理顶精子链球菌感染。入院前2年间歇性咯血。计算机断层扫描显示左上叶一薄壁、边界清楚的空洞性病变；病变充满实变性混浊。支气管肺泡灌洗液标本真菌培养呈灰白色霉菌；乳酚棉蓝染色显示尖孢葡萄具有尖孢葡萄的特征，呈锐角、分枝、隔的透明圆柱状菌丝。伏立康唑200mg，每日2次，连用8周，未见改善；因此，通过胸腔镜手术切除了她的左上肺叶。她的症状立即改善，手术切除后的胸片显示没有放射学进展或复发的证据。本报告表明，在免疫功能正常的宿主中，顶精子葡萄球菌肺部感染可能对伏立康唑没有很好的反应；因此，手术可以治愈这些病人。
The Scedosporium apiospermum complex is a group of emerging opportunistic fungal pathogens that affect both immunocompromised and immunocompetent individuals, most commonly via lung infection. Although they are resistant to many antifungal agents, this group of pathogens has a favorable susceptibility profile to azoles, especially voriconazole. Here, we describe the management of S. apiospermum infection in an otherwise healthy 44-year-old woman. She had exhibited intermittent hemoptysis for 2 years before admission to our hospital. Computed tomography revealed a thin-walled and well-circumscribed cavitary lesion in the left upper lobe; the lesion was filled with consolidative opacities. Fungal culture of bronchoalveolar lavage fluid specimens revealed grayish-white mold; lactophenol cotton blue staining revealed acute angle branched septate hyaline cylindrical hyphae, characteristic of S. apiospermum. Despite voriconazole 200 mg twice daily for 8 weeks, the patient showed no improvement; thus, her left upper lobe was removed via thoracoscopic surgery. Her symptoms immediately improved and chest radiography after surgical resection showed no evidence of radiological progression or reoccurrence. This report demonstrates that S. apiospermum lung infection may not respond well to voriconazole alone in immunocompetent hosts; thus, surgery could be curative for these patients.