急性淋巴细胞白血病患者侵袭性头状地霉感染1例及文献回顾

A Case of Invasive Fungal Infection Caused by Geotrichum Capitatum in Patients with Acute Lymphoblastic Leukaemia and Review of the Literature

目的:通过报道1例急性淋巴细胞白血病患者侵袭性头状地霉感染的临床资料,并结合文献探讨头状地霉感染的临床特点、有效的诊断及治疗方法。方法:报道国内首例急性淋巴细胞白血病患者化疗后骨髓抑制期感染头状地霉病例,并对该病的诊断及治疗等进行系统文献回顾。结果:该白血病患者经血培养证实为头状地霉感染,并累及肺脏、肝脏和皮肤,治疗过程中先后采用卡泊芬净、脂质体两性霉素B和脂质体两性霉素B联合伏立康唑等治疗,虽然脂质体两性霉素B联合伏立康唑治疗患者体温正常,临床症状稍有改善,但是患者在化疗后40天放弃治疗并死于心肺功能衰竭。结论:头状地霉感染的发病率低,临床症状不够典型,诊断困难,预后差。根据患者的临床表现,结合血培养、GM实验、G实验和CT扫描等检查,可有助于诊断。头状地霉感染尚无非常有效的治疗方式,采用脂质体两性霉素B或两性霉素B联合伏立康唑或其他新的抗真菌药物可能获得一定的疗效,早期诊断、早期联合治疗和患者早期脱离粒缺状态是治疗成功的关键。

Objective： To observe the clinical characteristics, diagnoses and treatment by reporting one case of acute lymphoblastic leukaemia patient with invasive Geotrichum capitatum infection and reviewing the literature. Methods： We report the first case of invasive Geotrichum capitatum infection in a neutropenic patient who received chemotherapy for acute lymphoblastic leukaemia. The diagnosis and treatment of Geotrichum capitaturn infections in hematologic patients were reviewed. Results： Geotrichum capitatum was isolated from blood cultures, the lungs, liver, and skins were involved. The infection was cured by caspofungin, liposomal amphotericin B, and a combination of voriconazole and liposomal amphoteriein B. Alteration of antifimgal treatment to liposomal amphotericin B and voriconazole resolved the fever with favorable, clinical response, but the patient died of cardiorespiratory failure on day 40. Conclusions： Invasive Geotrichum capitatum infection was relatively rare. The clinical symptoms of Geotrichum capitatum infection were unspecific, diagnostic difficulties, blood cultures, GM assay, G assay and CT scan could have a role in diagnosis. The treatment was not well established, using liposome amphotericin B or amphoteficin B combined with voriconazole or other new antifungal drugs may obtain certain curative effect. Early diagnosis, combined treatment, and out of neutropenic status may be the key of successful treatment.