东方伊蒙菌肺炎二例报告及文献复习_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

熊六波 ^1,3 , 罗梦 ^2,4 , 王倩 ³ , 王恋 ³ , 颜浩 ³ ,  贺建清 ¹

1. ;
2. ;
3. ;
4. ;

Corresponding author：

贺建清, Email: 18980602293@qq.com

Keywords：

东方伊蒙菌; 肺炎

DOI：

10.7507/1671-6205.202409088

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目的东方伊蒙菌（又称东方新兴真菌）属于伊蒙菌的一种菌属，是一种双向真菌，侵袭人类致肺炎罕见，常见于免疫低下人群，可导致患者呼吸衰竭危及生命。本文报道2例东方伊蒙菌肺炎患者。方法病例1：患者男，41岁，牧民，藏族，2020年4月就诊，有肾移植病史，为牧人，有马、羊、牛接触史，长期服用他克莫司、吗替麦考酚酯片。患者表现为咳嗽、胸痛1个月，胸部CT提示右肺下叶肺炎。支气管肺泡灌洗液（bronchoalveolar lavage fluid，BALF）培养1周及BALF行宏基因组二代测序（metagenomics next-generation sequencing，mNGS）均查见东方伊蒙菌，住院期间背部皮肤出现溃疡，分泌物培养查见东方伊蒙菌。给予泊沙康唑口服液治疗14个月复查胸部CT提示感染病灶完全吸收，随访4年目前生存良好。病例2：患者男，36岁，职员，汉族，2024年1月就诊，无免疫功能受损等基础疾病。患者表现为胸痛1个月，胸部CT提示左下肺肺炎，BALF行mNGS提示东方伊蒙菌。给予两性霉素B脂质体治疗1个月后胸痛减轻，复查胸部CT提示感染病灶完全吸收。随访至今无复发。结果东方伊蒙菌感染人群可表现为肺内及肺外症状，检查方法主要依靠病原菌培养及mNGS，免疫受损患者抗感染疗程长，免疫正常患者抗感染疗程根据病情可适当缩短。其治疗药物可选择两性霉素及唑类。结论东方伊蒙菌发病罕见，易误诊或漏诊，抗感染治疗无效时，尤其合并免疫抑制人群，临床医生应提高对东方伊蒙菌的警惕，早期诊断和治疗可减少死亡及改善预后。

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15.	中国药师协会, 中华医学会细菌感染与耐药防治学会, 国家卫生健康委临床抗微生物药物敏感性折点研究和标准制定专家委员会. 病原宏基因组高通量测序临床本地化检测规范专家共识. 中华预防医学杂志, 2024, 58(4): 454-465.
16.	Gast KB, Van der Hoeven A, de Boer MGJ, et al. Two cases of Emergomyces pasteurianus infection in immunocompromised patients in the Netherlands. Med Mycol Case Rep, 2019, 24: 5-8.
17.	Capoor MR, Mishra N, Kolte S, et al. Disseminated Emergomyces pasteurianus infection in India: a case report and review. Mycopathologia, 2020, 185(1): 193-200.
18.	Chik KK, To WK. Autochthonous Emergomyces pasteurianus pneumonia in an immunocompromised patient in Hong Kong: a case report. Hong Kong Med J, 2020, 26(5): 446-448.
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20.	Machiavello Roman FJ, Pischel L, Azar MM. Lung infections due to emerging fungal pathogens. Curr Opin Pulm Med, 2024, 30(3): 258-265.
21.	Vinayagamoorthy k, Gangavaram DR, Skiada A, et al. Emergomycosis, an Emerging thermally dimorphic fungal infection: a systematic review. J Fungi(Basel), 2023, 9(10): 1039.
22.	Höft MA, Duvenage L, Salie S, et al. The pathogenesis of experimental Emergomycosis in mice. PLoS Negl Trop Dis, 2024, 18(1): e0011850.
23.	夏宇, 考吾沙尔·巴合提江. 应用宏基因组二代测序技术分析慢性阻赛性肺疾病患者合并下呼吸道感染的BALF中微生物群落分布和载量. 中国呼吸与危重症监护杂志, 2024, 23(6): 414-422.
24.	Samaddar A, Sharma A. Emergomycosis, an emerging systemic mycosis in immunocompromised patients: current trends and future prospects. Front Med (Lausanne), 2021, 8: 670731.

