侵袭性肺迟缓曲霉病一例报道_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

黄超 ¹ ,  刘倩茜 ¹ , 卿雯琪 ¹ , 郭珊珊 ¹ , 陈云凤 ¹ , 陈俊 ²

1. ;
2. ;

Corresponding author：

刘倩茜, Email: chuan112500@126.com

Keywords：

迟缓曲霉; 侵袭性肺曲霉菌病; 艾沙康唑

DOI：

10.7507/1671-6205.202307016

Video：

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目的通过本病例及综述以提升对侵袭性肺迟缓曲霉病早期病原学诊断的重视，并为治疗方案提供参考依据。方法回顾我科诊治的1例COVID-19感染后继发的侵袭性肺迟缓曲霉病患者的临床资料，复习既往文献总结分析肺迟缓曲霉病的临床表现、诊断及治疗用药方案。结果患者79岁，老年男性，咳嗽、咳痰伴呼吸困难4月余。胸部CT提示：双肺数个结节灶，部分结节内空洞形成；散在实变影。G实验、GM结果阴性。气管镜肺泡灌洗液送检mNGS查见迟缓曲霉菌。给予伏立康唑治疗后效不佳，且继发肝功能异常，调整为艾沙康唑治疗后临床症状及肺部影像学征象好转。复习文献，共有12例个案报道，其中8例存在免疫抑制状态，4例合并慢性阻塞性肺病，6例为器官移植术后。临床选药以伏立康唑和两性霉素B居多，虽经治疗仍有66.7%（8例）患者在确诊后7周内死亡。结论本例为国内外首次使用艾沙康唑成功治疗侵袭性肺迟缓曲霉病的报告。侵袭性肺迟缓曲霉病属于罕见病，免疫抑制状态是其高危因素。该病进展迅速，具有高度耐药性，预后差，病死率高，早期病原学诊断尤为关键。

Citation： 黄超, 刘倩茜, 卿雯琪, 郭珊珊, 陈云凤, 陈俊. 侵袭性肺迟缓曲霉病一例报道. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(4): 271-274. doi: 10.7507/1671-6205.202307016 Copy

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25.	Lamoth F, Calandra T. Pulmonary aspergillosis: diagnosis and treatment. Eur Respir Rev, 2022, 31(166).
26.	陈欣, 林韧. 艾沙康唑临床应用专家共识(2023版). 临床血液学杂志, 2023, 36(05): 295-302.

