曲霉菌Aspergillus salwaensis致脊柱感染1例  

A case of Aspergillus salwaensis-induced spinal infection

作　　者：梁悦怡 温海楠[1] 陈东科[2] 刘焱超 孙立红 张盼 谢守军[1] LIANG Yueyi;WEN Hainan;CHEN Dongke;LIU Yanchao;SUN Lihong;ZHANG Pan;XIE Shoujun(Department of Clinical Laboratory,the Affiliated Hospital of Chengde Medical College,Chengde,Hebei 067000,China;Department of Clinical Laboratory,Beijing Hospital,Beijing 100000,China)

机构地区：[1]承德医学院附属医院南院区检验科,河北承德067000 [2]北京医院检验科,北京100000

出　　处：《中国热带医学》2023年第7期778-782,共5页China Tropical Medicine

基　　金：承德市科学技术研究与发展计划项目(No.201904A048)。

摘　　要：报道1例Aspergillus salwaensis致脊柱感染及实验室检测。采集2020年6月17日承德医学院附属医院收治的1例脊柱感染患者的炎性肉芽、坏死组织标本进行镜检、培养,对分离得到的菌株进行基质辅助激光解吸电离飞行时间质谱(matrix-assisted laser desorption ionization time-of-flight mass spectrometry, MALDI-TOF-MS)鉴定、分子鉴定及体外抗真菌药敏试验。患者女,62岁,临床表现以无明显诱因反复胸背部疼痛为主,初步诊断脊柱感染,左氧氟沙星治疗7 d效果不佳,行胸椎后路病灶清除术治疗,组织标本镜下可见真菌菌丝,分离到的菌株无典型结构,经MALDI-TOFMS多次鉴定均无结果,氟康唑治疗7 d后病情好转,胸背部疼痛较术前减轻,予出院,门诊随诊。后通过内转录间隔区(internal transcribed spacer, ITS)序列分析确定该菌为Aspergillus salwaensis,立即与临床医生沟通,联系患者将抗真菌药物更换为伏立康唑,术后1年随访患者自觉恢复良好,术区无疼痛,脊柱活动正常。对于无明显诱因的腰背部疼痛且常规抗生素治疗效果不佳的患者应考虑到脊柱真菌感染的可能。直接涂片报告镜检结果对临床抗菌药物的选择有重要意义。对于此类罕见的丝状真菌,菌落形态和镜下形态均不太典型、质谱鉴定不出结果时,采用ITS序列分析等分子生物学方法有助于尽早鉴定出真菌种类,提高鉴定速度。To report a case of Aspergillus salwaensis-induced spinal infection and its laboratory detection.The inflammatory granulation and necrotic tissue samples of a patient with spinal infection were collected from,the Affiliated Hospital of Chengde Medical College on June 17,2020 for direct smear microscopy and culture,and the isolated strain was identified by microscopy by smear staining,matrix-assisted laser desorption ionization-time-of-flight mass spectrometry(MALDI-TOF-MS),molecular identification and in vitro antifungal susceptibility test.The patient was 62 years old female and presented with recurrent chest and back pain with no obvious cause.The initial diagnosis was spinal infection,after 7 days of treatment with levofloxacin,the effect was not good.Surgery was then performed remove the lesion via posterior thoracic debridement,and fungal hypha was observed under microscope in tissue specimens.The isolated strains had no typical structure,MALDI-TOF-MS was used for identification for many times,but there was no identification result.After 7 days of fluconazole treatment,the patient's condition improved,and her chest and back pain were alleviated compared to before surgery.The patient was discharged and followed up in the outpatient department,the fungus was later identified as Aspergillus salwaensis by sequence analysis of the internal transcribed spacer(ITS)gene sequencing,and the patient's antifungal medication was changed to voriconazole after with the attending physician.The patient consciously recovered well with no pain in the operative area and normal spinal activity at 1 year follow-up.The possibility of spinal fungal infection should be considered in patients with back pain without a clear cause and poor response to routine antibiotic treatment.Direct smear report of microscopic results are very important for guiding clinical antibiotic selection for rare filament fungi with atypical colony and microscopic morphology and unsuccessful MALDI-TOF-MS identification,molecular biological methods such as IT

关 键 词：曲霉菌 Aspergillus salwaensis 脊柱感染 丝状真菌 基质辅助激光解吸电离飞行时间质谱 

分 类 号：R681.5[医药卫生—骨科学] R379[医药卫生—外科学]