Revista Iberoamericana De Micologia最新文献

Pneumocystis carinii infection drives upregulation of Fn1 expression that causes pulmonary fibrosis with an inflammatory response 卡氏肺囊虫感染导致 Fn1 表达上调，从而引起肺纤维化和炎症反应。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2024-01-01 DOI: 10.1016/j.riam.2024.04.002

Wenwen Yu , Hua Ye , Yunlei Li , Xiaoqiong Bao, Yangyang Ni, Xiangxiang Chen, Yangjie Sun, Ali Chen, Weilong Zhou, Jifa Li

Background

Pneumocystis carinii is an opportunistic fungal pathogen that may cause pneumonia and lead to pulmonary fibrosis.

Aims

This study attempted to investigate the role of P. carinii infection-related genes in regulating lung fibrosis in mice.

Methods

A screening of P. carinii infection-related differential mRNAs was performed using the GEO database, followed by protein–protein interaction (PPI) network construction using the STRING website in order to obtain P. carinii infection-related key genes. The development of a mouse model with gene aberrant expression was achieved by utilizing mice carrying the Cre-LoxP recombinase system. Dexamethasone was employed to induce tracheal infection in order to develop a model of pulmonary fibrosis, and the magnitude of lung injury was assessed by performing hematoxylin–eosin (H&E) staining and Masson staining. Lung coefficient and hydroxyproline level were assessed on sections of lung tissue as well. Finally, the magnitude of lung fibrosis and inflammation in mice was determined based on immunofluorescence and on the expression of genes associated with lung fibrosis and inflammation.

Results

Fn1 was found by PPI with the highest connectivity in the PPI network associated with immunity and inflammation. Besides, Fn1 was significantly highly expressed in P. carinii-infected mice samples. The P carinii pneumonia (PCP)+Fn1^fl/fl group had significantly higher lung coefficients, hydroxyproline levels and TNF-α, IL-6, IL-1β, IL-8 and NLRP3 expression levels, and significantly lower IL-10 expression levels. The results found in PCP+SPC-Cre:Fn1^fl/fl group were the opposite. The results of the pulmonary fibrosis level study showed that the PCP+Fn1^fl/fl group had the most intense H&E and Masson staining, and significantly higher expression levels of Col1A2, Col3A1 and α-SMA, which were lower in the PCP+SPC-Cre:Fn1^fl/fl group.

Conclusions

P. carinii infection may promote the upregulation of Fn1, which causes pulmonary fibrosis with an inflammatory response.

背景：目的：本研究试图探讨卡氏肺囊虫感染相关基因在调控小鼠肺纤维化中的作用：方法：利用GEO数据库对卡氏痢疾杆菌感染相关的差异mRNA进行筛选，然后利用STRING网站构建蛋白-蛋白相互作用（PPI）网络，以获得卡氏痢疾杆菌感染相关的关键基因。利用携带 Cre-LoxP 重组酶系统的小鼠建立了基因异常表达的小鼠模型。利用地塞米松诱导气管感染以建立肺纤维化模型，并通过苏木精-伊红（H&E）染色和马森染色评估肺损伤的程度。此外，还对肺组织切片的肺系数和羟脯氨酸水平进行了评估。最后，根据免疫荧光以及肺纤维化和炎症相关基因的表达确定了小鼠肺纤维化和炎症的程度：结果：PPI发现，在与免疫和炎症相关的PPI网络中，Fn1的连接性最高。此外，Fn1在卡里茵肺炎感染小鼠样本中明显高表达。卡里茵肺炎（PCP）+Fn1fl/fl组的肺系数、羟脯氨酸水平、TNF-α、IL-6、IL-1β、IL-8和NLRP3表达水平明显升高，而IL-10表达水平明显降低。PCP+SPC-Cre:Fn1fl/fl组的结果则相反。肺纤维化水平研究结果显示，PCP+Fn1fl/fl组的H&E和Masson染色最浓，Col1A2、Col3A1和α-SMA的表达水平明显较高，而PCP+SPC-Cre:Fn1fl/fl组则较低：结论：卡氏杆菌感染可能会促进Fn1的上调，从而导致肺纤维化并伴有炎症反应。

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引用次数: 0

Clinical response to prednisone in a severe case of infant-juvenile paracoccidioidomycosis 一例严重的婴幼儿副球孢子菌病患者对泼尼松的临床反应。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2024-01-01 DOI: 10.1016/j.riam.2024.04.001

Background

Paracoccidioidomycosis is a neglected tropical disease caused by fungi of the genus Paracoccidioides. A wide range of symptoms is related to the disease; however, lungs and skin are the sites predominantly affected. The disease is mostly seen in people living in rural areas in Latin America.

