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中国真菌学杂志 2016, Vol. 11  Issue (3): 145-148.

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非免疫抑制患者内源性土曲霉眼内炎1例及实验研究

赵颖, 王澎, 孙宏莉, 杨启文, 王瑶, 王贺, 徐英春, 赵玉沛   

  1. 中国医学科学院北京协和医学院北京协和医院检验科, 北京 100730
  • 收稿日期:2015-07-29 出版日期:2016-06-28 发布日期:2016-06-28
  • 通讯作者: 徐英春,E-mail:xycpumch@139.com E-mail:xycpumch@139.com
  • 作者简介:赵颖,女(汉族),硕士,助理研究员.E-mail:zhaoying28062806@163.com
  • 基金资助:

    卫生公益性行业科研专项(201402001)

A rare case of Aspergillus terreus endogenous endophthalmitis in a nonimmunocompromised patient and laboratory research

ZHAO Ying, WANG Peng, SUN Hong-li, YANG Qi-wen, WANG Yao, WANG He, XU Ying-chun, ZHAO Yu-pei   

  1. Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2015-07-29 Online:2016-06-28 Published:2016-06-28

摘要:

目的 报道1例非免疫抑制患者内源性土曲霉眼内炎及实验研究。方法 采集本院收治的1例非免疫抑制内源性眼内炎患者的玻璃体液,进行直接涂片镜检、培养,并进一步对分离到的菌株进行表型分析,分子鉴定及E-test法体外抗真菌药敏试验。结果 直接涂片镜检可见真菌孢子及有隔真菌丝,培养7 d后生长菌落较小,形态不典型,经分子鉴定及多次转种观察形态确定为土曲霉。E-test法测得MIC值(μg/mL):伊曲康唑0.250,伏立康唑0.125,两性霉素B 2.000。结论 早期诊断性和治疗性玻璃体切割术有利于获得足够的样本用于微生物鉴定,并可以减少玻璃体中微生物量及炎性物质。直接涂片迅速报告镜检结果对临床最初选择抗菌药物有重要意义。对于直接分离自临床标本的形态不典型的丝状真菌,采用ITS序列分析等分子生物学鉴定有助于尽早定种,缩短鉴定时间。

关键词: 土曲霉, 眼内炎, 分子鉴定

Abstract:

Objective To report a rare case of Aspergillus terreus endogenous endophthalmitis in a nonimmunocompromised patient and laboratory research.Methods A vitreous biopsy was taken for culture and direct smear microscopy,and further identified the isolate from culture positive plates by phenotype observation and molecular methods.In vitro antifungal susceptibility test was done by E-test method.Results Fungal spores and septate hyphae were found in vitreous direct smear.Tiny hair like colonies growed after 7 days in culture.The isolate was final identified as Aspergillus terreus according to morphology of the fungus and the results of phenotypic and molecular identification.The isolate's MICs (μg/mL) to itraconazole,voriconazole,amphotericin B were 0.25,0.125,2,respectively.Conclusion Early diagnostic and therapeutic vitrectomy was useful to obtaining sufficient samples for organism identification and also to reduce organism load and inflammatory mediators in the eye.Reporting the direct smear results timely to clinical physician is very meaningful for the initial selection of antimicrobial agents.For the clinical isolated filamentous fungi with atypical phenotype,ITS sequence analysis and other molecular methods can help to identify the fungal pathogen promptly.

Key words: Aspergillus terreus, endophthalmitis, molecular identification

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