Fonsecaea monophora致脑暗色丝孢霉病的诊疗分析  

Diagnosis and treatment of cerebral phaeohyphomycosis caused by Fonsecaea monophora

作　　者：杨驾煌 董伟[1] 徐珊玲[1] 刘真君[1] Yang Jiahuang;Dong Wei;Xu Shanling;Liu Zhenjun(Critical Care Department,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,China)

机构地区：[1]四川省肿瘤临床医学研究中心,四川省肿瘤医院/研究所,四川省癌症防治中心,电子科技大学附属肿瘤医院重症医学科,成都3610041

出　　处：《国际流行病学传染病学杂志》2024年第4期283-288,共6页International Journal of Epidemiology and Infectious Disease

摘　　要：目的了解Fonsecaea monophora致脑暗色丝孢霉病的临床表现及诊疗方法。方法采用描述性流行病学方法分析1例2023年6月就诊于四川省肿瘤临床研究中心的Fonsecaea monophora致脑暗色丝孢霉病病例。并回顾既往报道,对12例病例的临床特点归纳总结。结果脑Fonsecaea monophora主要感染免疫下降的患者(8例)。头痛(9例)和偏瘫(7例)是主要的临床表现,影像学上主要表现为单侧病变(11例),通常G试验阳性。以手术和抗真菌药物为主,伏立康唑(9例)和两性霉素B(8例)是主要的药物,患者具有高死亡率(6例)。在免疫正常和免疫下降感染宿主中的临床特点和预后没有差异性。和脑Cladophialophora bantiana感染比较,年龄、癫痫发生率、单侧病变率和伊曲康唑使用率有一定差异。结论脑Fonsecaea monophora通常感染免疫下降人群,表现为头痛和偏瘫,癫痫发生率低,单侧病变更多见。手术、三唑类或两性霉素B抗真菌药物是主要的治疗方法,有较高的死亡率。Objective To investigate the clinical manifestations and treatment methods of cerebral phaeohyphomycosis caused by Fonsecaea monophora.Methods Descriptive epidemiology method was conducted on one case of cerebral phaeohyphomycosis caused by Fonsecaea monophora at the Sichuan Clinical Research Center for Cancer in June 2023.Previous reports were reviewed and the clinical characteristics of 12 cases were summarized.Results Cerebral Fonsecaea monophora mainly infected immunocompromised patients(8 cases).Headache(8 cases)and hemiplegia(7 cases)were identified as the predominant clinical manifestations,and brain imaging typically revealed unilateral lesions(11 cases),accompanied by positive G-test.The cornerstone of treatment involved surgical intervention and administration of antifungal drugs,with voriconazole(9 cases)and amphotericin B(8 cases)being the primary medications used.However,a high mortality rate was observed(6 cases).There were no significant differences in clinical features and prognosis between immunocompetent and immunocompromised hosts.Patients infected with Fonsecaea monophora differed from those infected with Cladophialophora bantiana in terms of age,incidence of epilepsy,presence of unilateral disease,and use of itraconazole.Conclusions Cerebral infections caused by Fonsecaea monophora predominantly occur in immunocompromised individuals,presenting with headache and hemiparesis,low incidence of seizures,and frequent unilateral lesions.Surgery along with triazoles or amphotericin B are considered as the main therapeutic modalities.Nevertheless,the mortality remains high.

关 键 词：颅内感染 Fonsecaea monophora 脑暗色丝孢霉病 伏立康唑 

分 类 号：R742.9[医药卫生—神经病学与精神病学]