切换至 "中华医学电子期刊资源库"

中华诊断学电子杂志 ›› 2025, Vol. 13 ›› Issue (02) : 122 -125. doi: 10.3877/cma.j.issn.2095-655X.2025.02.009

病例诊断思维

链格孢菌致侵袭性肺部真菌感染一例并文献复习
张庭秀1, 胡绳1, 马李杰1,(), 肖贞良1   
  1. 1. 610083 成都,西部战区总医院呼吸与危重症医学科
  • 收稿日期:2025-01-12 出版日期:2025-05-26
  • 通信作者: 马李杰
  • 基金资助:
    四川省自然科学基金青年科学基金项目(2022NSFSC1323)

A case report of invasive pulmonary fungal infection caused by Alternaria spp. and literature review

Tingxiu Zhang1, Sheng Hu1, Lijie Ma1,(), Zhenliang Xiao1   

  1. 1. Department of Pulmonary and Critical Care Medicine,General Hospital of Western Theater Command, Chengdu 610083, China
  • Received:2025-01-12 Published:2025-05-26
  • Corresponding author: Lijie Ma
引用本文:

张庭秀, 胡绳, 马李杰, 肖贞良. 链格孢菌致侵袭性肺部真菌感染一例并文献复习[J/OL]. 中华诊断学电子杂志, 2025, 13(02): 122-125.

Tingxiu Zhang, Sheng Hu, Lijie Ma, Zhenliang Xiao. A case report of invasive pulmonary fungal infection caused by Alternaria spp. and literature review[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2025, 13(02): 122-125.

目的

探讨链格孢菌感染导致的侵袭性肺部真菌感染(IPFI)的诊断学特征。

方法

回顾性分析2024年5月31日于西部战区总医院呼吸与危重症医学科诊治的1例由链格孢菌感染导致的IPFI患者的临床资料,查阅并复习相关的文献资料。

结果

患者女性,84岁,以咳嗽、咳痰伴左侧胸痛起病,胸部CT提示双肺多发斑片及渗出影。常规抗感染治疗效果不佳,病灶无明显吸收。支气管镜检查未见异常,灌洗液行宏基因组二代测序(mNGS)检测后,明确病原体为链格孢菌。给予两性霉素B雾化吸入联合静脉使用伏立康唑抗真菌治疗,治疗10d后,症状明显改善,复查胸部CT显示病灶稍有吸收。出院后口服伏立康唑片,3个月后患者咳嗽、咳痰及胸痛症状完全缓解,胸部CT显示病灶明显吸收。

结论

mNGS可有效诊断链格孢菌导致的IPFI,两性霉素B联合伏立康唑治疗可达到良好的治疗效果。

Objective

To explore the diagnostic characteristics of invasive pulmonary fungal infection(IPFI)caused by Alternaria spp.

Methods

The clinical data of a patient with IPFI caused by Alternaria spp. infection, diagnosed and treated in the Pulmonary and Critical Care Medicine Department of Western Theater General Hospital on May 31, 2024 were retrospectively analyzed, and relevant literature was reviewed.

Results

The patient was an 84-year-old female who presented with cough, sputum production,and left-sided chest pain. Chest CT showed multiple patchy and exudative lesions in both lungs. Conventional anti-infection treatment was ineffective, with no significant absorption of the lesions. Bronchoscopy revealed no abnormalities, but metagenomic next-generation sequencing (mNGS) of the lavage fluid identified Alternaria spp. as the pathogen. The patient was treated with nebulized amphotericin B combined with intravenous voriconazole for antifungal therapy. After 10 days of treatment, symptoms significantly improved,and follow-up chest CT showed slight absorption of the lesions. After discharge, the patient continued taking oral voriconazole. Three months later, the patient′s cough, sputum production, and chest pain completely resolved, with chest CT showed significant absorption of the lesions.

Conclusion

mNGS can effectively diagnose IPFI caused by Alternaria spp., and the combination of amphotericin B and voriconazole can achieve favorable therapeutic outcomes.

