青霉病致病菌种多样性及其临床表现形式多样性的文献回顾

Retrospection of studies on pathogenic Penicillium strain diversity and clinical manifestation diversity of penicilliosis

青霉在自然界广泛分布,主要是腐生或寄生引起植物感染造成植物青霉病,很少感染免疫力正常的健康人类,随着近年来免疫缺陷患者的增多,开始出现越来越多青霉菌感染人类导致人类青霉病的病例报道,其引起的人类感染表现形式多样,易误诊。本文对Medline和中文文献数据库中的相关文献进行了系统查阅和分析,综合归纳了青霉病的致病种、地域分布、危险因子、临床表现形式、药物敏感性及其诊疗方案等。青霉病目前共报道20种致病菌种,包括Penicillium bicolor、P.bertai、P.brevicompactum、P.casei、P.citrinum、P.chrysogenum、P.commune、P.crustaceum、P.cyclopium、P.citreonigrum、P.capsulatum、P.decumbens、P.digitatum、P.emersonii、P.glaucum、P.janthinellum、P.lilanicum、P.purpurogenum、P.roqueforti和P.spinulosum,引起感染类型涉及肺部、腹膜、眼、心内膜、中枢神经系统、角膜、真菌血症、尿道、耳道、食管、脊椎旁、关节假体周围、鼻窦、播散感染、皮肤及甲等多个组织和器官的感染,还可以作为致敏原引起多种变应性疾病。临床分离青霉属真菌对棘白菌素类药物普遍敏感,两性霉素B中度耐药,唑类药物中泊沙康唑最敏感,本文对全面了解青霉病的特征及其临床医师的诊断具有重要的意义。

Penicillium species are ubiquitous in nature and mainly saprophytic or parasitic on plants causing penicilliosis.Few of them can infect healthy humans with normal immunity.With the increase of patients with immune deficiency in recent years,more and more cases of mankind penicilliosis with a variety of clinical types have been reported.It is not easy for clinicians to make an accurate diagnosis of penicilliosis if they are unfamiliar with these fungi.This retrospective paper are based on related literature in Medline and Chinese Literature Database,concerning pathogenic species,regional distribution,risk factors,clinical manifestations,drug sensitivity,diagnosis and treatment of penicilliosis.In total,20 species of pathogenetic Penicillium were reported currently,including Penicillium bicolor,P.bertai,P.brevicompactum,P.casei,P.citrinum,P.chrysogenum,P.commune,P.crustaceum,P.cyclopium,P.citreonigrum,P.capsulatum,P.decumbens,P.digitatum,P.emersonii,P.glaucum,P.janthinellum,P.lilanicum,P.purpurogenum,P.roqueforti and P.spinulosum.The clinical manifestation includes pulmonary infection,peritonium infection,endophthalmitis,endocarditis,central nervous system infection,keratitis,fungemia,urinary tract infection,otitis,esophagitis,paravertebral infection,periprosthetic joint infection,nasosinusitis,disseminated infection,skin infection,onychomycosis and so on.They can also cause a variety of allergic diseases as allergens.Clinical isolates of Penicillium spp.are generally sensitive to echinocandins,moderately resistant to amphotericin B,and posaconazole is the most sensitive azoles.This article aims at providing reference for a comprehensive understanding of the characteristics of penicilliosis and clinical diagnosis concerned.