继发肺结核合并两株不同表型烟曲霉感染病例1例

摘要/Abstract

摘要： 患者，男，69岁，因反复咳嗽、咳痰8个月，加重伴咯血4 d就诊。患者7年前曾患肺结核，抗痨治疗1年后治愈。就诊后第1次纤支镜灌洗液标本宏基因组二代测序检出结核分枝杆菌，血清和纤支镜灌洗液曲霉抗原半乳甘露聚糖试验阳性，第2次纤支镜灌洗液真菌培养出两种形态的烟曲霉（白色株和蓝绿色典型株），两株烟曲霉药敏试验结果相同且具有高度同源性。临床诊断继发肺结核合并侵袭性烟曲霉感染，予抗痨、伏立康唑抗真菌治疗，出院后继续抗痨，抗真菌治疗，定期随访复查胸部CT及痰涂片查抗酸杆菌。

关键词: 肺结核, 烟曲霉复合群, 白色变种, 真菌药物敏感性

Abstract: The patient was a 69-year-old male patient. He had recurrent coughing and sputum production for 8 months, with aggravated hemoptysis for 4 days. The patient had pulmonary tuberculosis 7 years ago, he was cured after 1 year of anti-tuberculosis treatment. Mycobacterium tuberculosis was detected by metagenomic second-generation sequencing of bronchoscopy lavage samples. Serum and bronchoscopy lavage fluid Aspergillus antigen galactomannan tests were positive. Two forms of Aspergillus fumigatus (white strain and typical smoke-green strain)were cultured from bronchoscopy lavage fluid .The two strains had the same susceptibility test results and high degree of homology. The patient was diagnosed as tuberculosis combined with invasive Aspergillus fumigatus infection. Anti-tuberculosis and voriconazole were given. Regular follow-up review of chest CT and sputum smear for acid-fast bacilli were recommended after discharged.

Key words: tuberculosis, Aspergillus fumigatus complex, albino strain, fungal drug sensitivity

中图分类号:

R519.8

王淑玲, 李艳敏, 张震, 王丽英, 颜令, 徐兰兰, 廖璞. 继发肺结核合并两株不同表型烟曲霉感染病例1例[J]. 中国真菌学杂志, 2022, 17(1): 44-48.

WANG Shuling, LI Yanmin, ZHANG Zhen, WANG Liying, YAN Ling, XU Lanlan, LIAO Pu. Pulmonary tuberculosis combined infection with two strains of Aspergillus fumigatus with different phenotypes[J]. Chinese Journal of Mycology, 2022, 17(1): 44-48.