1. Kenyon C, Corcoran C, Govender NP. An emmonsia species causing disseminated infection in South Africa. N Engl J Med, 2014, 370(3): 284. DOI: 10.1056/NEJMc 1314277.
2. Jiang YP, Dukik k, Munoz JF, et al. Phylogeny, ecology and taxonomy of systemic pathogens and their relatives in Ajellomycetaceae (Onygenales): Blastomyces, Emergomyces, Emmonsia, Emmonsiellopsis. Fungal Diversity, 2018, 90: 245-291.
3. Wang P, Kenyon C, de Hoog S, et al. A novel dimorphic pathogen, Emergomyces orientalis (Onygenales), agent of disseminated infection. Mycoses, 2017, 60(5): 310-319.
4. 冯佩英, 陆春. 伊蒙菌病与不育大孢子菌病. 中国真菌学杂志, 2015, 10(4): 245-248.
5. Dukik K, Muñoz JF, Jiang YP, et al. Novel taxa of thermally dimorphic systemic pathogens in the Ajellomycetaceae (Onygenales). Mycoses, 2017, 60(5): 296-309.
6. Schwartz IS, Govender NP, Sigler L, et al. Emergomyces: The global rise of new dimorphic fungal pathogens. PLoS Pathog, 2019, 15(9): e1007977.
7. Govender NP, Grayson W. Emergomycosis (Emergomyces africanus) in advanced HIV disease. Dermatopathology (Basel), 2019, 6(2): 63-69.
8. 杨英. 新发及罕见侵袭性真菌病原体的基因组研究及分子诊断. 解放军军事医学科学院;中国人民解放军军事医学科学院, 2017.
9. Ibe C, Mnyambwa NP, Mfinanga SG, et al. Emergomycosis in Africa: time to pay attention to this emerging deadly fungal infection. Int j Gen Med, 2023, 16: 2313-2322.
10. Thompson GR 3rd, Le T, Chindamporn A, et al. Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology. Lancet Infect Dis, 2021, 21(12): e364-e374.
11. Schwartz IS, Kenyon C, Lehloenya R, et al. AIDS-Related endemic mycoses in Western Cape, South Africa, and clinical mimics: a cross-sectional study of adults with advanced HIV and recent-onset, widespread skin lesions. Open Forum Infect Dis, 2017, 4(4): ofx186.
12. Reddy DL, Nel J, Govender NP. Review: emergomycosis. J Mycol Med, 2023, 33(1): 101313.
13. Schwartz IS, Sanche S, Wiederhold NP, et al. Emergomyces canadensis, a dimorphic fungus causing fatal systemic human disease in North Americas. Emerg Infect Dis, 2018, 24(4): 758-761.
14. He D, Quan M, Zhong H, et al. Emergomyces orientalis emergomycosis by metgagenomic next-generation sequencing. Emerg Infect Dis, 2021, 27(10): 2740-2742.
15. 中国药师协会, 中华医学会细菌感染与耐药防治学会, 国家卫生健康委临床抗微生物药物敏感性折点研究和标准制定专家委员会. 病原宏基因组高通量测序临床本地化检测规范专家共识. 中华预防医学杂志, 2024, 58(4): 454-465.
16. Gast KB, Van der Hoeven A, de Boer MGJ, et al. Two cases of Emergomyces pasteurianus infection in immunocompromised patients in the Netherlands. Med Mycol Case Rep, 2019, 24: 5-8.
17. Capoor MR, Mishra N, Kolte S, et al. Disseminated Emergomyces pasteurianus infection in India: a case report and review. Mycopathologia, 2020, 185(1): 193-200.
18. Chik KK, To WK. Autochthonous Emergomyces pasteurianus pneumonia in an immunocompromised patient in Hong Kong: a case report. Hong Kong Med J, 2020, 26(5): 446-448.
19. Pierce J, Sayeed S, Doern CD, et al. Emergomyces pasteurianus in man returning to the United States from Liberia and review of the literature. Emerg Infect Dis, 2023, 29(3): 635-639.
20. Machiavello Roman FJ, Pischel L, Azar MM. Lung infections due to emerging fungal pathogens. Curr Opin Pulm Med, 2024, 30(3): 258-265.
21. Vinayagamoorthy k, Gangavaram DR, Skiada A, et al. Emergomycosis, an Emerging thermally dimorphic fungal infection: a systematic review. J Fungi(Basel), 2023, 9(10): 1039.
22. Höft MA, Duvenage L, Salie S, et al. The pathogenesis of experimental Emergomycosis in mice. PLoS Negl Trop Dis, 2024, 18(1): e0011850.
23. 夏宇, 考吾沙尔·巴合提江. 应用宏基因组二代测序技术分析慢性阻赛性肺疾病患者合并下呼吸道感染的BALF中微生物群落分布和载量. 中国呼吸与危重症监护杂志, 2024, 23(6): 414-422.
24. Samaddar A, Sharma A. Emergomycosis, an emerging systemic mycosis in immunocompromised patients: current trends and future prospects. Front Med (Lausanne), 2021, 8: 670731.

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