白血病患者化疗后多发性曲霉菌骨髓炎的诊治  

Diagnosis and treatment of multiple Aspergillus osteomyelitis in leukemia patients after chemotherapy

作　　者：尹秀云[1] 陈建魁[1] 曾利军[1] 蒋虔[1] 于农[1] 宋世平[1] 宁红梅 黄媛[1] 金欣[1] 左向华[1] 陈祎霏[3] 

机构地区：[1]军事医学科学院附属医院检验科,北京100071 [2]全军造血干细胞研究所,北京100071 [3]北京大学医学部基础医学院,北京100191

出　　处：《中华医院感染学杂志》2014年第6期1339-1341,共3页Chinese Journal of Nosocomiology

基　　金：国家科技重大专项基金项目(2013ZX10004203);国家重大科学仪器设备开发专项基金项目(2012YQ18011708)

摘　　要：目的探讨黄曲霉菌引起急性淋巴细胞白血病患者化疗后多发性骨感染的试验诊断和治疗方法,总结免疫低下患者多发性曲霉菌骨髓炎的诊治措施。方法通过行C型臂透视引导下椎间隙穿刺活检术对患者进行取材做真菌培养,根据真菌培养菌落特点和镜下形态鉴定致病真菌,采用MIC方法进行真菌体外药敏试验,根据药敏试验结果进行治疗并进行文献复习。结果从患者腰椎间隙内采集的血性液体标本经培养、鉴定为黄曲霉菌,对伏立康唑、卡泊芬净有较低的MIC值,分别为0.25、0.03μg/ml;随后选用伏立康唑和两性霉素B脂质体联合治疗有效;经检索中国期刊网全文数据库、美国国立图书馆PubMed数据库,未见有关白血病患者合并曲霉菌性骨髓炎的中文报道,国外报道文献4篇(4例),但未见曲霉菌属引起白血病患者多发感染的报道。结论血液系统恶性肿瘤化疗后合并黄曲霉菌造成的多发性骨感染极其罕见,且难诊断、难治疗,病死率极高,应引起足够重视;应尽快对感染部位进行穿刺取活检或抽取液体行病原菌培养及药敏试验,积极获取病原学证据;早期诊断和及时进行合理的抗真菌治疗是降低高病死率的关键。OBJECTIVE To explore the measures for diagnosis and treatment of the acute lymphoblastic leukemia patients complicated with multiple bone infections caused by Aspergillus flavus after chemotherapy so as to put forward measures for the diagnosis and treatment of multiple Aspergillus osteomyelitis in the immunocompromised patients. METHODS The specimens were sampled for fungal culture through intervertebral disc puncture biopsy guided by C arm fluoroscopy, then the isolated pathogenic fungi were identified according to characteristics of the fungal colonies as well as the microscopic morphologic characteristics, the in vitro drug susceptibility testing was performed with the use of MIC method, the patients were treated based on the result of drug susceptibility testing, and the literature was reviewed. RESULTS Via fungal culture, the bloody fluid specimens collected from lumbar vertebra were identified as Aspergillus flavus ; the vitro tests showed that the MIC of voriconazole and caspofungin to the Aspergillus niger isolated from the specimens of culture blood were 0. 25gg/ml and 0. 03gg/ml, respectively; then we chose combination therapy of voriconazole and amphotercin B liposome, which acquired effective therapeutic effect. By searching the literatures from Chinese journal full-text databases （CJFD） and National Library of Medcine （PubMed）, we discovered no Chinese report on leukemia patient incorporated with Aspergillus osteomyelitis, and there was no report covering the multiple infections caused by the Aspergillus in the leukemia patients. CONCLUSION It is rare that the multiple bone infections are caused by Aspergillus after the chemotherapy for malignant tumors of blood system, which are extremely difficult to diagnose and cure, and the mortality is so high that great importance should be attached to. It is necessary to perform the puncture biopsy for the infection sites and extract fluid for culture of pathogens as well as conduct the drug susceptibility testing so as to actively ac quire etiologic

关 键 词：黄曲霉菌 白血病 化疗 多发性骨感染 伏立康唑 两性霉素B 

分 类 号：R379[医药卫生—病原生物学]