Case report

We present a pediatric case of severe disseminated paracoccidioidomycosis that slowly responded to the antifungal treatment. Within three months, symptoms evolved into hepatosplenomegaly, necrotic cervical and abdominal lymph nodes, and splenic abscess. Clinical response to amphotericin B deoxycholate and itraconazole was slow, resulting in pleural and peritoneal cavity effusions, heart failure and shock. Amphotericin B deoxycholate was replaced by the liposomal formulation, with no response. Subsequently, prednisone was added to the treatment, which led to improvement in the clinical response. Serological Paracoccidioides antibody titers were atypical, with very low titers in the critical phase and significant increase during the convalescence phase. The infection was finally cleared up with amphotericin B deoxycholate, liposomal amphotericin B and the use of corticosteroids. Paracoccidioidomycosis serology was non-reactive two years post-discharge.

Conclusions

Due to the intense inflammatory response triggered by Paracoccidioides cells, giving low-dose prednisone for a short period of time modulated the inflammatory response and supported antifungal treatment.

背景：副球孢子菌病是由副球孢子菌属真菌引起的一种被忽视的热带疾病。该病的症状多种多样，但主要受累部位是肺部和皮肤。这种疾病主要发生在拉丁美洲的农村地区：我们报告了一例严重的播散性副球孢子菌病儿科病例，患者对抗真菌治疗反应缓慢。三个月内，症状演变为肝脾肿大、颈部和腹部淋巴结坏死以及脾脓肿。脱氧胆酸两性霉素 B 和伊曲康唑的临床反应缓慢，导致胸腔和腹腔积液、心力衰竭和休克。脱氧胆酸两性霉素 B 被脂质体制剂取代，但无反应。随后，在治疗中加入了泼尼松，临床反应有所改善。血清学中的副球孢子菌抗体滴度不典型，在临界期滴度很低，而在恢复期滴度显著升高。通过使用脱氧胆酸两性霉素 B、两性霉素 B 脂质体和皮质类固醇，感染最终被清除。出院后两年，副球孢子菌病血清学检查未见反应：结论：由于副球孢子菌细胞引发了强烈的炎症反应，短期使用小剂量泼尼松可调节炎症反应，支持抗真菌治疗。

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引用次数: 0

Fungemia due to opportunistic fungi in patients with cancer 癌症患者因机会性真菌引起的菌血症。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2024-01-01 DOI: 10.1016/j.riam.2024.01.001

Background

Fungemia due to uncommon fungi and secondary to multiple risk factors has become an emergent health problem, particularly in oncology patients.

Aims

This study shows the following data collected during an 11-year period in a tertiary care oncologic center from patients with fungemia: demographic data, clinical characteristics, and outcome.

Methods

A retrospective study was performed at Instituto Nacional de Cancerología, a 135-bed referral cancer center in Mexico City, from July 2012 to June 2023. All episodes of non-Candida fungemia were included.

Results

Sixteen cases with uncommon fungemia were found in the database, representing 0.3% from all the blood cultures positive during the study period, and 8.5% from all the fungi isolated. The most common pathogens identified in our series were Histoplasma capsulatum, Acremonium spp., Trichosporon asahii, and Saccharomyces cerevisiae. Eight patients had hematologic malignancies, and five had severe neutropenia. In eight cases fungemia was considered catheter-related, in four cases was classified as primary, and in the last four it was diagnosed as disseminated fungal diseases. Mortality at 30 days was 43.8%.

Conclusions

The improved diagnostic tools have led to a better diagnosis of uncommon fungal infections. More aggressive therapeutic approaches, particularly in patients with malignancies, would increase survival rates in these potentially fatal diseases.

