肝移植围手术期使用艾沙康唑治疗毛孢子菌感染有效2例并经验分享  

The infection of Trichosporon effectively treated with isavuconazole during the perioperative period for liver transplantation:two cases report and experience sharing

作　　者：麦汉滔 张克林[1] 郭瑞莲[1] 庄苏园 何清[1] MAI Han-tao;ZHANG Ke-lin;GUO Rui-lian;ZHUANG Su-yuan;HE Qing(Liver Transplantation Intensive Care Unit,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510289,China)

机构地区：[1]中山大学孙逸仙纪念医院肝移植ICU,广州510289

出　　处：《岭南现代临床外科》2024年第5期330-334,共5页Lingnan Modern Clinics in Surgery

摘　　要：目的探讨艾沙康唑治疗毛孢子菌病的可行性及分享相关临床经验。方法通过对我院2例肝移植围手术期发生肺毛孢子感染病例的诊治经过进行回顾性分析,结合国内外文献资料学习,总结毛孢子菌病的特点与诊疗要点,以及评估艾沙康唑治疗毛孢子菌病的可行性。结果两例患者因“肝衰竭”行肝移植术,术前通过宏基因二代测序技术更早地发现肺部毛孢子菌感染,使用两性霉素B治疗后效果不佳,均选择加用艾沙康唑联合治疗;病例1术后还合并肺部烟曲霉菌感染,使用艾沙康唑时间将近10个月,影像学上的双肺病灶有改善且多次真菌相关病原学结果阴性;病例2艾沙康唑治疗时长为2周,最后治愈出院。截至投稿日期,病例1患者已死亡,病例2患者仍存活。结论艾沙康唑是一种潜在有效治疗毛孢子菌病的药物,可为临床提供多一种选择。Objective To explore the feasibility of isavuconazole in the treatment of Trichosporon infection and share clinical experience.Methods Through a retrospective analysis of the treatment process of two cases of pneumonia caused by Trichosporon during the perioperative period of liver trans-plantation at our hospital,combined with the study of relevant literature,we summarize the characteristics and treatment points of trichosporonosis,as well as the evaluate the feasibility of using isavuconazole to treat trichosporonosis.Results Two patients underwent liver transplantation for“liver failure,”and the lung trichosporonosiswas detected earlier through metagenomic next-generation sequencing technology before the operation.After treatment with amphotericin B failed,two patients were treated with isavucon-azole in combination.Case 1 was also complicated with pulmonary Aspergillus fumigatus infection after surgery.The treatment of isavuconazolefor nearly 10 months showed improvement in both pulmonary lesions on imaging and negative results of fungal etiology for many times.Case 2 was treated with isavuconazole for 2 weeks and finally cured.As of the submission date,case 1 patient had died and Case 2 patient was still alive.Conclusion Isavuconazole is a potentially effective drug for trichosporonosis.

关 键 词：艾沙康唑 毛孢子菌 肝衰竭 肝移植 

分 类 号：R657.3[医药卫生—外科学] R639[医药卫生—临床医学]