PDF(Pubmed)
Abstract：
Aspergillus stands as the predominant fungal genus in the airways of cystic fibrosis (CF) patients, significantly contributing to their morbidity and mortality. Aspergillus fumigatus represents the primary causative species for infections, though the emergence of rare species within the Aspergillus section Fumigati has become noteworthy. Among these, Aspergillus lentulus is particularly significant due to its frequent misidentification and intrinsic resistance to azole antifungal agents. In the management of invasive aspergillosis and resistant infections, combination antifungal therapy has proven to be an effective approach. This report documents a case involving the death of a CF patient due to a pulmonary exacerbation linked to the colonization of multiple Aspergillus species, including A. lentulus, A. fumigatus, and A. terreus, and treated with Itraconazole (ITC) monotherapy. We delineated the procedures used to characterize the Aspergillus isolates in clinical settings and simulated in vitro the impact of the combination antifungal therapy on the isolates obtained from the patient. We evaluated three different combinations: Amphotericin B (AMB)+Voriconazole (VRC), AMB+Anidulafungin (AND), and VRC+AND. Notably, all strains isolated from the patient exhibited a significant decrease in their minimum inhibitory concentration (MIC) or minimum effective concentration (MEC) values when treated with all antifungal combinations. The VRC+AMB combination demonstrated the most synergistic effects. This case report emphasizes the critical importance of susceptibility testing and precise identification of Aspergillus species to enhance patient prognosis. It also underscores the potential benefits of combined antifungal treatment, which, in this case, could have led to a more favourable patient outcome.
摘要：
曲霉是囊性纤维化（CF）患者气道中的主要真菌属，显着导致其发病率和死亡率。烟曲霉是感染的主要致病物种，尽管在曲霉菌部分中出现了稀有物种，但Fumigati已经变得值得注意。其中,由于其频繁的错误鉴定和对唑类抗真菌剂的内在抗性,因此肠曲霉特别重要。在侵袭性曲霉病和耐药感染的管理中，联合抗真菌治疗已被证明是一种有效的方法。该报告记录了一例CF患者因肺部恶化而死亡的病例，该肺部恶化与多种曲霉属物种的定植有关。包括A.lentulus，A.烟,和A.terreus，并用伊曲康唑（ITC）单药治疗。我们描述了用于在临床环境中表征曲霉属分离株的程序，并在体外模拟了联合抗真菌治疗对从患者获得的分离株的影响。我们评估了三种不同的组合：两性霉素B（AMB）+伏立康唑（VRC），AMB+Anidulafungin(AND),和VRC+AND。值得注意的是,当使用所有抗真菌组合治疗时,从患者中分离出的所有菌株的最小抑制浓度(MIC)或最小有效浓度(MEC)值均显著降低.VRC+AMB组合表现出最大的协同作用。此病例报告强调了敏感性测试和曲霉菌种的精确鉴定对改善患者预后的至关重要性。它还强调了联合抗真菌治疗的潜在益处，which,在这种情况下,可能会导致更有利的患者结果。
