流感相关颅内曲霉菌病1例并文献复习

Influenza-associated intracranial aspergillosis:a case report and literature review

探讨流感相关颅内曲霉菌病的临床特征、早期识别及预后。回顾性分析2022年中南大学湘雅三医院儿科收治的1例流感相关颅内曲霉菌病患儿的临床资料。通过检索中国知网、万方数据库、Web of Science、PubMed等中英文数据库,检索时间截至2023年11月,根据纳入和排除标准筛选文献,对所有流感相关颅内曲霉病的临床特征、诊断、治疗及预后进行总结,检索共获得5篇5例流感相关曲霉菌病个案报道,其中包括1例儿童患者,加上本研究的1例儿童流感相关颅内曲霉菌病,一共6例流感相关曲霉菌病患者。6例患者临床表现为意识障碍、偏瘫、瞳孔改变、行为异常、癫痫等,多数病例通过病理或尸检查找病原体诊断,本例患儿通过病原宏基因二代测序(metagenomic next-generation sequencing,mNGS)确诊病原体,治疗上均首选抗真菌药物治疗。存活患者中66.7%接受手术治疗,6例患者中死亡率达50.0%。流感相关颅内曲霉菌病罕见,儿童和成人均可发生,预后差。在流感早期如有神经系统症状,应进行真菌感染筛查,宏基因二代测序能提高颅内曲霉菌病的诊断率。

To investigate the clinical features,early recognition and prognosis of influenza-associated intracranial aspergillosis.The clinical data of a child with influenza-related intracranial aspergillosis admitted to the Department of Pediatrics of the Third Xiangya Hospital of Central South University in 2022 were retrospectively analyzed.By searching CNKI,Wanfang Database,Web of Science,PubMed and other Chinese and English databases as of November 2023,literature was screened according to inclusion and exclusion criteria,and the clinical characteristics,diagnosis,treatment and prognosis of all influenza-related intracranial aspergillus disease were summarized.A total of 5 reports of 5 cases of influenza-associated aspergillosis were obtained,including 1 child patient and 1 child influenza-associated intracranial aspergillosis in this study,and a total of 6 influenza-associated aspergillosis patients.The clinical manifestations of the 6 patients were disturbance of consciousness,hemiplegia,pupil changes,behavioral abnormalities,epilepsy,etc.Most of the cases were diagnosed through pathology or autopsy to find pathogens.In this case,the pathogens were confirmed through metagenomic next-generation sequencing(mNGS).Antifungal drugs were the first choice for treatment.66.7%of the surviving patients received surgical treatment,and the mortality rate of 6 patients reached 50.0%.Influenza-associated intracranial aspergillosis is rare,can occur in both children and adults,and has a poor prognosis.In the early stage of influenza,if there are neurological symptoms,screening for fungal infection should be conducted.Acer second generation sequencing can improve the diagnosis rate of intracranial aspergillosis.