多主棒孢菌致真菌性角膜溃疡1例并文献复习

Fungal corneal ulcer due to Corynespora cassiicola:a case report and literature review

目的报道1例多主棒孢菌引起的真菌性角膜溃疡病例并复习相关文献,提高临床对该菌引起感染性疾病的认识。方法回顾性分析1例多主棒孢菌致真菌性角膜溃疡病例资料,并以英文关键词“Corynespora cassiicola”、中文关键词“棒孢菌”和“棒孢霉”为检索词,检索PubMed、中国知网、万方和维普数据库等国内外报道的病例,结合文献综合分析多主棒孢菌临床感染的特点。结果该例患者临床表现和实验室检查符合真菌性角膜溃疡的临床特征,病变角膜组织培养提示多主棒孢菌生长,经右眼角膜移植术及抗真菌治疗后好转。复习文献并结合该例,共12例多主棒孢菌临床感染病例。除1例病例资料不完整外,其余11例中男8例,女3例,年龄8~84岁。患者多存在基础疾病,包括糖尿病2例、慢性阻塞性肺疾病1例、高血压1例、慢性阻塞性肺疾病合并高血压1例;感染危险因素包括胱天蛋白酶募集域蛋白9(CARD9)基因突变3例、植物暴露4例(3例农民、1例眼外伤)、长期使用激素2例、侵袭性诊疗操作1例;11例均引起暗色丝孢霉病,感染部位包括皮下感染7例、眼部感染3例、中枢神经系统感染1例,临床表现主要与受累组织系统相关;临床治疗中两性霉素B、伏立康唑、伊曲康唑、特比萘芬是最常用的抗菌药物,联合外科手术治疗者3例;临床转归中9例患者好转,2例患者无明显改善。结论多主棒孢菌引起的临床感染罕见,以皮下暗色丝孢霉病为主,眼部感染次之。对于存在基础疾病或免疫功能缺陷,并有植物暴露史的患者,临床应提高警惕。临床以抗真菌治疗为主,外科手术可作为快速清除病原体的重要治疗手段。该菌感染总体预后良好。

Objective To report a case of fungal corneal ulcer due to Corynespora cassiicola and review the related literature to improve clinical awareness of infections caused by C.cassiicola.Methods One case of fungal corneal ulcer caused by C.cassiicola was retrospectively analyzed.Similar cases were searched from PubMed,CNKI,Wanfang,and VIP databases by English keywords“Corynespora cassiicola”and Chinese keywords“棒孢菌”and“棒孢霉”.Clinical characteristics of C.cassiicola infections were comprehensively analyzed considering the reports at home and abroad.Results The patient’s clinical presentation and laboratory tests were consistent with fungal corneal ulcer.C.cassiicola was cultured from the infected cornea.The patient improved after penetrating keratoplasty of right eye and antifungal treatment.A total of 12 cases of human C.cassiicola infection were retrieved.One case was excluded due to incomplete clinical data.The remaining 11 cases included 8 males and 3 females,aged from 8-84 years.Most patients had underlying diseases,including diabetes mellitus in 2 cases,chronic obstructive pulmonary disease in 1 case,hypertension in 1 case,and chronic obstructive pulmonary disease plus hypertension in 1 case.The risk factors for C.cassiicola infection included CARD9 gene mutation in 3 cases,plants exposure in 4 cases(including 3 farmers and 1 ocular trauma),long-term steroids use in 2 cases,and invasive procedure in 1 case.Phaeohyphomycosis was identified in all the 11 cases,including subcutaneous infection(7 cases),ocular infection(3 cases),and central nervous system infection(1 case).The clinical manifestations were mainly related to the affected tissues and systems.Amphotericin B,voriconazole,itraconazole and terbinafine were the most commonly used antifungal drugs in clinical treatment.Three patients were treated with antifungal drugs and surgery.Nine patients improved after treatment and 2 patients did not respond well to the treatments.Conclusions Clinical infections caused by C.cassiicola are rarely reported.Subcutaneous phaeohyphomycosis is the most common clinical manifestation,followed by ocular infection.For the patients with underlying disease or immune deficiency and a history of plant exposure,clinicians should be aware of this disease.Antifungal treatment is the main treatment approach.Surgery may be appropriate for rapid removal of pathogens.The overall prognosis of C.cassiicola infections is satisfactory.