背景：由不常见真菌引起并继发于多种风险因素的真菌血症已成为一个紧迫的健康问题，尤其是在肿瘤患者中。目的：本研究显示了在一家三级肿瘤中心的11年间收集的真菌血症患者的以下数据：人口统计学数据、临床特征和结果：2012年7月至2023年6月，在墨西哥城一家拥有135张床位的癌症转诊中心--国立癌症研究所（Instituto Nacional de Cancerología）进行了一项回顾性研究。研究纳入了所有非念珠菌性真菌病病例：结果：数据库中发现了16例非典型真菌血症病例，占研究期间所有血液培养阳性病例的0.3%，占所有真菌分离病例的8.5%。在我们的系列研究中，最常见的病原体是荚膜组织胞浆菌（Histoplasma capsulatum）、Acremonium spp.、旭三孢子菌（Trichosporon asahii）和酿酒酵母菌（Saccharomyces cerevisiae）。八名患者患有血液系统恶性肿瘤，五名患者患有严重的中性粒细胞减少症。8例真菌血症被认为与导管有关，4例被归类为原发性，最后4例被诊断为播散性真菌病。30天后的死亡率为43.8%：结论：诊断工具的改进提高了对不常见真菌感染的诊断率。更积极的治疗方法，尤其是针对恶性肿瘤患者的治疗方法，将提高这些潜在致命疾病的存活率。

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引用次数: 0

Azole resistance in a clinical isolate of Aspergillus fumigatus from Chile 智利烟曲霉临床分离株的唑类抗药性。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2024-01-01 DOI: 10.1016/j.riam.2024.04.003

Eduardo Álvarez Duarte , Nicolás Cepeda , Jean Miranda

Background

Aspergillus fumigatus is a ubiquitous opportunistic pathogen. This fungus can acquire resistance to azole antifungals due to different mutations in the cyp51A gene. Azole resistance has been observed in several continents and appears to be a globally distributed phenomenon. Specific mutations in cyp51A that lead to azole resistance, such as the TR34/L98H modification, have been reported.

Aims

To evaluate the azole resistance in clinically isolated A. fumigatus strains.

Methods

As a result of our passive surveillance strategy, a total of 23 A. fumigatus isolates from clinical origins were identified through a phylogenetic analysis using the ITS region and β-tubulin gene fragments, and typed with the CSP microsatellite. Azole susceptibility profiles were performed by disk diffusion and microdilution broth methodologies according to CLSI guidelines.

Results

Here we describe, for the first time, the detection of azole-resistant A. fumigatus isolates from clinical origins in Chile with mutations in the cyp51A gene. In addition to the TR34/L98H mutation, one isolate exhibited an F46Y/M172V/E427K-type mutation. Furthermore, microsatellite typing based on cell surface protein (CSP) was performed, showing the t02 (TR34/L98H), t15 (F46Y/M172V/E427K) and t01 (susceptible clinical isolates) genotypes.

Conclusions

Our study demonstrates the presence of mutations related to azole resistance in A. fumigatus strains isolated from clinical samples in Chile. In order to obtain information that may help to tackle the spread of antifungal resistance among A. fumigatus populations, and to ensure the efficacy of future treatments against aspergillosis, a further research is necessary.

背景：烟曲霉是一种无处不在的机会性病原体。由于 cyp51A 基因的不同突变，这种真菌可获得对唑类抗真菌药的抗药性。唑类抗真菌剂的抗药性已在几大洲被观察到，而且似乎是一种全球分布现象。目的：评估临床分离的烟曲霉菌株的唑类抗药性：方法：通过被动监测策略，利用 ITS 区域和 β-管蛋白基因片段进行系统发育分析，确定了 23 株临床分离的烟曲霉菌株，并用 CSP 微卫星进行了分型。根据 CLSI 指南，通过盘式扩散和微量稀释肉汤法进行了唑类药敏性分析：结果：我们在此首次发现了来自智利临床的耐唑烟曲霉分离物，其cyp51A基因发生了突变。除了 TR34/L98H 突变外，其中一个分离株还出现了 F46Y/M172V/E427K 型突变。此外，还进行了基于细胞表面蛋白（CSP）的微卫星分型，显示出 t02（TR34/L98H）、t15（F46Y/M172V/E427K）和 t01（易感临床分离株）基因型：我们的研究表明，从智利临床样本中分离出的烟曲霉菌株中存在与唑类抗性相关的突变。为了获得有助于解决烟曲霉菌抗药性扩散问题的信息，并确保未来治疗曲霉菌病的疗效，有必要开展进一步的研究。

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引用次数: 0

Experimental study of specific and nonspecific blood culture bottles for the diagnosis of candidemia 用于诊断念珠菌血症的特异性和非特异性血液培养瓶的实验研究。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2024-01-01 DOI: 10.1016/j.riam.2024.06.001

Leandre Carmem Wilot , Vanice Rodrigues Poester , Cecília Bittencourt Severo , Karine Ortiz Sanchotene , Bruna Muradás Esperon , Mariana Rodrigues Trápaga , David A. Stevens , Melissa Orzechowski Xavier

Background

Early diagnosis of candidemia is critical for the correct management and treatment of patients.

