侵袭性真菌病在儿童血液肿瘤化疗与造血干细胞移植患者中的特征与诊疗挑战

Characteristics and challenges in diagnosis and treatment of invasive fungal diseases in pediatric hematologic oncology chemotherapy and hematopoietic stem cell transplant patients

侵袭性真菌病(IFD)在血液系统恶性肿瘤和造血干细胞移植患者中发病率高,尤其影响儿童。IFD不仅能提高这些患者的死亡率,而且诊断和治疗方面存在多重挑战。其中,曲霉菌、念珠菌和毛霉菌为主要的病原体。这些真菌引起的感染通常表现为非特异性症状,如发热和呼吸困难,进一步增加诊断的复杂性。目前,多种诊断手段如血清学检测和组织活检用于识别病原体,但效果有限。使用预防性抗真菌治疗效果明显,但也存在突破性真菌感染的风险。新的诊断技术如宏基因组二代测序和药物治疗监测可能提供更有效的解决方案。跨学科的协作和进一步的研究是改善这些高风险患者的治疗效果和预后的关键。

Invasive fungal diseases(IFD)are prevalent among patients with hematologic malignancies and those undergoing hematopoietic stem cell transplantation,particularly affecting children.IFD not only increase mortality rates in these patients,but also pose multifaceted challenges in diagnosis and treatment.Major pathogens include Aspergillus,Candida and Mucor species.Infections caused by these fungi typically manifest as non-specific symptoms like fever and respiratory distress,further complicating diagnosis.Current diagnostic approaches,such as serological tests and tissue biopsies,are employed to identify the causative agents but with limited efficacy.Antifungal prophylaxis shows promise,yet there remains a risk of breakthrough fungal infections.Emerging diagnostic techniques like metagenomic next-generation sequencing and therapeutic drug monitoring may offer more effective solutions.Interdisciplinary collaboration and further research are pivotal to enhance the therapeutic outcomes and prognosis for these high-risk patients.