肺移植术后赛多孢子菌感染一例并文献复习

目的总结分析肺移植术后患者赛多孢子菌感染的临床特点、诊治和预后,提高临床诊治水平。方法回顾性分析广州医科大学附属第一医院呼吸与危重症医学科收治的1例肺移植术后赛多孢子菌感染患者的临床资料。以"scedosporium"/"scedosporiosis"+"lung transplant"或"scedosporium"/"scedosporiosis"+"lung transplantation"为英文检索词,在Pubmed数据库检索;以"赛多孢子菌"+"肺移植"为中文检索词,分别在万方数据库和中国知网数据库检索。检索时间截至2018年5月,分析其临床特点,诊治方案和预后。结果患者男性,65岁,右肺移植术后7个月余。临床表现为反复抽搐、呼吸困难和多器官功能衰竭,胸部CT提示右下肺结节性病灶,肺泡灌洗液培养+DNA测序诊断为多育赛多孢子菌。虽然经过联合抗真菌治疗,患者最终死亡。文献检索后经过筛选剔除,共检索出相关文献20篇,均为个案报道,共报道35例。感染多为播散性,可累及多器官,死亡率高;胸部CT和纤维支气管镜下表现无特异性,诊断主要依靠培养结合DNA测序。治疗上需要联合抗真菌药物。结论肺移植术后患者赛多孢子菌感染多为播散性,死亡率高。临床上应对高危患者提高警惕,以做到早期诊断和治疗。

Scedosporium infection in lung transplant patients: a case report and literature review

Objective To investigate the clinical features,diagnosis and treatment of scedosporiosis in lung transplant patients.Methods A retrospective analysis was carried out on a lung transplant patient with scedosporiosis admitted to the First Affiliated Hospital of Guangzhou Medical University.A literature review was performed with"scedosporium"/"scedosporiosis"+"lung transplant"or"scedosporium"/"scedosporiosis"+"lung transplantation"as the key words in Pubmed,Wanfang Database and China Knowledge Resource Integrated Database.The date of retrieval was up to May 2018.Related articles of scedosporiosis in lung transplant patients were retrieved.Clinical characters,diagnosis,treatment and outcome were analyzed.Results The patient was a 65 years old male who received the right lung transplantation 7 months before.He presented with seizure,dyspnea and multiple organ failure.The CT scan illustrated right lower pulmonary nodular lesions.The culture and DNA sequencing of the bronchoalveolar lavage fluid established the diagnosis of scedosporium prolificans.The patient died finally despite the combined antifungal treatment.Literature review found 20 relative articles,and all of which were case report with a total of 35 patients.Scedosporium was always disseminated and with a high mortality,with no specificity in chest CT and bronchoscopy.The diagnosis always established by the culture and DNA sequencing,and the combination of anti-fugal agents was needed.Conclusions Scedosporium in lung transplant patient is a disseminated disease with high mortality.The high risk patients should be focused on and early diagnosis and treatment was demanded.