1例免疫缺陷患儿播散性马尔尼菲篮状菌感染的药学监护  

Pharmaceutical Care of an Immunocompromised Child with Disseminated Talaromyces Marneffei Infection

作　　者：马欢 朗晓琴 谷文睿 枉前 MA Huan;LANG Xiaoqin;GU Wenrui;WANG Qian(Department of Pharmacy,The First Hospital Affiliated Army Medical University,Chongqing,China 400038)

机构地区：[1]中国人民解放军陆军军医大学第一附属医院药学部,重庆400038

出　　处：《中国药业》2025年第3期124-127,共4页China Pharmaceuticals

基　　金：重庆市卫生健康委员会临床药学重点专科建设项目[渝卫办发﹝2023﹞2号]。

摘　　要：目的为临床安全、合理治疗免疫缺陷患儿播散性马尔尼菲篮状菌(TM)感染提供参考。方法临床药师通过参与1例免疫缺陷患儿播散性TM感染的治疗,结合相关指南、专家共识、患儿检查结果对其抗真菌用药的选择、药品不良反应(ADR)等实施药学监护。结果基于患儿的血培养结果为TM,临床药师建议予两性霉素B脱氧胆酸盐抗真菌;但患儿仍反复高热,痰培养结果仍为TM,考虑为播散性TM,建议加用注射用伏立康唑联合抗真菌;患儿病情稳定后,调整为伏立康唑片单药口服治疗。同时建议行基因检测,结果提示X连锁高免疫球蛋白M综合征,出院继续口服伊曲康唑口服液维持治疗。随访6个月,患儿预后良好,无复发。结论目前,尚无关于预防及治疗免疫缺陷患儿播散性TM感染的标准或指南,临床药师参与免疫缺陷患儿播散性TM感染的药学监护,可提高合理用药水平,保障用药安全。Objective To provide a reference for the safe and rational treatment of disseminated Talaromyces marneffei(TM)infection in an immunocompromised child in the clinic.Methods The clinical pharmacist participated in the treatment of a disseminated TM infection in an immunocompromised child,and implemented pharmaceutical care for the selection of antifungal drugs and adverse drug reactions(ADRs)based on relevant guidelines,expert consensus,and the child's examination results.Results Due to the blood culture results of the child being TM,the clinical pharmacist recommended administering amphotericin B deoxycholate(AmBd)for antifungal treatment.However,the child still had recurrent high fever,and the sputum culture result was still TM,the clinical pharmacist considered the child to be disseminated TM and recommended adding Fluconazole Injection combined with antifungal therapy.After the child's condition was stable,the pharmacist adjusted the treatment plan to Voriconazole Tablets as a monotherapy.Meanwhile,the pharmacist suggested that the child took genetic testing,and the results indicated the child had X-linked high immunoglobulin M syndrome.The child was discharged and continued to receive oral Itraconazole Oral Solution for maintenance treatment.After six months of follow-up,the child had a good prognosis with no recurrence.Conclusion At present,there are no standards or guidelines for the prevention and treatment of disseminated TM infection in immunocompromised children.The participation of clinical pharmacists in the pharmaceutical care of disseminated TM in the immunocompromised child can improve rational drug use and ensure medication safety.

关 键 词：马尔尼菲篮状菌 免疫缺陷 临床药师 药学监护 

分 类 号：R95[医药卫生—药学]