图1 链格孢菌致侵袭性肺部真菌感染患者治疗前后胸部CT图像 注:a为入院时(2024年5月31日)胸部CT图像,示双肺内多发斑片、片絮影,以左肺内显著,并见大片实变影;b为伏立康唑联合两性霉素B雾化吸入治疗10d后(2024年6月11日)胸部CT图像,部分病灶较图a稍有吸收;c图为伏立康唑治疗1个月后(2024年7月19日)胸部CT图像,左肺内病灶较图b明显吸收减少;d图为伏立康唑治疗3个月后(2024年9月11日)胸部CT图像,示双肺内少许斑片、片絮影,病灶明显吸收减少(箭头所示)
[1]
Bakri SJ,Omar AF.Delayed scleral buckle infection due to Alternaria species[J].Semin Ophthalmol,2013,28(1):9-10.DOI:10.3109/08820538.2012.702262.
[2]
满燕,梁刚,李安,等.链格孢霉毒素检测方法研究进展[J].食品安全质量检测学报,2016,7(2):453-458.
[3]
Zhao S,Li J,Liu J,et al.Secondary metabolites of Alternaria:a comprehensive review of chemical diversity and pharmacological properties[J].Front Microbiol,2022(13):1085666.DOI:10.3389/fmicb.2022.1085666.
[4]
Yurchenko E,Karpova D,Burovinskaya M,et al.Leaf spot caused by Alternaria spp.Is a new disease of grapevine[J].Plants (Basel),2024,13(23):3335.DOI:10.3390/plants13233335.
[5]
Wang H,Guo Y,Luo Z,et al.Recent advances in Alternaria phytotoxins:a review of their occurrence,structure,bioactivity,and biosynthesis[J].J Fungi (Basel),2022,8(2):168.DOI:10.3390/jof8020168.
[6]
Lopes L, Borges-Costa J, Soares-Almeida L, et al. Cutaneous alternariosis caused by Alternaria infectoria:three cases in kidney transplant patients[J].Healthcare (Basel),2013,1(1):100-106.DOI:10.3390/healthcare1010100.
[7]
Lawrence DP,Gannibal PB,Peever TL,et al.The sections of Alternaria:formalizing species-group concepts[J].Mycologia,2013,105(3):530-546.DOI:10.3852/12-249.
[8]
Xia X,Liu Z,Shen H.Subcutaneous phaeohyphomycosis caused by Alternaria section Alternaria[J].Int J Infect Dis,2023(134):99-101.DOI:10.1016/j.ijid.2023.05.066.
[9]
Chen H,Zhu R.Alternaria allergy and immunotherapy[J].Int Arch Allergy Immunol,2024,185(10):964-974.DOI:10.1159/000539237.
[10]
Schmey T,Tominello-Ramirez CS,Brune C,et al.Alternaria diseases on potato and tomato[J].Mol Plant Pathol,2024,25(3):e13435.DOI:10.1111/mpp.13435.
[11]
Pinto VE, Patriarca A. Alternaria species and their associated mycotoxins[J].Methods Mol Biol,2017(1542):13-32.DOI:10.1007/978-1-4939-6707-0_2.
[12]
Kieselová K,Gomes T,Santiago F,et al.Emerging cutaneous phaeohyphomycosis caused by Alternaria infectoria[J].Acta Med Port,2021,34(11):774-778.DOI:10.20344/amp.13496.
[13]
Sinha P, Singh M, Sagar T, et al. Cytological clues to Alternaria alternata[J].Diagn Cytopathol,2021,49(7):E269-E272.DOI:10.1002/dc.24702.
[14]
Chen A,Mao X,Sun Q,et al.Alternaria mycotoxins:an overview of toxicity,metabolism,and analysis in food[J].J Agric Food Chem,2021,69(28):7817-7830.DOI:10.1021/acs.jafc.1c03007.
