发热伴血小板减少综合征并侵袭性肺曲霉病一例及文献复习  

One severe fever case with thrombocytopenia syndrome and invasive pulmonary aspergillosis and review of the literatures

作　　者：程健[1] 魏洪霞[1] 池云[1] 成骢[1] 胡志亮[1] 姚文虎[1] 

机构地区：[1]东南大学附属第二医院感染科,南京市210003

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第3期118-121,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：江苏省卫生厅预防医学科研课题(No.Y2012073);南京市医学科技发展项目(NO.YKK12117)

摘　　要：目的提高对发热伴血小板减少综合征、侵袭性肺曲霉病及两病并发的临床特点的认识。方法结合1例发热伴血小板减少综合征并侵袭性肺曲霉病患者的临床资料及文献复习,对本病的临床表现、实验室指标检查、影像学、诊断和治疗进行分析。结果发热伴血小板减少综合征以发热伴全身乏力为主要表现,可出现肝、肾、心、凝血等多脏器多功能损伤,白细胞和血小板计数均减少。侵袭性肺曲霉病在难以取得病理的情况下,应紧密结合其高危因素、临床症状、影像学及痰培养、G试验和GM试验等做出临床诊断,尽早治疗以降低病死率。结论发热伴血小板减少综合征并侵袭性肺曲霉病临床罕见,其发生可能由于发热伴血小板减少综合征急性期白细胞计数减少、免疫力低下,导致侵袭性肺曲霉病等机会性感染的发生。Objective To improve our understanding of the clinical features of severe fever with thrombocytopenia syndrome （SFTS） and invasive pulmonary aspergillosis （IPA）. Methods The clinical manifestations, laboratory tests, radiographic, diagnosis and treatment of SFTS with IPA were analyzed by the clinical data of a patient with both of the two diseases through the literature review. Results Fever and malaise were the main clinical manifestations of SFTS. Damage of multiple-organ （such as liver, kidney, heart and coagulation） and leukocytopenia and thrombocytopenia may occur. As it was hard to get the pathological data of lung, IPA should be diagnosed through risk factors, clinical symptoms, radiographic, sputum culture, serum galactomannan and plasma 1,3-β-D glucan measurement so as to start empirical antifungal treatment as early as possible and reduce the mortality. Conclusions The occurrence of SFTS with IPA is rare in clinic. Patient with SFTS may have hypoimmunity and leukocytopenia in acute phase, leading to opportunistic infections, such as IPA.

关 键 词：发热伴血小板减少综合征 侵袭性肺曲霉病 综述文献 

分 类 号：R510[医药卫生—内科学]