溺水后侵袭性曲霉病三例并文献复习  

Invasive aspergillosis after near-drowning： case reports and review of the literature

作　　者：李培[1] 曹鄂洪[1] 赵蓓蕾[1] 孙辉明[1] 李渺苗[1] 徐瑾[1] 宋勇[1] 施毅[1] 

机构地区：[1]南京大学临床医学院／南京军区南京总医院呼吸科,210002

出　　处：《中华结核和呼吸杂志》2011年第9期657-662,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的 提高临床医生对溺水后侵袭性曲霉病（invasive aspergillosis IA）的认识。方法收集2005年10月至2010年8月南京军区南京总医院收治的3例，结合文献报道的8例溺水后IA的临床症状、病程及影像资料进行分析。结果 3例溺水后IA中女2例，男1例，年龄为18、32和72岁。溺水前均无免疫功能缺陷的临床表现。2例因车祸溺水，1例意外跌入污水池。3例溺水后均出现呼吸衰竭，并接受气管插管机械通气和广谱抗生素治疗；1例出现一过性白细胞减少，2例接受糖皮质激素治疗。3例均在溺水后9～11d出现病情加重，2例痰培养曲霉阳性。3例胸部CT均见双肺多发结节、实变及空洞影。1例发生颅内曲霉感染，头颅核磁共振检查示多发性脑脓肿。1例死亡，尸检确诊曲霉侵袭肺、脑、心肌及肾脏；2例为临床诊断，曲霉仅侵袭肺脏，经治疗好转出院。文献报道溺水后IA较少。以“near-drowning”和“aspergillosis”为检索词，未设定时间限制，搜索Pubmed数据库，共获得7例溺水后IA的病例报道；以“溺水”和“侵袭性肺曲霉病”为检索词检索中国期刊网全文数据库、万方数据库和中国医院数字图书馆期刊全文数据库，获得1篇国内溺水后IA的病例报道[11]。8篇报道中，最早发表于1984年，最近的发表于2010年，其中5例为确诊病例，3例为临床诊断病例。结论 免疫功能正常的宿主溺水后可罹患IA。曲霉感染多发生在溺水后1～2周，合并中枢神经系统的IA患者预后差。Objective The purpose of this study was to analyze the clinical presentations and disease courses of invasive aspergillosis （IA） in patients after near-drowning.Methods The clinical data of 3 cases of invasive aspergillosis after near-drowning from Oct.2005 to Aug.2010 in this hospital were retrospectively analyzed, and the related literature was reviewed.Results There were 1 male and 2 female patients, aged from 18 to 72 years.All of them had been immunocompetent before drowning.Two patients drowned because of traffic accident, and 1 fell in sewage by accident.All of the 3 patients were intubated because of acute respiratory failure, and received broad-spectrum antibiotic therapy. One had transient leucopenia, and 2 patients received glucocorticoid therapy.The condition of the 3 cases deteriorated 9 to 11 days after near-drowning.Aspergillus was isolated from sputum samples of 2 patients at the same time.Thoracic CT findings included multiple nodules, consolidation and cavity formation. Multiple abcesses in cerebral parenchynm were found in 1 patient with invasive cerebral aspergillosis.One patient died, whose lungs, cerebral parenchyma, myocardium and kidney were all infected by aspergillus.The other 2 patients,whose infection limited to the lungs, had a positive prognosis.Using the terms ＂aspergillosis＂ and ＂neardrowning＂ a PUBMED search yielded 7 articles, published between 1984 and 2010. Using the terms ＂invasive pulmonary aspergillosis＂ and ＂near-drowning＂, searching Wangfang data and CHED data,encompass 1 article, published in 2009.In all of the 8 articles, there are 5 final diagnosis cases and 3 clinical diagnosis cases.Conclusions IA was very rare in immunocompetent hosts but had been reported in previously healthy individuals after near-drowning.Aspergillosis might develop 1 to 2 weeks after neardrowning, and the prognosis was poor in patients with central nervous system involvement.

关 键 词：曲霉菌病 溺水 

分 类 号：R519[医药卫生—内科学]