Aims

To test the efficacy of different blood culture bottles in the growth of Candida strains.

Methods

We compared the performance of BD BACTEC™ Plus Aerobic/F (Aero) culture bottles with the specific BD BACTEC™ Mycosis IC/F Lytic (Myco) culture bottles using the BD BACTEC™ FX 40 automated blood culture system to determine the mean time-to-detection (TTD) in Candida species. One isolate each of six Candida species was inoculated into blood culture bottles (final concentration, 1–5 CFU ml⁻¹) and incubated at 37 °C until automated growth detection.

Results

Candida albicans and Nakaseomyces glabratus (Candida glabrata) were detected earlier in the specific culture bottle, whereas Candida tropicalis was detected earlier in the nonspecific bottle; Candida parapsilosis, Pichia kudriavzevii (Candida krusei), and Meyerozyma guilliermondii (Candida guilliermondii) presented similar TTD in both bottles.

Conclusions

Our study suggests the suitability of using both bottles in clinical laboratories for a faster diagnosis and prompt starting of any treatment.

背景：念珠菌血症的早期诊断对于患者的正确治疗至关重要：目的：测试不同血液培养瓶对念珠菌菌株生长的功效：我们使用 BD BACTEC™ FX 40 自动血液培养系统比较了 BD BACTEC™ Plus Aerobic/F (Aero) 培养瓶和特定的 BD BACTEC™ Mycosis IC/F Lytic (Myco) 培养瓶的性能，以确定念珠菌菌株的平均检测时间 (TTD)。将六种念珠菌中的每一种接种到血液培养瓶中（最终浓度为 1-5CFUml-1），并在 37°C 温度下培养至自动生长检测：结果：白色念珠菌和光滑念珠菌（Nakaseomyces glabratus）在特异性培养瓶中更早被检测到，而热带念珠菌在非特异性培养瓶中更早被检测到；副丝状念珠菌、Pichia kudriavzevii（克鲁塞念珠菌）和Meyerozyma guilliermondii（吉利蒙念珠菌）在两种培养瓶中的TTD相似：我们的研究表明，在临床实验室中使用这两种瓶子可以更快地做出诊断并迅速开始治疗。

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引用次数: 0

Scedosporium boydii finding in an immunocompromised patient and review of the literature. 在一名免疫力低下的患者身上发现的童贞癣菌及文献综述。

IF 1.9 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2023-10-01 Epub Date: 2024-02-07 DOI: 10.1016/j.riam.2023.10.001

Silvana Ramadán, Hernán Dalmaso, Alicia Luque, Maximiliano Sortino, María Luján Cuestas, Katherine Hermida Alava, Diego Bertola, Lucía Bulacio

Background: Scedosporiasis is an emerging mycosis that has gained importance in recent years due to its worldwide prevalence. It is caused by species of the Scedosporium apiospermum complex. These species can cause opportunistic infections in immunocompromised patients and, occasionally, in immunocompetent patients as well. The high intrinsic antifungal resistance make these infections difficult to manage.

Aims: The objective of this study was to interpret the mycological findings in a transplant patient, together with the images obtained in the radiological studies, in order to provide an early and effective antifungal therapy.

Methods: The mycological analysis of samples taken from a heart transplant patient with radiological images suggesting a fungal infection was performed. Computed tomography scan of the head and thorax showed space-occupying lesions in both the frontal lobe and cerebellum, and multiple pulmonary nodules. The nodules were punctured and the samples obtained were analyzed according to the procedures for mycological analysis. The identity of the isolates was confirmed by nucleotide sequencing. Eventually, the antifungal susceptibility was studied.

Results: The fungal isolates obtained, whose identity was confirmed by sequencing, belonged to the species Scedosporium boydii. Injured tissues were surgically removed and a treatment with amphotericin B and voriconazole-minimum inhibitory concentration (MIC) 0.5μg/mL and ≥0.5μg/mL respectively - was administered.

Conclusions: Although the patient died due to complications of a Klebsiella pneumoniae sepsis refractory to treatment, the progression of the fungal disease, although slow, was favourable in the early phases of the treatment due to a correct diagnosis and the antifungal susceptibility test carried out. Clinical cases of this nature highlight the need to increase the epidemiological study of these microorganisms, as well as the proper treatment of the diseases caused, in order to achieve early diagnoses that reduce the morbidity and mortality of patients.

