背景:头芽裂菌感染是一种罕见的真菌感染,主要发生于免疫缺陷患者,会导致多器官受累。目前,没有明确的指定治疗方案.该病例是免疫功能正常的头状裂殖菌肺部感染的罕见病例,通过联合抗真菌治疗得到有效控制。
方法:我们报告了一位67岁的男性吸烟者,谁,在清理了很长一段时间的小平房后,没有任何保护措施,咳嗽伴有咳痰,发烧和呼吸困难。入院前抗感染药物(阿莫西林和罗红霉素)效果不大,病人的病情恶化了。既往史:肺结核合并胸膜炎6年。胸部计算机断层扫描(CT)显示右上叶陈旧性结核和两个下叶炎症的证据。白细胞计数14.51×109/L,中性粒细胞为13.39×109/L,C反应蛋白(CRP)为170mg/L。广谱抗生素哌拉西林钠4.0g和他唑巴坦钠0.5gq8h经验性给药5天。通过支气管肺泡灌洗液的下一代宏基因组测序(NGS)和痰的质谱分析证实了头状芽胞杆菌感染。然后他改用伏立康唑抗真菌药物联合两性霉素B雾化吸入。他的体温恢复正常,咳痰、呼吸困难缓解。白细胞总数降至8.10×109/L,中性粒细胞为5.81×109/L,CRP降至76.8mg/L。
结论:本病例说明免疫功能正常的患者可发生头芽裂菌感染。质谱和宏基因组NGS方法在鉴定这种真菌感染方面可能比传统方法具有优势。此外,伏立康唑和雾化两性霉素B的组合可以用作治疗头花裂菌感染的新方案。对于有环境暴露史的肺部感染,早期病原体鉴定和培养,和适当的抗生素治疗是优化结果的关键。
BACKGROUND: Blastoschizomyces capitatus infection is a rare fungal infection; mainly occurring in immunodeficient patients, which can cause multiple organ involvement. At present, there is no clear designated treatment regimen. This case was a rare example of Blastoschizomyces capitatus lung infection in patient with normal immune function, which was effectively controlled by combined antifungal therapy.
METHODS: We report a 67-year-old male smoker, who, after cleaning a small bungalow for a long period, without any protective measures, developed cough with expectoration, fever and dyspnea. Pre-admission anti-infective medication (amoxicillin and roxithromycin) had little effect, and the patient\'s condition worsened. He had a past history of pulmonary tuberculosis with pleurisy 6 years before. Chest computed tomography (CT) showed evidence of old tuberculosis in the right upper lobe and inflammation in both lower lobes. White blood cell count was 14.51×109/L, neutrophils was 13.39×109/L and C-reactive protein (CRP) was 170 mg/L. Broad-spectrum antibiotics piperacillin sodium 4.0 g and tazobactam sodium 0.5 g q8h were administered empirically for 5 days. Blastoschizomyces capitatus infection was confirmed by next generation of macro genome sequencing (NGS) of bronchoalveolar lavage fluid and mass spectrum analysis of sputum. He was then switched to voriconazole antifungal therapy combined with aerosol inhalation of amphotericin B. His temperature normalized, expectoration and dyspnea were relieved. Total white cell count fell to 8.10×109/L, neutrophils to 5.81×109/L, and CRP to 76.8 mg/L.
CONCLUSIONS: This case demonstrates that Blastoschizomyces capitatus infection can occur in patients with normal immune function. Mass spectrometry and metagenomic NGS methods may have an advantage over traditional methods in identifying this fungal infection. In addition, the combination of voriconazole and nebulized amphotericin B can be employed as a novel regimen for treating Blastoschizomyces capitatus infection. For pulmonary infection with a history of environmental exposure, early pathogen identification and culture, and appropriate antibiotic treatment are key to optimizing outcome.