Invasive Fungal Infections in Patients with Chronic Granulomatous Disease
Invasive Fungal Infections in Patients with Chronic Granulomatous Disease
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DOI：
10.1007/978-1-4614-4726-9_3
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发表时间：
2013-01-01
期刊：
影响因子：
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通讯作者：
Warris, Adilia
中科院分区：
文献类型：
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作者：
Henriet, Stefanie;Verweij, Paul E.;Warris, Adilia
侵袭性真菌感染是慢性肉芽肿病（CGD）患者的主要威胁。本研究通过广泛回顾流行病学、临床、诊断和治疗数据，对CGD宿主中已发表的侵袭性真菌感染进行了全面概述。除了通常轻微的临床表现外，目前使用的侵袭性曲霉病诊断在CGD患者中的敏感性较低，并且不能容易地转化为这种非曲霉菌病宿主。烟曲霉（Aspergillus fumigatus）和A. nidulans是最常见的孤立物种。A.在其他免疫功能低下的患者中很少报告nidulans感染，这表明该真菌与CGD宿主之间存在独特的相互作用。毛霉菌病的发生主要是在用免疫抑制药物治疗炎症并发症的情况下。念珠菌感染是罕见的，不引起皮肤粘膜疾病，但确实显示出年龄依赖性的临床表现。CGD患者对多种真菌病原体敏感，这表明需要确定致病真菌，通常通过侵入性诊断，以指导最佳和合理的治疗。这篇综述总结了目前对CGD患者侵袭性真菌感染的认识，并将作为指导最佳治疗策略的起点，并指导旨在改善预后的进一步研究。
Invasive fungal infections are a major threat for chronic granulomatous disease (CGD) patients. The present study provides a comprehensive overview of published invasive fungal infections in the CGD host through an extensive review of epidemiological, clinical, diagnostic and therapeutic data. In addition to the often mild clinical presentation, the currently used diagnostics for invasive aspergillosis have low sensitivity in CGD patients and cannot be easily translated to this non-neutropenic host. Aspergillus fumigatus and A. nidulans are the most commonly isolated species. A. nidulans infections are seldom reported in other immunocompromised patients, indicating a unique interaction between this fungus and the CGD host. The occurrence of mucormycosis is mainly noted in the setting of treatment of inflammatory complications with immunosuppressive drugs. Candida infections are infrequently seen and do not cause mucocutaneous disease but do show an age-dependent clinical presentation. The CGD patient is susceptible to a wide range of fungal pathogens, indicating the need to determine the causative fungus, often by invasive diagnostics, to guide optimal and rational treatment. This review summarizes current understanding of invasive fungal infections in patients with CGD and will serve as a starting point to guide optimal treatment strategies and to direct further research aimed at improving outcomes.