异基因造血干细胞移植患者肺毛霉菌病的临床表现:21例系列报告及文献复习

IF 2.1 4区 医学 Q3 RESPIRATORY SYSTEM
J. Bao, Chunyu Liu, Yongxia Dong, Yu Xu, Zhan-wei Wang, K. Sun, W. Xi, Keqiang Wang, P. Gong, Zhancheng Gao
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A total of 21 patients fulfilled the diagnostic criteria for pulmonary mucormycosis according to the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. Demographic and clinical data, mycological and histopathological records, and treatment and prognosis data were collected. Clinical variables were compared between survivors and nonsurvivors. The survival days of patients with and without graft-versus-host disease (GVHD) and hemoptysis were compared separately. Results Most of the recipients of allo-HSCT were male patients with a mean age of 43 years. Acute myeloid leukemia (AML) was the most common primary hematologic malignancy. Extrapulmonary involvement accounted for 28.6%, of the cases, including central nervous system (n = 5) and skin and soft tissue (n = 1). The median time to infection was 96 days after allo-HSCT. 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引用次数: 5

摘要

简介毛霉菌病是一种罕见的侵袭性疾病,由与毛霉目相关的机会性病原体引起,在免疫功能受损的宿主中,尤其是在异基因造血干细胞移植(allo-HSCT)的接受者中,病死率很高。异基因造血干细胞移植受者肺毛霉菌病的诊断和治疗仍然具有挑战性。目的本研究旨在总结和分析异基因造血干细胞移植受者肺毛霉菌病的临床特征,以探索这种罕见真菌感染在特定人群中的进一步临床研究方向。方法回顾性分析2010年1月至2020年12月在我院接受同种异体造血干细胞移植的患者的肺毛霉菌病。根据欧洲癌症研究与治疗组织和真菌病研究小组(EORTC/MSG)标准,共有21名患者符合肺毛霉菌病诊断标准。收集人口统计学和临床数据、真菌学和组织病理学记录以及治疗和预后数据。比较幸存者和非幸存者的临床变量。分别比较有和无移植物抗宿主病(GVHD)和咳血患者的生存天数。结果接受异基因造血干细胞移植的患者多为男性,平均年龄43岁 年。急性髓细胞白血病(AML)是最常见的原发性血液系统恶性肿瘤。肺外受累占28.6%,包括中枢神经系统(n = 5) 以及皮肤和软组织(n = 1) 。中位感染时间为异基因造血干细胞移植后96天。临床表现非特异性,包括发烧(76.2%)和咳嗽(85.7%),以及呼吸困难(19.0%)、胸痛(38.1%)和咳血(61.9%)。磨玻璃浸润(95.0%)和结节/肿块(80%)是胸部CT最常见的影像学表现。最常见的病原体是根霉(63.2%),突破性感染占90.5%,其中15例在1年内死亡,从确诊到死亡的中位时间为47天。结论毛霉菌病是一种致命的感染性疾病。异基因造血干细胞移植受者的机会性感染主要是突破性感染,可能有季节性分布(夏季和秋季),秋季死亡病例更多。在感染初期和抗真菌治疗后都可以看到明显的反向晕征。在我们的病例系列中,肺外受累的肺毛霉菌病患者在一年内100%死亡。感染前GVHD患者和100天内非幸存者咳血的患者比幸存者多。感染和咳血前患有移植物抗宿主病的患者的生存时间比没有感染的患者短。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Manifestations of Pulmonary Mucormycosis in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation: A 21-Case Series Report and Literature Review
Introduction Mucormycosis is a rare, invasive disease caused by opportunistic pathogens related to the Mucorales order with high fatality rates in immunocompromised hosts, especially in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Diagnosis and treatment of pulmonary mucormycosis in recipients of allo-HSCT remains challenging. Purpose The aim of this study is to summarize and analyze the clinical features of pulmonary mucormycosis in recipients of allo-HSCT to explore further clinical research directions for this rare fungal infection in the particular populations. Methods We retrospectively reviewed pulmonary mucormycosis in patients who received allo-HSCT in our hospital from January 2010 to December 2020. A total of 21 patients fulfilled the diagnostic criteria for pulmonary mucormycosis according to the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. Demographic and clinical data, mycological and histopathological records, and treatment and prognosis data were collected. Clinical variables were compared between survivors and nonsurvivors. The survival days of patients with and without graft-versus-host disease (GVHD) and hemoptysis were compared separately. Results Most of the recipients of allo-HSCT were male patients with a mean age of 43 years. Acute myeloid leukemia (AML) was the most common primary hematologic malignancy. Extrapulmonary involvement accounted for 28.6%, of the cases, including central nervous system (n = 5) and skin and soft tissue (n = 1). The median time to infection was 96 days after allo-HSCT. Clinical presentations were nonspecific, including fever (76.2%) and cough (85.7%), as well as dyspnea (19.0%), chest pain (38.1%), and hemoptysis (61.9%). Ground-glass infiltrates (95.0%) and nodules/masses (80%) were the most common radiographic patterns on chest CT. The most common pathogen was Rhizopus (63.2%), and breakthrough infection accounted for 90.5%. Fifteen of the patients died within one year, and the median time from diagnosis to death was 47 days. Conclusion Mucormycosis is a fatal infection disease. Opportunistic infections in recipients of allo-HSCT are mainly breakthrough infections and may have a seasonal distribution (summer and autumn) and more cases of death in autumn. The marked reversed halo sign can be seen both in the initial stage of infection and after antifungal treatment. In our case series, patients with pulmonary mucormycosis with extrapulmonary involvement 100% died within one year. There are more patients with GVHD before infection and hemoptysis in nonsurvivors than survivors within 100 days. Patients with GVHD before infection and hemoptysis have a shorter survival time than those without.
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来源期刊
Canadian respiratory journal
Canadian respiratory journal 医学-呼吸系统
CiteScore
4.20
自引率
0.00%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Canadian Respiratory Journal is a peer-reviewed, Open Access journal that aims to provide a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes original research articles, review articles, and clinical studies related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention, lung cancer, airway and lung infections, as well as any other respiratory diseases.
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