由黑色酵母样真菌皮肤Exophiala引起的全身性感染很少见,但与高死亡率相关,尤其是在免疫功能低下的患者中。我们报告了第一例早产极低出生体重(ELBW)的新生儿,尽管使用脂质体两性霉素(AMB)和氟康唑进行了抗真菌治疗,但该新生儿仍死亡。我们还对所有由E.dermatitidis引起的真菌血症病例进行了系统评价,目的是更好地了解风险因素。治疗策略和结果。
一个男性,ELBW早产儿,在他出生后不久,出现了心动过缓,呼吸暂停,最终坏死性小肠结肠炎伴肠穿孔,需要手术干预。同时,他也有多种发生血流感染的危险因素,比如插管,机械通气,中心静脉导管(CVC),肠外营养,经验性和长期使用抗生素。他的血培养呈阳性,在氟康唑预防性治疗和抗生素经验性治疗期间,首先是朱氏不动杆菌,然后是肺炎克雷伯菌和柏林大肠杆菌。尽管用广谱抗生素治疗,脂质体AMB和氟康唑,新生儿死了。文献综述确定了另外12例E.dermatitidis血流感染,主要是血液系统恶性肿瘤和实体器官移植受者(61%),尽管CVC去除和抗真菌治疗,总死亡率为38%。
由于E.dermatitidis感染的罕见,对这种酵母的特性知之甚少,鉴定方法和最佳治疗方法。通过常见的生化测试进行鉴定是有问题的,需要分子鉴定。尽管进行了适当的抗真菌治疗,但新生儿真菌血症的解决仍然很困难,尤其是在具有多种严重危险因素的情况下,例如目前的危险因素。治疗性干预可包括CVC去除和使用唑(药敏试验后伊曲康唑或氟康唑)或AMB单一疗法治疗至少3周,但不包括棘白菌素或AMB加唑联合疗法。
Systemic infections caused by the black yeast-like fungus Exophiala dermatitidis are rare, but are associated with high mortality especially in immunocompromised patients. We report the first
case of E. dermatitidis fungemia in a premature extremely low birth weight (ELBW) neonate who succumbed despite antifungal therapy with liposomal amphotericin (AMB) and fluconazole. A systematic review of all fungemia cases due to E. dermatitidis was also conducted aiming for a better understanding of the risk factors, treatment strategies and outcomes.
A male, ELBW premature neonate, soon after his birth, developed bradycardia, apnoea and ultimately necrotizing enterocolitis with intestinal perforation requiring surgical intervention. Meanwhile, he had also multiple risk factors for developing bloodstream infection, such as intubation, mechanical ventilation, central venous catheter (CVC), parenteral nutrition, empirical and prolonged antibiotic use. His blood cultures were positive, firstly for Acinetobacter junii and then for Klebsiella pneumoniae together with E. dermatitidis while on fluconazole prophylaxis and antibiotic empiric therapy. Despite the treatment with broad spectrum antibiotics, liposomal AMB and fluconazole, the newborn succumbed. A literature review identified another 12 E. dermatitidis bloodstream infections, mainly in patients with hematologic malignancies and solid organ transplant recipients (61%), with overall mortality 38% despite CVC removal and antifungal therapy.
Due to the rarity of E. dermatitidis infections, little is known about the characteristics of this yeast, the identification methods and the optimal therapy. Identification by common biochemical tests was problematic requiring molecular identification. Resolution of neonatal fungemia is difficult despite proper antifungal therapy especially in cases with multiple and severe risk factors like the present one. Therapeutic intervention may include CVC removal and treatment for at least 3 weeks with an azole (itraconazole or fluconazole after susceptibility testing) or AMB monotherapy but not echinocandins or AMB plus azole combination therapy.