拟康宁木霉引起血流感染1例及文献综述

Bloodstream infection caused by Trichoderma koningiopsis: one case report and literature review

摘要:

目的 报告1例拟康宁木霉引起血流感染患者的诊断、治疗情况。 方法 总结1例拟康宁木霉引起血流感染患者的临床诊疗过程，并检索数据库相关文献进行复习。 结果 患者男性，60岁，因"间断发热伴腰膝痛半月余"入院，依据检查结果，给予头孢曲松钠、左氧氟沙星、更昔洛韦治疗无明显好转。外周血第二代测序技术（NGS）检测为拟康宁木霉，考虑木霉菌血流感染，给予伏立康唑口服后患者发作间期逐渐延长，由每2~3 d发作一次延长至每4~5 d发作一次，体温峰值有所下降，腰及膝关节疼痛程度减轻；出院后继续口服伏立康唑，随访1个月余患者逐渐退热，腰膝痛随之缓解，但出院2个月后猝死。检索外文文献报道病例38例（中国1例），中文文献报道病例2例，共计40例。文献检索统计木霉感染患者基础疾病以器官移植（12例）、血液病（9例）、腹膜透析（6例）为主，患者临床表现以肺部感染（8例）、腹膜炎（6例）、播散感染（5例）为主，地区分布以欧美国家居多（26例），亚洲5例，非洲2例，南美洲1例，地区不详6例。检出病原体以长梗木霉为主（24例）。 结论 木霉是一种机会致病菌，多发生于免疫功能低下者，易误诊，建议尽早送检NGS明确病原体，以争取救治时机，降低病死率。

Abstract:

Objective To report the diagnosis and treatment of a patient with bloodstream infection (BSI) caused by Trichoderma koningiopsis (T. koningiopsis). Methods Clinical diagnosis and treatment processes of an adult patient admitted to a hospital due to BSI caused by T. koningiopsis were summarized. Relevant reports were retrieved from databases for reviewing. Results A 60-year-old male patient was admitted to hospital due to "intermittent fever with lumbago and knee pain for more than half a month". According to the examination results, the patient was treated with ceftriaxone sodium, levofloxacin and ganciclovir, but didn't achieve obvious improvement. T. koningiopsis was identified by next-generation sequencing (NGS) of peripheral blood, thus T. koningiopsis BSI was considered. After oral administration of voriconazole, the interval between episodes of patients gradually prolonged, from one episode every 2-3 days to one episode every 4-5 days, peak temperature of the patient decreased, and the lumbago and knee pain alleviated. After discharge, the patient continued taking voriconazole orally. After a follow-up of more than 1 month, fever gradually subsided, lumbago and knee pain was relieved, but the patient died suddenly 2 months after discharge. A total of 40 cases were retrieved from literatures, out of which 38 cases were reported by foreign literatures and 2 reported in Chinese. According to the literature retrieval statistics, the under-lying diseases of patients with Trichoderma infection were mainly organ transplantation (n=12), hematological di-sease (n=9), and peritoneal dialysis (n=6). The main clinical manifestations of patients were mainly pulmonary infection (n=8), peritonitis (n=6), and disseminated infection (n=5). The regional distribution was mainly in European and American countries (n=26), 5 cases in Asia, 2 cases in Africa, 1 case in South America, and 6 cases in unknown regions. Trichoderma longibrachiatum was as the main detected pathogen (n=24). Conclusion Trichoderma is an opportunistic pathogen, whose infection often occurs in patients with low immunity, and is easy to be misdiagnosed. It is recommended to conduct NGS to identify the pathogen as soon as possible for timely treatment and reduce mortality.