1. Patterson TF, Thompson GR, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis, 2016, 63(4): e1-e60.
2. Glampedakis E, Erard V, Lamoth F. Clinical Relevance and Characteristics of Aspergillus calidoustus and Other Aspergillus Species of Section Usti. J Fungi (Basel), 2020, 6(2): 84.
3. Nematollahi S, Permpalung N, Zhang SX, et al. Aspergillus lentulus: An Under-recognized Cause of Antifungal Drug-Resistant Aspergillosis. Open Forum Infect Dis, 2021, 8(8): b392.
4. Staab JF, Kahn JN, Marr KA. Differential Aspergillus lentulus echinocandin susceptibilities are Fksp independent. Antimicrob Agents Chemother, 2010, 54(12): 4992-4998.
5. Alhambra A, Catalan M, Moragues MD, et al. Isolation of Aspergillus lentulus in Spain from a critically ill patient with chronic obstructive pulmonary disease. Rev Iberoam Micol, 2008, 25(4): 246-249.
6. Montenegro G, Sanchez PS, Jewtuchowicz VM, et al. Phenotypic and genotypic characterization of Aspergillus lentulus and Aspergillus fumigatus isolates in a patient with probable invasive aspergillosis. J Med Microbiol, 2009, 58(Pt 3): 391-395.
7. Yoshida H, Seki M, Umeyama T, et al. Invasive pulmonary aspergillosis due to Aspergillus lentulus: Successful treatment of a liver transplant patient. J Infect Chemother, 2015, 21(6): 479-481.
8. Shivasabesan G, Logan B, Brennan X, et al. Disseminated Aspergillus lentulus Infection in a Heart Transplant Recipient: A Case Report. Clin Infect Dis, 2022, 75(7): 1235-1238.
9. Ahmed J, Singh G, Xess I, et al. Emerging Aspergillus lentulus infections in India. Indian J Med Microbiol, 2022, 40(1): 160-162.
10. Bastos VR, Santos DW, Padovan AC, et al. Early invasive pulmonary aspergillosis in a kidney transplant recipient caused by Aspergillus lentulus: first Brazilian report. Mycopathologia, 2015, 179(3-4): 299-305.
11. Zbinden A, Imhof A, Wilhelm M J, et al. Fatal outcome after heart transplantation caused by Aspergillus lentulus. Transpl Infect Dis, 2012, 14(5): E60-E63.
12. Gurcan S, Tikvesli M, Ustundag S, et al. A Case Report on Aspergillus lentulus Pneumonia. Balkan Med J, 2013, 30(4): 429-431.
13. Zhang H, Liu G, He L, et al. Life-threatening pulmonary coinfection with Mycobacterium tuberculosis and Aspergillus lentulus in a diabetic patient diagnosed by metagenome next-generation sequencing. BMC Infect Dis, 2023, 23(1): 88.
14. Imbert S, Normand AC, Cassaing S, et al. Multicentric Analysis of the Species Distribution and Antifungal Susceptibility of Cryptic Isolates from Aspergillus Section Fumigati. Antimicrob Agents Chemother, 2020, 64(12): e01374-20.
15. Balajee SA, Weaver M, Imhof A, et al. Aspergillus fumigatus variant with decreased susceptibility to multiple antifungals. Antimicrob Agents Chemother, 2004, 48(4): 1197-1203.
16. Alcazar-Fuoli L, Mellado E, Alastruey-Izquierdo A, et al. Aspergillus section Fumigati: antifungal susceptibility patterns and sequence-based identification. Antimicrob Agents Chemother, 2008, 52(4): 1244-1251.
17. Yu SY, Guo LN, Xiao M, et al. Clinical and Microbiological Characterization of Invasive Pulmonary Aspergillosis Caused by Aspergillus lentulus in China. Front Microbiol, 2020, 11: 1672.
18. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis, 2006, 42(10): 1417-1427.
19. Hoenigl M, Egger M, Price J, et al. Metagenomic Next-Generation Sequencing of Plasma for Diagnosis of COVID-19-Associated Pulmonary Aspergillosis. J Clin Microbiol, 2023, 61(3): e185922.
20. Gu L, Liu W, Ru M, et al. The application of metagenomic next-generation sequencing in diagnosing Chlamydia psittaci pneumonia: a report of five cases. BMC Pulm Med, 2020, 20(1): 65.
21. Zhang P, Chen Y, Li S, et al. Metagenomic next-generation sequencing for the clinical diagnosis and prognosis of acute respiratory distress syndrome caused by severe pneumonia: a retrospective study. PeerJ, 2020, 8: e9623.
22. Zhan W, Liu Q, Yang C, et al. Evaluation of metagenomic next-generation sequencing diagnosis for invasive pulmonary aspergillosis in immunocompromised and immunocompetent patients. Mycoses, 2023, 66(4): 331-337.
23. Diao Z, Han D, Zhang R, et al. Metagenomics next-generation sequencing tests take the stage in the diagnosis of lower respiratory tract infections. J Adv Res, 2022, 38: 201-212.
24. Qin Z, Zou Y, Huang Z, et al. Metagenomic next-generation sequencing contributes to the diagnosis of mixed pulmonary infection: a case report. Ann Clin Microbiol Antimicrob, 2022, 21(1): 52.
25. Lamoth F, Calandra T. Pulmonary aspergillosis: diagnosis and treatment. Eur Respir Rev, 2022, 31(166).
26. 陈欣, 林韧. 艾沙康唑临床应用专家共识(2023版). 临床血液学杂志, 2023, 36(05): 295-302.

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侵袭性肺迟缓曲霉病一例报道

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