无基础疾病儿童侵袭性真菌病的临床研究

A clinical study of invasive fungal disease in children without underlying diseases

摘要:

目的 探讨无基础疾病儿童侵袭性真菌病 （IFD） 的临床特点。方法 回顾性分析49例无基础疾病侵袭性真菌病患儿的临床资料。结果 无基础疾病侵袭性真菌病儿童的病原检出率为76% （37/49），其中新型隐球菌 （17例，46%）、白色假丝酵母菌 （10例，27%）、曲霉菌及近平滑假丝酵母菌 （各3例，均占8%） 为最常见的病原。真菌性肺炎最多见 （17例，46%），病原以白色假丝酵母菌为主 （9例，53%）。49例患儿均存在至少一项感染高危因素，主要为抗生素使用、长时间住院以及侵袭性操作。行G试验检查的24例中17例阳性 （71%）。49例患儿均接受抗真菌治疗，37例 （75%） 治愈，3例 （6%） 仍在治疗中，5例 （10%） 死亡，4例 （8%） 失访。结论 对于无基础疾病的IFD患儿，新型隐球菌、念珠菌为其主要病原，肺部感染最为多见。长期大量使用抗生素是较突出危险因素。无基础疾病的IFD患儿对于抗真菌药物敏感，预后较好。

Abstract:

Objective To investigate the clinical features of invasive fungal disease (IFD) in children without underlying diseases. Methods The clinical data of 49 children without underlying diseases who were diagnosed with IFD were retrospectively studied. Results Fungal pathogens were detected in 37 (76%) out of 49 patients, including Cryptococcus neoformans (17 children, 46%), Candida albicans (10 children, 27%), Aspergillus (3 children, 8%), and Candida parapsilosis (3 children, 8%). Fungal pneumonia (17 children, 46%) was the most commonly seen disease, with Candida albicans as the major pathogen (9 children, 53%). The 49 children had at least one high-risk factor for infection, including the use of antibiotics, a long length of hospital stay, and invasive procedures. Of all the children, 82% did not respond well to antibiotic treatment or experienced recurrent pyrexia. Among the 24 children who underwent G tests, 17 (71%) showed positive results. All the children were given antifungal therapy, and among these children, 37 (75%) were cured, 3 (6%) were still in the treatment, 5 (10%) died, and 4 (8%) were lost to follow-up. Conclusions In IFD children without underlying diseases, Cryptococcus neoformans and Candida are the main pathogens, and lung infection is the most common disease. Long-term use of high-dose antibiotics may be an important risk factor for fungal infection. The IFD children without underlying diseases are sensitive to antifungal drugs and have a satisfactory prognosis.