摘要
目的探讨真菌性心内膜炎(FE)的临床特点,以提高对FE的认识。方法分析我院确诊的6例FE的临床资料。结果①6例患者中,4例男性,病程15d^9个月;②3例患者存在心脏基础病,风湿性心脏病2例,先天性心脏病换瓣术后1例,另系统性红斑狼疮(SLE)2例;③易患因素:长期使用广谱抗生素(5例次)、糖皮质激素使用(3例次)、狼疮活动(2例次)、心脏手术、呼吸机相关性肺炎、真菌性皮炎等(各1例次);④主要临床表现为发热(6/6)、栓塞(5/6);超声心动图(UCG)检出瓣周漏及瓣周积脓1例、赘生物5例,并且所有赘生物最大直径均≥1.2cm;⑤6例患者共检出致病真菌7株,其中念珠菌最多(4株),另有毛霉、隐球菌及青霉(各1株);⑥2例SLE患者接受了单纯抗真菌药物治疗,1例好转,1例死亡;另4例患者均接受了手术和药物联合治疗,痊愈2例,复发后死亡2例;结论FE是严重的深部真菌感染之一,多数患者存在诱因及基础疾病,临床表现具有起病隐匿、病程长、赘生物体积大、栓塞发生率高等特点,早期诊断及内外科联合治疗有利于改善预后。
Objective To investigate the clinical characteristics, therapeutic approaches and outcomes of fungal endocarditis （FE）. Methods The clinical profiles of 6 FE patients, who were treated in Peking Union Medical College Hospital from 1998 to 2004, were analyzed. All cases were documented infectious endocarditis fIE） based on Duke＇s new criteria and fungi detected in microbiological studies. Results ① Of the 6 FE cases, 4 were male and 2 female. The average age was 38.3 ± 9. 4 years old. The average duration before diagnosis was 3.75 ± 3.28 months. ② The underlying diseases were rheumatic heart diseases in 2 cases, valvular replacement in 1 case, and systemic lupus erythematosus in 2 cases. Five of the 6 patients developed FE during hospitalization. ③ The common predisposing factors were long term broad-spectrum antibiotics therapy （5/6）, corticosteroid treatment （3/6）, active lupus （2/6）. ④ Fever （6/6） and embolism （5/6） were the most common clinical manifestations. The echocardiogram findings were large vegetations （all vegetations had a diameter of ≥ 1. 2 cm） in 5 patients, peri-valvular empyema in 1 patient. ⑤ A total of 7 strains of fungi were detected from 6 patients. Candida was the most frequently isolated fungi （n = 4）. Additionally, Mucor, Cryptococcus neoformans and Penicillium （1 each） were also identified from the removed embolus and vegetations; ⑥ Two patients were treated with anti-fungal agents conservatively, 1 improved and 1 died. The other 4 patients received both medical and surgical treatment. Two were cured, the other 2 died after relapse. Conclusions FE is a rare but severe disease. It usually occurs in immunocompromised patients with underlying diseases. Clinical features of such infection are insidious onset, longer course, larger vegetation, and higher incidence of embolism. Early diagnosis and medical therapy combined with surgical management are helpful for improving the outcomes.
出处
《中国抗感染化疗杂志》
2005年第4期205-209,共5页
Chinese Journal of Infection and Chemotherapy
