摘要
白血病继发毛霉菌和曲霉菌混合感染十分少见,诊断困难,进展速度快,严重时可危及生命。本文报道1例急性髓系白血病儿童化学治疗后继发毛霉菌和曲霉菌感染儿童的临床特点及诊疗过程。患儿为12岁男性,诱导化学治疗中出现发热、咳嗽等表现,血液、脑脊液、肺泡灌洗液宏基因组二代测序均检测出微小根毛霉、黄曲霉,先后应用两性霉素B、泊沙康唑、伏立康唑抗真菌治疗,并行皮肤清创术、纤支镜肺泡灌洗及镜下局部用药,患儿感染控制良好。白血病混合真菌感染的临床表现无特异性,病情进展快,易出现播散型,应早诊断、早治疗,推荐联合应用抗真菌药物,手术有助于改善病情。
Leukemia complicated with Mucor and Aspergillus coinfection is very rare,which is difficult to diagnose,and life-threatening.The clinical characteristics,diagnosis and treatment in a child with acute myeloid leukemia(AML),who developed mucormycosis and aspergillus coinfection after chemotherapy,was reported.This case was a 12-year-old boy who presented with fever and cough during chemotherapy.Rhizomucor pusillus and Aspergillus flavus were detected in his blood,cerebrospinal fluid and alveolar lavage fluid by metagenomic next-generation sequencing(mNGS).Amphotericin B,posaconazole,and voriconazole were successively used for antifungal therapy.Skin debridement,bronchoalveolar lavage and local perfusion under bronchoscopy were performed.The infection of children was well controlled.The clinical manifestations of leukemia with mixed fungal infection are non-specific.The disease progresses rapidly and is prone to spread.Early diagnosis and treatment should be carried out.Combined antifungal therapy is recommended,and surgery is helpful to improve the patient’s condition.
作者
张远
杨明华
ZHANG Yuan;YANG Minghua(Department of Pediatrics,Third Xiangya Hospital,Central South University,Hunan Clinical Research Center of Pediatric Cancer,Changsha 410013,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2023年第7期1105-1112,共8页
Journal of Central South University ：Medical Science
基金
国家自然科学基金(81974000,82270185)
湖南省自然科学基金(2021JJ10077)
湖南省科技创新计划项目(2022RC3077)。
关键词
儿童
白血病
侵袭性真菌病
毛霉菌
曲霉菌
children
leukemia
invasive fungal disease
mucormycosis
Aspergillus
