尖端赛多孢和多育赛多孢所致的深部真菌感染2例并文献复习

Invasive Scedosporium apiospermum and Scedosporium prolificans infections:case report and review

目的分别报道国内少见的由尖端赛多孢导致的化脓性关节感染伴骨髓炎和多育赛多孢的血行播散感染。方法取患者1的关节冲洗液和患者2的外周血标本直接涂片和真菌培养,根据真菌培养的菌落特点和镜下形态,鉴定致病菌种,并对分离的致病菌进行体外药敏试验。结果两个病例分别培养出尖端赛多孢和多育赛多孢。体外药敏试验显示两种菌对伏立康唑有较低的MIC值,而都对两性霉素B高耐。结论赛多孢菌的感染少见,且难治疗。应加深对少见真菌病的认识,提高诊治水平。

Objective To report two cases of septic arthriris of the knee caused by Scedosporium apiospermum after injury and disseminated Scedosporium prolificans infection after received blood stem cell transplantion. Methods Arthral wash fluid from case 1 was examinated by direct microscopy and fungal cultivation. Blood cultivate from case 2 was performed. The isolates from two patients were identified. Antifungal susceptibility testing was also performed. Results Isolates from case 1 and case 2 were identified as Scedosporium apiospermum and Scedosporium prolificans respectively. Voriconazole showed low MIC value, but amphotericin B showed high resistance against 2 strains in vitro susceptibility testing. Conclusion Scedosporium spp. Infection is not common in clinic and hard to treat. Deepening recognition of less-common invasive fungal infection is helpful to improve the level of diagnosis and treatment.