PDF(Pubmed)
Abstract：
Invasive fungal diseases pose a significant threat to non-neutropenic ICU patients, with Candida and Aspergillus infections being the most common. However, diagnosing these infections in the ICU population remains challenging due to overlapping clinical features, poor sensitivity of blood cultures, and invasive sampling requirements. The classical host criteria for defining invasive fungal disease do not fully apply to ICU patients, leading to missed or delayed diagnoses. Recent advancements have improved our understanding of invasive fungal diseases, leading to revised definitions and diagnostic criteria. However, the diagnostic difficulties in ICU patients remain unresolved, highlighting the need for further research and evidence generation. Invasive candidiasis is the most prevalent form of invasive fungal disease in non-neutropenic ICU patients, presenting as candidemia and deep-seated candidiasis. Diagnosis relies on positive blood cultures or histopathology, while non-culture-based techniques such as beta-D-glucan assay and PCR-based tests show promise. Invasive aspergillosis predominantly manifests as invasive pulmonary aspergillosis in ICU patients, often associated with comorbidities and respiratory deterioration in viral pneumonia. Diagnosis remains challenging due to poor sensitivity of blood cultures and difficulties in performing lung biopsies. Various diagnostic criteria have been proposed, including mycological evidence, clinical/radiological factors and expanded list of host factors. Non-culture-based techniques such as galactomannan assay and PCR-based tests can aid in diagnosis. Antifungal management involves tailored therapy based on guidelines and individual patient factors. The complexity of diagnosing and managing invasive fungal diseases in ICU patients underscore the importance of ongoing research and the need for updated diagnostic criteria and treatment approaches. Invasive fungal disease, Invasive fungal infection, Invasive candidiasis, Invasive aspergillosis, Antifungal drugs.
摘要：
侵袭性真菌病对非中性粒细胞缺乏的ICU患者构成重大威胁，念珠菌和曲霉菌感染是最常见的。然而,由于重叠的临床特征，在ICU人群中诊断这些感染仍然具有挑战性，血培养的敏感性差，和侵入性采样要求。定义侵袭性真菌病的经典宿主标准并不完全适用于ICU患者。导致漏诊或延误诊断。最近的进展提高了我们对侵袭性真菌病的认识，导致修订的定义和诊断标准。然而,ICU患者的诊断困难仍未解决，强调需要进一步研究和证据生成。侵袭性念珠菌病是非中性粒细胞减少性ICU患者中最常见的侵袭性真菌病。表现为念珠菌血症和深层念珠菌病。诊断依赖于阳性血培养或组织病理学,而基于非培养的技术，如β-D-葡聚糖测定和基于PCR的测试显示出希望。侵袭性曲霉病主要表现为ICU患者的侵袭性肺曲霉病，通常与病毒性肺炎的合并症和呼吸道恶化有关。由于血液培养的敏感性差以及进行肺活检的困难,诊断仍然具有挑战性。已经提出了各种诊断标准，包括真菌学证据,临床/放射学因素和扩大的宿主因素列表。基于非培养的技术如半乳甘露聚糖测定和基于PCR的测试可以帮助诊断。抗真菌管理涉及基于指南和个体患者因素的定制治疗。ICU患者中侵袭性真菌病的诊断和管理的复杂性强调了正在进行的研究的重要性以及更新的诊断标准和治疗方法的需要。侵袭性真菌病,侵袭性真菌感染,侵袭性念珠菌病,侵袭性曲霉病,抗真菌药物。
