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重症登革热合并侵袭性肺曲霉感染3例
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Abstract:
目的：报道3例重症登革热合并侵袭性肺曲霉感染的患者。方法：对3例重症登革热合并侵袭性肺真菌感染患者进行回顾性分析。结果：3例患者血清GM试验均为阳性，1例患者痰培养提示曲霉菌感染，另外2例患者在胸部影像学出现异常，结合支气管镜表现及肺泡灌洗液宏基因组二代测序(metagenomic next-generation sequencing, mNGS)结果提示真菌感染，可能此时已延误抗真菌治疗时机。入院后3例患者均予呼吸支持、糖皮质激素、抗感染、胰岛素等治疗，经治疗后存活1例，死亡2例。结论：重症登革热发生侵袭性肺真菌感染的机率大，死亡率高，合并糖尿病、高血压、肥胖等基础疾病时，实时监测患者的临床表现、影像学及早期完善痰培养、血清及肺泡灌洗液曲霉菌GM试验等，及时发现真菌感染，对于重症患者应更早期完善mNGS检测，根据病原学及时调整抗感染治疗方案，同时应注意控制血糖。
Objective: To report 3 cases of severe dengue fever combined with invasive pulmonary aspergillus infection. Methods: 3 cases of severe dengue fever combined with invasive pulmonary fungal infection were retrospectively analyzed. Result: The serum GM test of 3 patients was positive, and the sputum culture of 1 patient suggested aspergillus infection. The other two patients showed abnormalities in chest imaging, which combined with bronchoscopic findings and metagenomic next-generation sequencing (mNGS) results suggested fungal infection. The time for antifungal treatment may have been delayed. After admission, all three patients were treated with respiratory support, glucocorticoids, anti-infection, insulin, etc. After treatment, 1 patient survived and 2 died. Conclusion: Patients with severe dengue fever have a high incidence of invasive pulmonary fungal infections and a high mortality rate. When complicated with underlying diseases such as diabetes, hypertension, and obesity, it is crucial to continuously monitor the patient’s clinical manifestations and imaging findings, and promptly perform early diagnostic measures such as sputum culture, aspergillus galactomannan (GM) testing on serum and bronchoalveolar lavage fluid, to detect fungal infections in a timely manner. For severe cases, metagenomic next-generation sequencing (mNGS) testing should be completed even earlier, and anti-infective treatment plans should be adjusted promptly based on etiological findings. Meanwhile, attention should be paid to controlling blood glucose levels.
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