背景:头孢孢子虫病是一种新兴的真菌病,近年来由于其在世界范围内的流行而变得越来越重要。它是由Scedosporiumapiospermum复合体的物种引起的。这些物种可导致免疫功能低下患者的机会性感染,偶尔,在有免疫能力的患者中也是如此。高的内在抗真菌耐药性使这些感染难以管理。
目的:本研究的目的是解释移植患者的真菌学结果,连同放射学研究中获得的图像,以便提供早期有效的抗真菌治疗。
方法:对来自心脏移植患者的样本进行真菌学分析,放射学图像提示真菌感染。头部和胸部的计算机断层扫描扫描显示额叶和小脑均有占位性病变,和多个肺结节.穿刺结节,并根据真菌学分析程序分析获得的样品。通过核苷酸测序确认分离物的身份。最终,研究了抗真菌药物的敏感性。
结果:获得的真菌分离株,通过测序确认了其身份,属于Scedosporiumboydii物种。手术切除损伤的组织,并分别给予两性霉素B和伏立康唑的最低抑制浓度(MIC)0.5μg/mL和≥0.5μg/mL。
结论:尽管患者因肺炎克雷伯菌败血症的并发症而死亡,真菌疾病的进展,虽然缓慢,由于正确的诊断和进行的抗真菌药敏试验,在治疗的早期阶段是有利的。这种性质的临床病例强调需要增加对这些微生物的流行病学研究,以及对引起的疾病的适当治疗,以实现降低患者发病率和死亡率的早期诊断。
BACKGROUND: Scedosporiasis is an emerging mycosis that has gained importance in recent years due to its worldwide prevalence. It is caused by species of the Scedosporium apiospermum complex. These species can cause opportunistic infections in immunocompromised patients and, occasionally, in immunocompetent patients as well. The high intrinsic antifungal resistance make these infections difficult to manage.
OBJECTIVE: The objective of this study was to interpret the mycological findings in a transplant patient, together with the images obtained in the radiological studies, in order to provide an early and effective antifungal therapy.
METHODS: The mycological analysis of samples taken from a heart transplant patient with radiological images suggesting a fungal infection was performed. Computed tomography scan of the head and thorax showed space-occupying lesions in both the frontal lobe and cerebellum, and multiple pulmonary nodules. The nodules were punctured and the samples obtained were analyzed according to the procedures for mycological analysis. The identity of the isolates was confirmed by nucleotide sequencing. Eventually, the antifungal susceptibility was studied.
RESULTS: The fungal isolates obtained, whose identity was confirmed by sequencing, belonged to the species Scedosporium boydii. Injured tissues were surgically removed and a treatment with amphotericin B and voriconazole-minimum inhibitory concentration (MIC) 0.5μg/mL and ≥0.5μg/mL respectively - was administered.
CONCLUSIONS: Although the patient died due to complications of a Klebsiella pneumoniae sepsis refractory to treatment, the progression of the fungal disease, although slow, was favourable in the early phases of the treatment due to a correct diagnosis and the antifungal susceptibility test carried out. Clinical cases of this nature highlight the need to increase the epidemiological study of these microorganisms, as well as the proper treatment of the diseases caused, in order to achieve early diagnoses that reduce the morbidity and mortality of patients.