CAJ | 학술논문

目的探讨非血液肿瘤和儿科重症监护病房(PICU)患儿侵袭性真菌感染的高危因素,以提高对侵袭性真菌感染的诊断水平.方法回顾性分析2007年1月至2012年11月首都医科大学附属北京儿童医院确诊和临床诊断为侵袭性真菌病的85例患儿,均为非血液肿瘤和PICU病房患儿,总结发生侵袭性真菌病的宿主高危因素.结果本组85例中,假丝酵母菌感染42例,曲霉感染20例,隐球菌感染21例,组织胞浆菌感染1例,毛霉感染1例.42例假丝酵母菌感染中,5例为1岁以内婴儿,3例为联合免疫缺陷病,1例为细胞免疫缺陷,25例因原发病长期应用激素和(或)两种以上抗生素继发感染,5例为肠道手术后和慢性腹泻病,1例为反流性胃食管炎,2例无明显宿主因素.20例曲霉感染中,10例为慢性肉芽肿病,5例1个月以上应用激素,3例长期应用激素和两种以上抗生素联合使用,2例无明显宿主因素.21例隐球菌感染中,2例为1个月以上应用激素,2例为抗体缺陷为主的免疫缺陷,其余无明显宿主因素.毛霉感染1例,为糖尿病患儿.组织胞浆菌感染1例,为免疫缺陷病患儿.结论非血液肿瘤和PICU病房患儿侵袭性真菌病的高危因素为原发性免疫功能缺陷病以及长期应用激素和(或)两种以上抗生素联合长期使用.此外,侵袭性假丝酵母菌感染高危因素为小婴儿.多数隐球菌感染以及个别曲霉感染无明显宿主因素.
목적 탐토비혈액종류화인과중증감호병방(PICU)환인침습성진균감염적고위인소,이제고대침습성진균감염적진단수평.방법 회고성분석2007년1월지2012년11월수도의과대학부속북경인동의원학진화림상진단위침습성진균병적85례환인,균위비혈액종류화PICU병방환인,총결발생침습성진균병적숙주고위인소.결과 본조85례중,가사효모균감염42례,곡매감염20례,은구균감염21례,조직포장균감염1례,모매감염1례.42례가사효모균감염중,5례위1세이내영인,3례위연합면역결함병,1례위세포면역결함,25례인원발병장기응용격소화(혹)량충이상항생소계발감염,5례위장도수술후화만성복사병,1례위반류성위식관염,2례무명현숙주인소.20례곡매감염중,10례위만성육아종병,5례1개월이상응용격소,3례장기응용격소화량충이상항생소연합사용,2례무명현숙주인소.21례은구균감염중,2례위1개월이상응용격소,2례위항체결함위주적면역결함,기여무명현숙주인소.모매감염1례,위당뇨병환인.조직포장균감염1례,위면역결함병환인.결론 비혈액종류화PICU병방환인침습성진균병적고위인소위원발성면역공능결함병이급장기응용격소화(혹)량충이상항생소연합장기사용.차외,침습성가사효모균감염고위인소위소영인.다수은구균감염이급개별곡매감염무명현숙주인소.
Objective To determine risk factors of invasive fungal infections (IFI) in patients admitted to non-hematological oncology department and pediatric intensive care unit (PICU),in order to improve diagnostic level of invasive fungal infections.Method We retrospectively assessed 85 hospitalized pediatric patients with invasive fungal infections in Beijing Children's Hospital Affiliated to Capital Medical University from Jan.2007 to Nov.2012.All the cases were either from non-hematological oncology department or the PICU.We reviewed risk factors of invasive fungal infections.Result Among 85 patients,42 had invasive candida infection,20 invasive aspergillus infection,21 cryptococcus infection,I Histoplasma capsulatum infection and 1 Mucor mucedo infection.In the 42 patients with invasive candida infection,5 were young infants,3 had combined immunodeficiency,1 cellular immunodeficiency,25 secondary infection due to long term use of corticosteroids and/or combined use of more than 2 kinds of antibiotics with primary disease,5 prior intestinal tract surgery or chronic diarrheal disease,1 reflux gastritis.In the 20 patients with invasive aspergillosis infection,10 patients had chronic granulomatous disease,5 long term use of corticosteroids ≥ 1 month,3 long term use of corticosteroids and combined use of more than 2 kinds of antibiotics,2 had no apparent host factors.In the 21 patients with cryptococcus infection,2 patients had used corticosteroids ≥ 1 month,2 had immunodeficiency mainly for lack of antibodies,while others had no apparent host factors.The child with Mucor mucedo infection had diabetes mellitus.And the one with Histoplasma capsulatum infection had immunodeficiency.Conclusion High risk factors for IFI in patients admitted to non-hematological oncology department and PICU are primary immunodeficiency disease and long term use of corticosteroids and/or long term combined use of more than 2 kinds of antibiotics.Besides,young infant is also a high risk factor for invasive candida infection.Most of the cryptococcus infections and certain aspergillosis had no obvious host factors.