伊曲康唑注射剂治疗伴有肺结核史的侵袭性真菌感染2例

Two cases of invasive fungi infection with tuberculosis history treated with itraconazole injections

目的报道2例伴有肺结核史的侵袭性真菌感染经伊曲康唑注射剂治疗经过,探讨伴有肺结核史患者的抗真菌治疗经验。方法例1为49岁"支气管肺囊肿合并感染,陈旧性肺结核"男性患者,诊断为侵袭性肺曲霉感染确诊病例。例2为51岁"右侧自发性气胸,慢性阻塞性肺病,陈旧性肺结核"男性患者,诊断为侵袭性肺念珠菌感染拟诊病例。均予伊曲康唑注射剂治疗2周结合抗细菌治疗,并作临床和真菌学疗效监测。结果治疗两周后两患者临床症状和体征均得到明显改善,标本真菌镜检转阴,培养仍为阳性。结论在有肺结核病史存在的侵袭性真菌感染抗真菌治疗时间可能需要延长。合理应用抗生素、激素,严格掌握用药指针、时机、剂量与疗程是控制真菌感染的重要因素。

Objective We reported two cases of invasive fungi infection with tuberculosis history treated with itraconazole injections. The experience of anti-fungi treatment in the patients with tuberculosis was discussed. Methods The first case, a 49-year-old man with bronchi-lung cysts and old lung tuberculosis, was definitely diagnosed as invasive aspergillus infection of lung. The second case was a 51-year-old man with right spontaneous pneumothorax, chronic obstructive lung disease and old pulmonary tuberculosis. He was suspiciously diagnosed as invasive pulmonary monilia infection. Both patients were treated with injections of itraconazole for two weeks combined with antibiotics. We made the surveillance of clinical and mycologic effects. Results Both patients improved in clinical manifestations and symptoms after two weeks＇ therapy. Mycology results showed negative under microscope but still positive in culture. Conclusion The duration of anti-fungi therapy for invasive fungi infection should be prolonged in patients with lung tuberculosis. Reasonable administration of antibiotics and corticosteroids, their indications, application time, dosage and duration are important factors for controlling fungi infection.