血液肿瘤患儿深部真菌感染诊断和治疗的临床分析

目的 探讨血液肿瘤患儿深部真菌感染的临床特征及其诊断和治疗.方法 回顾性分析2006年1月～2011年10月210例血液肿瘤经微生物学检查证实深部真菌感染患儿的相关诱因、临床特点、真菌培养结果和治疗方案并进行分析.结果 210例患儿从血或深部分泌物中共分离出168株菌种,其中念珠菌134株,占79.7％,包括白色念珠菌102株,热带念珠菌株23,近平滑念珠菌9株；曲霉菌27株,占16.1％；假丝酵母菌5株,占3.0％；毛霉菌2株,占1.2％.其余42例根据典型的影像学改变和治疗效果诊断为真菌感染.感染部位以肺部最常见,占69.5％,主要表现为咳嗽、咯痰、气促、喘憋,CT可见大片结节状或团块状高密度影；其次为肠道和泌尿系统,分别占14.9％和10.1％,其他还有败血症和皮肤感染.210例患儿全部行抗真菌药物治疗,同时加强对症支持治疗,其中单用氟康唑者83例,单用伊曲康唑者56例,单用两性霉素B者38例,其余33例联合或先后应用上述药物治疗.治愈66例,好转78例,恶化死亡42例,24例因原发病未缓解自动出院.结论 血液肿瘤患儿深部真菌感染诊断困难,最常见的感染部位为肺部,最常见的病原菌为念珠菌和曲霉菌.对于粒细胞减少发热患者抗生素治疗无效时,应及早行肺部CT检查.

Clinical analysis of diagnosis and treatment in deep fungal infection in children with blood tumor

OBJECTIVE To study the clinical features and diagnosis and treatment of deep fungal infections in children with hematological malignancies.METHODS Retrospectively analyzed related causes,clinical features,fungal culture results and treatment programs of 210 children confirmed deep fungal infections by microbial examination from January 2006 to October 2011.RESULTS 168 strains were isolated from blood or deep secretion of 210 cases,Candida 134 strains,accounting for 79.7%,including 102 strains Candida albicans,Candida tropicalis 23 strains,parapsilosis 9strains;Aspergillus 27,accounting for 16.1%;5 strains Candida,accounting for 3.0%;mucormycosis 2,accounting for 1.2%.The remaining 42 cases were diagnosed as fungal infections based on typical radiological changes and treatment.Lung infection was the most common,accounting for 69.5%,mainly manifested as cough,expectoration,shortness of breath,wheezing,CT showed large areas of nodular or mass density;followed by intestinal and urinary systems,respectively,accounted for 14.9% and 10.1%,other sepsis and skin infections.210 children were all with antifungal therapy,while strengthening the symptomatic and supportive treatment alone with fluconazole in 38 cases,single itraconazole of 56 cases,the amphotericin B 38 cases,and the remaining 33 cases jointly or successively were applied with the above medication.66 cases were cured,78 cases were improved,and deterioration of death was in 42 cases,24 cases with primary disease and no relief was automatically discharged.CONCLUSION Blood tumor in children with deep fungal infection is difficult to be diagnosed.The most common site of infection is the lung,the most common pathogens are Candida and Aspergillus.For patients with neutropenic fever,when antibiotic therapy is invalid,it should early give lung CT scan.