参考文献

[1] HOSSEINI M, SHAKERIMOGHADDAM A, GHAZALIBINA M, et al. Aspergillus coinfection among patients with pulmonary tuberculosis in Asia and Africa countries; A systematic review and meta-analysis of cross-sectional studies[J]. Microb Pathog,2020,141:104018.
[2] Clinical and Laboratory Standard Institute. Epidemiological cutoff values for antifungal susceptibility testing[S]. 3rd ed. Wayne, PA: CLSI, 2020, document M59.
[3] Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi[S]. 2nd ed.Wayne, PA: CLSI,2008,document M38-A2.
[4] TACCONE F S, VAN DEN ABEELE A M, BULPA P,et al. Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes[J]. Crit Care, 2015,19(1):7.
[5] VALIANTE V, BALDIN C, HORTSCHANSKY P, et al. The Aspergillus fumigatus conidial melanin production is regulated by the bifunctional bHLH DevR and MADS-box RlmA transcription factors[J]. Mol Microbiol, 2016,102(2):321-335.
[6] PIHET M, VANDEPUTTE P, TRONCHIN G,et al. Melanin is an essential component for the integrity of the cell wall of Aspergillus fumigatus conidia[J]. BMC Microbiol, 2009, 9: 177.DOI: 10.1186/1471-2180-9-177.
[7] JAHN B,LANGFELDER K,SCHINDEL C,et al.PKSP-dependent reduction of phagolysosome fusion and intracellular kill of Aspergillus fumigatus conidia by human monocyte-derived macrophages[J]. Cell Microbiol,2002,4(12):793-803.
[8] HEINEKAMP T, THYWIBEN A, MACHELEIDT J, et al. Aspergillus fumigatus melanins: interference with the host endocytosis pathway and impact on virulence[J]. Front Microbiol, 2013, 3: 440.DOI: 10.3389/fmicb.2012.00440.
[9] VOLLING K, THYWISSEN A, BRAKHAGE A A, et al. Phagocytosis of melanized Aspergillus conidia by macrophages exerts cytoprotective effects by sustained PI3K/Akt signalling[J]. Cell Microbiol. 2011, 13(8): 1130-1148.
[10] CALLISTER M E, GRIFFITHS M J, NICHOLSON A G, et al. A fatal case of disseminated aspergillosis caused by a non-sporulating strain of Aspergillus fumigatus[J]. J Clin Pathol, 2004, 57(9): 991-992.
[11] ZHANG Z, JIANG Y, CHEN J,et al. In vitro and in vivo characterization of two nonsporulating Aspergillus fumigatus clinical isolates from immunocompetent patients[J]. Med Mycol, 2020, 58(4): 543-551.
[12] LI Y, WANG H, ZHAO YP,et al. Evaluation of the Bruker Biotyper matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system for identification of Aspergillus species directly from growth on solid agar media[J]. Front Microbiol, 2017, 8: 1209.DOI: 10.3389/fmicb.2017.01209.
[13] PANDA A, GHOSH A K, MIRDHA B R, et al. MALDI-TOF mass spectrometry for rapid identification of clinical fungal isolates based on ribosomal protein biomarkers[J]. J Microbiol Methods, 2015, 109: 93-105. DOI: 10.1016/j.mimet.2014.12.014.
[14] MCMULLEN A R, WALLACE M A, PINCUS D H,et al. Evaluation of the Vitek MS matrix-assisted laser desorption ionization-time of flight mass spectrometry system for identification of clinically relevant filamentous fungi[J]. J Clin Microbiol, 2016, 54(8): 2068-2073.
[15] KATZ M E, DOUGALL A M, WEEKS K, et al. Multiple genetically distinct groups revealed among clinical isolates identified as atypical Aspergillus fumigatus[J]. J Clin Microbiol, 2005, 43(2): 551-555.
[16] RESENDIZ SHARPE A, LAGROU K, MEIS JF,et al. Triazole resistance surveillance in Aspergillus fumigatus[J]. Med Mycol, 2018, 56(suppl_1): 83-92.
[17] WIEDERHOLD N P, VERWEIJ P E. Aspergillus fumigatus and pan-azole resistance: who should be concerned[J]? Curr Opin Infect Dis, 2020, 33(4): 290-297.
[18] MEIJER E F J, DOFFERHOFF A S M, HOITING O, et al. Azole-resistant COVID-19-associated pulmonary aspergillosis in an immunocompetent host: a case report[J]. J Fungi (Basel), 2020, 6(2): 79.
[19] WANG H C, HUANG J C, LIN Y H, et al. Prevalence, mechanisms and genetic relatedness of the human pathogenic fungus Aspergillus fumigatus exhibiting resistance to medical azoles in the environment of Taiwan[J]. Environ Microbiol, 2018, 20(1): 270-280.
[20] 李颖, 王贺, 张戈, 等. Sensititre Yeast One显色药敏板与微量肉汤稀释法检测曲霉体外抗真菌药物敏感性的一致性研究[J]. 中国真菌学杂志, 2020, 15(4): 197-201.
[21] ZHANG C, KONG Q, CAI Z, et al. The newly nonsporulated characterization of an Aspergillus fumigatus isolate from an immunocompetent patient and its clinic indication[J]. Fungal Genet Biol, 2015, 81: 250-260. DOI: 10.1016/j.fgb.2015.03.001.