背景：头孢子虫病是一种新出现的真菌病，近年来由于在全球范围内的流行而变得越来越重要。它是由Scedosporium apiospermum复合菌种引起的。这些孢子菌可导致免疫力低下的患者发生机会性感染，偶尔也会导致免疫力正常的患者发生机会性感染。本研究的目的是结合放射学研究获得的图像，对一名移植患者的真菌学检查结果进行解读，以便及早提供有效的抗真菌治疗：方法：对一名心脏移植患者的样本进行了真菌学分析，其放射学图像显示存在真菌感染。头部和胸部的计算机断层扫描显示，额叶和小脑均有占位性病变，肺部有多个结节。对结节进行了穿刺，并按照真菌学分析程序对获得的样本进行了分析。通过核苷酸测序确认了分离物的身份。最后，对抗真菌药敏性进行了研究：结果：通过测序确认的真菌分离物属于Scedosporium boydii。手术切除了受伤组织，并使用两性霉素 B 和伏立康唑（最低抑菌浓度（MIC）分别为 0.5μg/mL 和≥0.5μg/mL）进行治疗：结论：虽然患者因难治性肺炎克雷伯菌败血症并发症而死亡，但由于诊断正确和进行了抗真菌药敏试验，真菌病的进展虽然缓慢，但在治疗的早期阶段是有利的。这种性质的临床病例突出表明，有必要加强对这些微生物的流行病学研究，并对引起的疾病进行适当治疗，以便实现早期诊断，降低患者的发病率和死亡率。

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引用次数: 0

Isolation of filamentous basidiomycetes from respiratory samples in a tertiary care Spanish hospital. 从西班牙一家三级医院的呼吸道样本中分离出丝状基枝菌。

IF 1.9 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2023-10-01 Epub Date: 2024-02-06 DOI: 10.1016/j.riam.2023.11.001

Iker Falces-Romero, Inmaculada Quiles-Melero, Julio García-Rodríguez

Background: The clinical significance of the filamentous basidiomycetes isolated from clinical samples is not always clear. Thus, these fungi have been considered environmental contaminants traditionally.

Aims: To review those clinical cases in which filamentous basidiomycetes from respiratory samples had been isolated.

Methods: The retrospective study was carried out in a single tertiary care hospital. We recovered all culture-confirmed isolations of filamentous basidiomycetes from respiratory samples (bronchial aspirate [BAS], bronchoalveolar lavage [BAL] and sputum) analyzed between the years 2020 and 2023. Isolates were identified by ITS region sequencing.

Results: In six patients a filamentous basidiomycete had been isolated from a respiratory sample. The species identified were all different: Fomitopsis sp. (BAS), Trametes ljubarskyi (BAL), Stereum gausapatum (BAS), Porostereum spadiaceum (BAS), Phlebia subserialis (sputum) and Inonotus levis (BAL). All the patients were immunosuppressed or had an underlying disease with pulmonary involvement. None of them received any specific antifungal treatment (in relation with the fungus isolated) and all six improved clinically and were discharged.

Conclusions: The isolation of filamentous basidiomycetes in these patients had uncertain clinical significance. However, the isolation of any filamentous basidiomycete in respiratory samples from immunosuppressed patients or patients with chronic pulmonary disease is an emerging situation that should be carefully assessed in the context of chronic allergic episodes or suspicion of invasive fungal infections.

背景：从临床样本中分离出的丝状基枝真菌的临床意义并不总是很明确。目的：回顾从呼吸道样本中分离出丝状基枝菌的临床病例：回顾性研究在一家三级甲等医院进行。我们从 2020 年至 2023 年期间分析的呼吸道样本（支气管吸出物[BAS]、支气管肺泡灌洗液[BAL]和痰液）中回收了所有经培养证实的丝状基枝菌分离物。通过 ITS 区域测序对分离菌进行鉴定：结果：有六名患者从呼吸道样本中分离出丝状基枝菌。鉴定出的菌种各不相同：Fomitopsis sp. (BAS)、Trametes ljubarskyi (BAL)、Stereum gausapatum (BAS)、Porostereum spadiaceum (BAS)、Phlebia subserialis (痰)和 Inonotus levis (BAL)。所有患者都有免疫抑制或肺部受累的基础疾病。他们都没有接受任何特殊的抗真菌治疗（与分离到的真菌有关），所有六名患者的临床症状均有所改善并痊愈出院：结论：在这些患者中分离出丝状玄拟真菌的临床意义并不确定。然而，从免疫抑制患者或慢性肺部疾病患者的呼吸道样本中分离出任何丝状基霉菌都是一种新情况，在慢性过敏性疾病发作或怀疑有侵袭性真菌感染时应仔细评估。

