慢性肉芽肿病患儿侵袭性曲霉菌病4例分析  

Invasive aspergillosis in 4 children with chronic granulomatous disease

作　　者：贺建新[1] 殷菊[2] 刘秀云[2] 赵顺英[2] 徐保平[2] 胡英惠[2] 申昆玲[2] 江载芳[2] 

机构地区：[1]北京市儿科研究所呼吸功能室北京儿童医院,北京100045 [2]北京儿童医院呼吸内科,北京100045

出　　处：《临床儿科杂志》2012年第6期528-530,共3页Journal of Clinical Pediatrics

摘　　要：目的观察慢性肉芽肿病患儿患侵袭性曲霉菌病的临床特点。方法收集4例经基因检测明确诊断慢性肉芽肿病伴侵袭性曲霉菌病患儿的临床资料并总结其起病时间、症状、体征、组织病理、影像学表现、治疗、转归情况。结果 4例患儿均为烟曲霉菌感染。3例经肺组织或脓液培养确诊为侵袭性肺曲霉菌病。起病年龄17 d～3月,入院前病程为17～40 d。有发热、咳嗽等不典型症状,无感染中毒貌;肺内体征为呼吸音减弱,肺部影像学异常出现时间10～13 d,肺CT表现为结节、不规则、球形或类圆形高密度灶,不伴有晕轮征、新月征及空洞;肺组织病理均示肉芽肿性化脓性炎症,无菌丝血管侵蚀或凝固坏死。1例伊曲康唑治疗治愈,1例切除受累肺叶后治愈,1例卡泊芬净治疗死亡,另1例曲霉菌关节炎伊曲康唑治疗控制。结论对慢性肉芽肿病患儿,在新生儿期或婴儿早期,呼吸道症状及体征不典型,但影像学异常明显,肺CT表现为结节或团块影,肺组织病理表现为化脓性肉芽肿性炎症者,应注意侵袭性肺曲霉菌病可能。Objective To investigate the clinical features of invasive aspergillosis cases with chronic granulomatous disease（CGD）.Methods From Jul 2007 to Oct 2010,invasive aspergillosis was definitely diagnosed in 4 CGD cases.The records were reviewed,including the first presenting sign and its occurring age,physical examinations,radiological and histopathological features,treatment and pharmaceutical effect.Results Aspergillosis fumagitus was positive for all 4 cases.Invasive pulmonary aspergillosis was diagnosed in 3 cases whose isolation was from lung specimen in 2 cases,lung specimen pus in 1 case.The occurring age was 17 days to 3 months,with nonspecific fever and cough symptoms.Physical examination showed decreased breath sound.10-13 days was needed for radiologic infiltrates to occur.Chest CT showed nodules,irregular,ball-like,circle-like high density loci without halo sign,crescent sigh or cavities.Lung specimen histopathology showed pyo-granulomatous inflammation without hyphal vascular envasion or coagulative necrosis.Purulent aspergillosive arthritis was diagnosed in 1 case by positive arthral pus.Oral itraconazole was given to 2 cases,one with complete resolution,one with controlled course.One died with intravenous caspofungin.One was cured after lung lobe resection.Conclusions For infants even newborn with nonspecific respiratory symptoms and apparently nodular,massive radiologic infiltrates,with pyo-granulomatous inflammation in lung specimen,invasive pulmonary aspergillosis in CGD cases should be highly suspected.

关 键 词：侵袭性曲霉菌病 慢性肉芽肿病 儿童 

分 类 号：R725.1[医药卫生—儿科]