肺部暗色丝孢霉病1例并文献复习

Pulmonary phaeohyphomycosis due to Exophiala jeanselmei:a case report and review of literature

目的加强对暗色丝孢霉病的临床表现和病原学特点的认识,提高诊治率。方法分析2008年广州医科大学附属第一医院收治的1例甄氏外瓶霉所致的肺部暗色丝孢霉病患者的临床、影像学及病原学资料,结合1995年1月至2013年8月国内报道的23例有完整资料的暗色丝孢霉病病例进行复习。结果 24例暗色丝孢霉病中,男15例,女9例,年龄4～76岁,平均（40.0±21.8）岁。既往体健者17例,有基础疾病者7例。皮肤和皮下组织感染18例,肺部和中枢神经系统感染各2例,鼻窦和睑结膜感染各1例。单纯临床标本培养阳性的5例中,皮肤脓液1例,肺组织2例,脑脊液2例;单纯病理学阳性1例;组织培养和组织病理同时阳性18例。24株暗色丝孢霉中进行了鉴定分型的有22株,以甄氏外瓶霉为主（7株）。23例接受治疗的患者中,单纯药物治疗18例,抗真菌治疗联合手术切除局部病灶4例,抗真菌治疗联合XD-635AB光动力激光治疗1例。其中单用伊曲康唑10例,获得了较好疗效。结论该系列暗色丝孢霉病患者多有基础疾病或使用免疫抑制剂、糖皮质激素史,临床表现以皮肤和皮下组织感染为主,皮损多分布于四肢、面部和胸腹部。最常见者由甄氏外瓶霉引起,其次为疣状瓶霉和棘状外瓶霉。伊曲康唑对大多数病例有效：对于难治性感染,可根据药敏试验结果用药。

Objective To better understanding the clinical presentatiobs of phaeohyphomycosis,and improve the diagnosis and management of the disease.Methods We reported,a case of pulmonary phaeohyphomycosis caused by Exophiala jeanselmei at the First Affiliated Hospital of Guangzhou Medipal University in 2008,and reviewed the relevant literature.The clinical,radiological and etiological features were summarized based on this case and the other 23 phaeohyphomycosis patients reported in China from January 1995 to August 2013.Results 24 Chinese cases of phaeohyphomycosis have been reported to date,including15 males and 9 females.The age of these patients ranged from 4 to 76（mean 40,0 ± 21,8） years old.Seventeen patients were otherwise healthy.The other 7 patients,had complications,Clinical presentations of phaeohyphomycosis vary widely,including cutaneous and subcutaneous infeption in 18 cases,pulmonary and central nervous system involvement in two cases each,paranasal sinus and palpebral conjunctiva infection one case each..The diagnosis of 18 cases were confirmed both microbiologically and histologically.One case was confirmed histologically alone,Five pases were identified microbiologically alone.The samples for culture were collected from skin abscess（1/（？）,pulmonary tissue（2/5）,and cervical spinal fluid（2/5）,respectively.Twenty-two strains of causative organisms were identified,7 of which were Exophiala jeanselmei.Twenty-three patients received treatment.They were cured by antifungal agents alone（18） or in conjunction with surgical resection（4）,or assisted with XD-635AB-based photodynamic laser therapy（1）.Specifically,10 patients were cured by itraconazole alone.Conclusions In China,most patients of phaeohyphomycosis have concurrent conditions or have previously received immunosuppressive agents and corticosteroids.Cutaneous and subcutaneous infection were most common,located mainly on limbs,face,chest and abdominal skin.The most frequently isolated pathogen is Exophiala jeanselmei,followed by Phialophora verrucosa and Exophiala spinifera.Itraconazole therapy would he very effective.Susceptibility testing is very useful in case of refractory infection.