儿童侵袭性真菌感染的临床特征及病原菌分析

Clinical characteristics and pathogens of invasive fungal infections in children

摘要:

目的：探讨儿童侵袭性真菌感染的临床特征及病原菌分布。方法：回顾性分析2008～2012年间诊断为侵袭性真菌感染的104例患儿的临床资料。结果：104例患儿中，新生儿20例，婴幼儿48例，学龄前期及学龄期儿童（年长儿）36例。新生儿组中，早产儿比例较高（70%）；多患有肺透明膜病（45%）、肺炎（30%）等基础疾病；给予全胃肠外营养的患儿比例较其他两个年龄组高（P<0.01）。新生儿组及婴幼儿组机械通气比例明显高于年长儿组（P<0.05）。年长儿组多为血液恶性肿瘤患儿，粒细胞减少及接受化疗的患儿比例较其他两个年龄组高（P<0.05）。感染部位以肺部多见（61.5%），其次为败血症（14.4%）、肠道（12.5%），神经系统感染仅见于年长儿。104例患儿中共分离出105株真菌，包括假丝酵母菌 90株，隐球菌6株和其他真菌9株，以白色假丝酵母菌最多（52/105，49.5%），非白色假丝酵母菌比例也较高（38/105，36.2%）。假丝酵母菌对5-氟胞嘧啶及两性霉素B的敏感性较高，对三唑类药物敏感性相对较低。结论：侵袭性真菌感染可发生于各年龄儿童，各年龄组间危险因素有异同；假丝酵母菌是其主要病原菌，白色假丝酵母菌所占比例高，非白色假丝酵母菌也占较高比例。假丝酵母菌对5-氟胞嘧啶和两性霉素B较为敏感。

Abstract:

OBJECTIVE: To study the clinical characteristics and pathogens of invasive fungal infection in children. METHODS: The clinical data of 104 children who suffered from invasive fungal infections between 2008 and 2012 was retrospectively reviewed. RESULTS: Of the 104 cases, 20 occurred in neonates, 48 in infants and 36 in preschool and school-aged children (old-aged children). Prematurity (70%), hyaline membrane disease (45%) and pneumonia (30%) were commonly comorbid in the neonate group. In addition, the percentage of cases receiving total parenteral nutrition was higher in the neonate group than in the other two age groups (P<0.01). Mechanical ventilation was more frequent in neonate and infant groups than in the old-aged children (P<0.01). Hematological malignancy was the most common underlying disease, and the percentage of children who had neutropenia and accepted chemotherapy was higher in the old-aged children than in the other two age groups (P<0.05). Lung infection was the most common (61.5%), followed by sepsis (14.4%) and intestinal tract infection (12.5%), while nervous system infections were found only in old-aged children. A total of 105 strains of fungi were isolated from the 104 patients, including Candida (n=90, 85.7%), Cryptococcus (n=6) and others (n=9). The most commonly isolated species was Candida albicans (n=52, 49.5%). Non-Candida albicans Candida accounted for 36.2% (n=38). The rate of susceptibility of Candida species to 5-fluorocytosine and amphotericin B was higher than fluconazole. CONCLUSIONS: Invasive fungal infections can occur in children at various ages. There are differences in the risk factors for invasive fungal infections between age groups. Candida species are the main pathogens of childhood invasive fungal infections, and both Candida albicans and non-Candida albicans Candida are common. Fluorocytosine and amphotericin B are sensitive antifungal agents for infections caused by Candida species.