[15]
Cardona S,Yusef S,Silva E,et al.Cerebral phaeohyphomycosis caused by Alternaria spp.:a case report[J].Med Mycol Case Rep,2020(27):11-13.DOI:10.1016/j.mmcr.2019.12.001.
[16]
Fernandes C,Casadevall A,Gonçalves T.Mechanisms of Alternaria pathogenesis in animals and plants[J].FEMS Microbiol Rev,2023,47(6):fuad061 [pii].DOI:10.1093/femsre/fuad061.
[17]
Waqas M,Prencipe S,Guarnaccia V,et al.Molecular characterization and pathogenicity of Alternaria spp.associated with black rot of sweet cherries in Italy[J].J Fungi (Basel),2023,9(10):992.DOI:10.3390/jof9100992.
[18]
Colosi IA,Crişan M,Ţoc DA,et al.First reported case of a clinically nonresponsive-to-Itraconazole Alternaria alternata isolated from a skin infection of a nonimmunocompromised patient from romania[J].J Fungi (Basel),2023,9(8):839.DOI:10.3390/jof9080839.
[19]
Singh B,Denning DW.Allergic bronchopulmonary mycosis due to Alternaria:case report and review[J].Med Mycol Case Rep,2012,1(1):20-23.DOI:10.1016/j.mmcr.2012.02.001.
[20]
Leite J,Romano J,Lopes V,et al.Case report:Alternaria alternata keratitis[J].Int Med Case Rep J,2023(16):59-64.DOI:10.2147/IMCRJ.S392781.
[21]
Kim G,Yoo SJ,Yoo JR,et al.The first case report of thorn-induced Alternaria alternata infection of the hand in an immunocompetent host[J].BMC Infect Dis,2022,22(1):1-6.DOI:10.1186/s12879-022-07280-y.
[22]
Hernandez-Ramirez G,Barber D,Tome-Amat J,et al.Alternaria as an inducer of allergic sensitization[J].J Fungi (Basel),2021,7(10):838.DOI:10.3390/jof7100838.
[1] 袁传杰, 杨雪, 朱渝. 内脏利什曼病临床药物治疗研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2022, 18(04): 387-392.
[2] 李晋辉, 王华, 唐军, 伍金林, 宁刚. 早产儿白色念珠菌深部感染的临床治疗[J/OL]. 中华妇幼临床医学杂志(电子版), 2017, 13(04): 397-402.
[3] 任丹凤, 韩群英, 樊万虎, 张曦. 两性霉素B脂质体梯形方案成功治疗复发性黑热病一例[J/OL]. 中华实验和临床感染病杂志(电子版), 2020, 14(06): 523-527.
[4] 宋文彬, 李肖山, 李勇, 李兴德, 龙国慧, 张阳, 宋沧桑. 肝移植受者围手术期真菌性眼内炎一例[J/OL]. 中华移植杂志(电子版), 2022, 16(02): 101-104.
[5] 韩冰, 王健, 赵帅, 张亦弛, 丁瀚, 顾劲扬. 肝移植术后中枢神经系统曲霉感染一例[J/OL]. 中华移植杂志(电子版), 2021, 15(01): 49-51.
[6] 施卉, 石晓萍, 陈璋璋, 许青, 崔春晓, 王婷. 基于伏立康唑血药浓度监测治疗肝移植围手术期曲霉感染一例[J/OL]. 中华移植杂志(电子版), 2020, 14(05): 307-310.
[7] 吴娇艳, 鹿静雅, 符萌, 刘影. 侵袭性真菌性肺炎MSCT影像特征及与IL-17、IL-23相关性[J/OL]. 中华肺部疾病杂志(电子版), 2022, 15(06): 835-837.
[8] 王磊, 姜春菲, 甄成亮, 金方圆, 周枫叶, 刘红星. 白血病患者伏立康唑血药浓度监测的回顾性研究[J/OL]. 中华临床医师杂志(电子版), 2018, 12(03): 156-159.
[9] 武薇, 李钊, 邵长周, 姜鲁宁, 吕高超, 李勇. 肺毛霉病临床诊断学特征分析并文献复习[J/OL]. 中华诊断学电子杂志, 2016, 04(04): 272-276.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?