轮枝样镰刀菌致腹膜透析相关性腹膜炎及菌血症1例并文献复习

Peritoneal dialysis-related peritonitis and bacteremia caused by Fusarium verticillioides:a case report and literature review

镰刀菌是一种条件致病真菌,国内外少有镰刀菌导致腹膜炎的报道。该文报道轮枝样镰刀菌性腹膜炎并发菌血症1例并复习相关文献。该患者因发热、腹痛入院,确诊腹膜炎后初始治疗使用万古霉素联合头孢他啶每日夜间留腹治疗3 d,效果欠佳。抗生素升级为万古霉素联合美罗培南每日夜间留腹2 d,仍无效果。后续腹水培养确定为镰刀菌,治疗方案改为伏立康唑抗真菌治疗并改行血液透析,但患者出现透析导管相关感染,治愈后仍反复发热,感染指标无好转。进一步行高通量基因检测查全血感染病原微生物,临床明确为轮枝样镰刀菌菌血症。单用伏立康唑效果不佳,联合两性霉素B治疗,感染迅速控制后患者治愈出院。镰刀菌致病性强,希望引起临床医师的重视。

Fusarium is a kind of conditional pathogenic fungus.There are few reports of peritonitis caused by Fusarium at home and abroad.This paper reports a case of Fusariumverticillioides peritonitis complicated with bacteremia and reviews relevant literature.The patient was admitted to the hospital due to fever and abdominal pain.After peritonitis was diagnosed,the initial treatment was vancomycin plus ceftazidime kept in the abdominal cavity every night for 3 days,but the effect was not good.The antibiotic was upgraded to vancomycin plus meropenem for 2 days,but still,there was no effect.Subsequently,Fusarium was found after ascites fluid culture,and the treatment regimen was changed to voriconazole antifungal therapy and hemodialysis.However,the patient developed a dialysis catheter-related infection.After the infection was cured,the fever was still repeated,and the infection indexes did not improve.Further,the pathogenic microorganism of whole blood infection was detected by high-throughput gene detection,and it was clinically confirmed as Fusarium verticillioides.At last,the patient recovered and was discharged from the hospital after treatment with voriconazole combined with amphotericin B.Fusarium is highly pathogenic,and it is hoped to attract more attention of clinicians.