PDF(Pubmed)
Abstract：
BACKGROUND PAECILOMYCES: and Penicillium are considered as rare opportunistic pathogens in immunocompromised hosts, and pneumonia caused by Paecilomyces and Penicillium is rare. In this study, we present first case of severe pneumonia with pleural effusion caused by co-infection of Paecilomyces variotii (P. variotii) and Penicillium oxalicum (P. oxalicum) in a 66-year-old female with poorly controlled type 2 diabetes. CASE PRESENTATION: A 56-year-old woman patient presented to hospital for nausea, poor appetite, and vomiting for one day. On the second day of admission, blood culture and renal puncture fluid culture grew multidrug-resistant Escherichia coli (imipenem/cilastatin sensitive), and she received combination therapy with imipenem/cilastatin (1 g, every 8 h) and vancomycin (0.5 g, every 12 h). On the fourth day, she developed symptoms of respiratory failure. Pulmonary computed tomography (CT) showed an increase in pneumonia compared to before, with minor pleural effusion on both sides. Two fungi were isolated repeatedly from BALF culture, which were confirmed as P. variotii and P. oxalicum by Internal transcribed spacer (ITS) sequencing. Her pleural effusion was completely absorbed, pneumonia symptoms have significantly improved and discharged with receiving liposomal amphotericin B treatment for four weeks. CONCLUSIONS: It is worth noting that clinicians and laboratory personnel should not simply consider Paecilomyces and Penicillium species as contaminants, especially in immunocompromised patients. Early fungal identification and antifungal drug sensitivity are crucial for clinical drug selection and patient prognosis.
摘要：
背景：在免疫功能低下的宿主中，青霉被认为是罕见的机会性病原体，由拟青霉和青霉引起的肺炎很少见。在这项研究中,我们介绍了第一例由变色拟青霉合并感染引起的重症肺炎伴胸腔积液(P.variotii)和草酸青霉(P.草酸）在一名66岁的2型糖尿病控制不佳的女性中。案例介绍：一名56岁的女性患者因恶心入院，食欲不振,呕吐了一天。入学的第二天，血培养和肾穿刺液培养生长多重耐药大肠杆菌（亚胺培南/西司他丁敏感），她接受了亚胺培南/西司他丁的联合治疗（1克，每8小时)和万古霉素(0.5g，每12小时)。第四天,她出现了呼吸衰竭的症状。肺部计算机断层扫描（CT）显示肺炎比以前增加，两侧有少量胸腔积液。从BALF培养物中反复分离出两种真菌，通过内部转录间隔区（ITS）测序确认为变形杆菌和草酸杆菌。她的胸腔积液完全吸收了,接受脂质体两性霉素B治疗4周后,肺炎症状得到明显改善并出院.结论：值得注意的是，临床医生和实验室人员不应该简单地将拟青霉属和青霉属视为污染物，尤其是免疫功能低下的患者。早期真菌识别和抗真菌药物敏感性对临床药物选择和患者预后至关重要。
