胃癌患者化疗后引发黑曲霉菌血症的实验诊断和治疗

Experimental diagnosis and treatment of Aspergillus niger infections in patient with stomach cancer

目的探讨黑曲霉菌引起胃癌患者血流感染的实验诊断方法和治疗措施。方法采用BacT/Alert 3D全自动血培养仪进行血培养;仪器报警后,结合GM、G试验、sCRP和PCT等血清学结果,将标本转种于沙氏培养基行真菌培养。根据其菌落特点和镜下形态等特征鉴定真菌种类,采用MIC方法进行真菌体外药敏试验。结果从该患者血培养标本中分离出真菌并鉴定为黑曲霉菌,体外药敏试验显示对伏立康唑、卡泊芬净有较低的MIC值,分别为0.25μg/mL、0.06g/mL.遂选用伏立康唑治疗取得满意效果。结论通过行血培养,结合GM和G试验等血清学方法及sCRP和PCT等感染指标,可指导曲霉菌的培养和鉴定。

Objective To discuss the laboratory diagnosis and therapeutic measures of bloodstream infection caused by Aspergil- lus niger in patients with gastric carcinoma after the chemotherapy. Methods The BacT/ Alert 31） full-automatic blood culture in strument was used to culture the blood. After the microbial positive alarm, combining the serological results of GM, GKT, sCRP, PCT and other methods, the specimen of Blood culture were inoculated in Sabouraud medium to do fungal cuhure. According to the bacterial colony and morphological characteristics under the microscope to identify the pathogenic fungi. And then employ the MIC way to do drug sensitive test of fungi in vitro. Results The vitro tests showed that the MIC of voriconazole and caspofungin to the aspergillus niger isolated from the specimen of culture blood were relatively lower, they were 0.25 gg/mL, and 0.06 g/mL respec- tively. Voriconazole was chosen as treatment drug and achieved satisfactory results. Conclusion Through blood culture, combining the GM and GKT tests and other serological methods, plus sCRP and PCT infection index, all of these could help to guide the i- denlification of Aspergillus niger.