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引用次数: 0

The number of species that cause blastomycosis is increasing 引起芽生菌病的种类正在增加

IF 1.9 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2023-04-01 DOI: 10.1016/j.riam.2022.07.001

F. Javier Cabañes

引用次数: 0

Problemas clínicos en Micología Médica: problema número 56 【医学真菌学临床问题:第56题】

IF 1.9 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2023-04-01 DOI: 10.1016/j.riam.2022.12.001

Fernando Messina , Emmanuel Marin , Alejandro Sansostera , Mercedes Romero , Roxana Depardo , Ricardo Negroni , Blanca Leonel , Gabriela Santiso

We present the case of a twenty six year-old woman with rheumatoid arthritis, treated with certolizumab. She sought medical attention due to cough, fever and night sweats. X-ray exam showed a miliary pneumonia. She was treated for tuberculosis and 50 days later she presented with aphasia. Magnetic nuclear resonance revealed brain lesions. Histoplasma capsulatum PCR test and urinary antigen were positive, so an antifungal treatment with voriconazole was started. Visual adverse effects forced to change the antifungal schedule in both the length of treatment and the antifungal drug. With this measure the patient progressed favorably. The test of urinary Histoplasma capsulatum antigen and PCR amplification were key to make a diagnosis and also for a follow-up.

我们提出的情况下，26岁的妇女与类风湿性关节炎，certolizumab治疗。她因咳嗽、发烧和盗汗而求医。x光检查显示是军人肺炎。她接受了肺结核治疗，50天后出现失语。核磁共振显示脑损伤。荚膜组织浆体PCR检测及尿抗原阳性，给予伏立康唑抗真菌治疗。视觉不良反应迫使抗真菌方案在治疗时间和抗真菌药物两方面发生改变。采取这种措施后，病人进展顺利。尿荚膜组织浆抗原检测和PCR扩增是诊断和随访的关键。

引用次数: 0

Necrotizing pneumonia due to Aspergillus and Salmonella after immune checkpoint inhibitor treatment: An unusual case and review of the literature 免疫检查点抑制剂治疗后曲霉和沙门氏菌引起的坏死性肺炎:一个不寻常的病例和文献回顾

IF 1.9 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2023-04-01 DOI: 10.1016/j.riam.2023.05.001

Muhammed Cihan Işık , Oğuz Karcıoğlu , Gülşen Hazırolan , Dolunay Gülmez , Mehmet Ruhi Onur , Mehmet Mahir Kunt , Sevtap Arikan-Akdagli , Gökhan Metan

Background

Immune checkpoint inhibitors (ICIs) are a promising new treatment for different types of cancer. The infectious complications in patients taking ICIs are rare.

Case report

A 58-year-old male who received chemotherapy consisting of pembrolizumab (PD-1 inhibitor) for esophagus squamous cell carcinoma one month before was admitted to the emergency room with shortness of breath soon after fiberoptic bronchoscopy, which was done for the inspection of the lower airway. A computed tomography of the chest revealed a progressive consolidation on the right upper lobe. Salmonella group D was isolated from the bronchoalveolar lavage (BAL) fluid culture. The fungal culture of the same clinical sample yielded Aspergillus niger; furthermore, a high titer (above the cut-off values) of Aspergillus antigen was found both in the BAL fluid and serum of the patient. Despite the effective spectrum and appropriate dose of antimicrobial treatment, the patient died due to disseminated intravascular coagulopathy.

Conclusions

Awareness of unusual pathogens in the etiology of pneumonia after ICI treatment may help to avoid underdiagnosis.

免疫检查点抑制剂(ICIs)是一种很有前景的治疗不同类型癌症的新方法。注射ICIs患者的感染并发症很少见。病例报告:一名58岁男性患者在一个月前接受了由派姆单抗(PD-1抑制剂)组成的食管鳞状细胞癌化疗，在进行纤维支气管镜检查后不久因呼吸急促而入住急诊室，该检查是为了检查下气道。胸部计算机断层扫描显示右上肺叶进行性实变。从支气管肺泡灌洗(BAL)液培养中分离出D组沙门氏菌。同一临床样品的真菌培养产生黑曲霉;此外，在患者的BAL液和血清中发现了高滴度(高于临界值)的曲霉抗原。尽管抗菌药物治疗有效且剂量合适，患者还是死于弥散性血管内凝血病。结论对ICI治疗后肺炎病因中异常病原体的认识有助于避免漏诊。

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引用次数: 0