尖端赛多孢子菌引起急性髓性白血病患者多重感染的诊断研究

Diagnosis of multiple infections caused by Scedosporium apiospermumin patients with acute myeloid leukemia

目的探讨尖端赛多孢子菌及细菌引起急性髓性白血病患者多重感染的诊断方法和治疗措施。方法连续采集患者左侧腹股沟分泌物或坏死组织行真菌和细菌培养,同时对阴茎冠状沟和包皮做病原菌检查;采用法国生物梅里埃公司VITEK-2全自动微生物分析仪对细菌进行鉴定和药敏试验;根据真菌培养的菌落特点和镜下形态鉴定致病真菌,采用MIC方法进行真菌体外药敏试验。结果抗真菌治疗前患者左侧腹股沟分泌物连续4次行真菌培养,均检测出尖端赛多孢子菌,体外药敏试验显示对伏立康唑有较低的MIC值。结论尖端赛多孢子菌的感染少见,且难治疗,极易感染免疫低下的患者合并细菌引起多重感染;及时进行分离、培养、鉴定和药物敏感性试验,及早进行病原学诊断,正确选用抗菌药物是治疗成功与否的关键。

Objective To explore the diagnostic methods and treatment measures of multiple infections by Scedosporium apiospermum among patients with acute myeloid leukemia. Methods The secretions or nec- rotic tissue specimens were collected from the left groin of patients for fungal and bacterial culturing; the de- tection of pathogenic bacteria in coronary sulcus of penis and prepuce was conducted. Bio Merieux VITEK-2 automatic microorganism analyzer was used for identification and drug sensitivity test of the bacteria; Fungi were identified based on the morphological and microscopic observation. MIC method was used to test the sus- ceptibility of fungi in vitro. Results Scedosporiurn apiosperrnum was detected in left groin secretions for 4 consecutive times. Drug sensitivity test in vitro showed lower MIC values to voriconazole. Conclusion Sce- dosporium apiosperrnum infection is rare and difficult to treat, which can very likely cause multiple infec- tions in immunosuppressed patients, timely separation, culture, identification and drug sensitivity test, as well as early etiological diagnosis and proper use of antibiotics are the key to successful treatment.