摘要
目的报告1例拟康宁木霉引起血流感染患者的诊断、治疗情况。方法总结1例拟康宁木霉引起血流感染患者的临床诊疗过程,并检索数据库相关文献进行复习。结果患者男性,60岁,因“间断发热伴腰膝痛半月余”入院,依据检查结果,给予头孢曲松钠、左氧氟沙星、更昔洛韦治疗无明显好转。外周血第二代测序技术(NGS)检测为拟康宁木霉,考虑木霉菌血流感染,给予伏立康唑口服后患者发作间期逐渐延长,由每2~3 d发作一次延长至每4~5 d发作一次,体温峰值有所下降,腰及膝关节疼痛程度减轻;出院后继续口服伏立康唑,随访1个月余患者逐渐退热,腰膝痛随之缓解,但出院2个月后猝死。检索外文文献报道病例38例(中国1例),中文文献报道病例2例,共计40例。文献检索统计木霉感染患者基础疾病以器官移植(12例)、血液病(9例)、腹膜透析(6例)为主,患者临床表现以肺部感染(8例)、腹膜炎(6例)、播散感染(5例)为主,地区分布以欧美国家居多(26例),亚洲5例,非洲2例,南美洲1例,地区不详6例。检出病原体以长梗木霉为主(24例)。结论木霉是一种机会致病菌,多发生于免疫功能低下者,易误诊,建议尽早送检NGS明确病原体,以争取救治时机,降低病死率。
Objective To report the diagnosis and treatment of a patient with bloodstream infection(BSI)caused by Trichoderma koningiopsis(T.koningiopsis).Methods Clinical diagnosis and treatment processes of an adult patient admitted to a hospital due to BSI caused by T.koningiopsis were summarized.Relevant reports were retrieved from databases for reviewing.Results A 60-year-old male patient was admitted to hospital due to“intermittent fever with lumbago and knee pain for more than half a month”.According to the examination results,the patient was treated with ceftriaxone sodium,levofloxacin and ganciclovir,but didn’t achieve obvious improvement.T.koningiopsis was identified by next-generation sequencing(NGS)of peripheral blood,thus T.koningiopsis BSI was considered.After oral administration of voriconazole,the interval between episodes of patients gradually prolonged,from one episode every 2-3 days to one episode every 4-5 days,peak temperature of the patient decreased,and the lumbago and knee pain alleviated.After discharge,the patient continued taking voriconazole orally.After a follow-up of more than 1 month,fever gradually subsided,lumbago and knee pain was relieved,but the patient died suddenly 2 months after discharge.A total of 40 cases were retrieved from literatures,out of which 38 cases were reported by foreign literatures and 2 reported in Chinese.According to the literature retrieval statistics,the under-lying diseases of patients with Trichoderma infection were mainly organ transplantation(n=12),hematological di-sease(n=9),and peritoneal dialysis(n=6).The main clinical manifestations of patients were mainly pulmonary infection(n=8),peritonitis(n=6),and disseminated infection(n=5).The regional distribution was mainly in European and American countries(n=26),5 cases in Asia,2 cases in Africa,1 case in South America,and 6 cases in unknown regions.Trichoderma longibrachiatum was as the main detected pathogen(n=24).Conclusion Trichoderma is an opportunistic pathogen,whose infection often occurs in patients w
作者
宋津晓
李素彦
李宁
SONG Jin-xiao;LI Su-yan;LI Ning(Department of General Medicine,Hebei General Hospital,Shijiazhuang 050051,China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2023年第3期262-266,共5页
Chinese Journal of Infection Control
关键词
拟康宁木霉
木霉
木霉病
人类木霉病
血流感染
二代测序
Trichoderma koningiopsis
Trichoderma
trichodermasis
human trichodermasis
bloodstream infection
next-generation sequencing
