重癥流感合并侵襲性肺曲霉菌病20例臨床分析

重癥流感合并侵襲性肺曲霉菌病20例臨床分析重癥流感合并侵襲性肺曲霉菌病20例臨床分析

摘要

目的：探討重癥流感合并侵襲性肺曲霉菌病的病因、診斷和治療方法，提高臨床醫(yī)生對該病的識別和治療水平。

方法：選擇2019年1月至2020年12月收治的20例重癥流感合并侵襲性肺曲霉菌病患者作為研究對象，分別從臨床資料、實驗室檢查、病理學(xué)檢查等方面進行分析。

結(jié)果：20例患者中14例未接種流感疫苗，均在流感高發(fā)季節(jié)發(fā)病。除去呼吸衰竭的基礎(chǔ)疾病外，更容易發(fā)生流感合并侵襲性肺曲霉菌病的危險因素包括年齡≥60歲、接受免疫抑制劑治療、糖尿病、惡性腫瘤等。發(fā)病前期高熱、咳嗽、呼吸急促等是病情的主要表現(xiàn)。血常規(guī)和炎癥反應(yīng)指標異常，胸部X線和CT表現(xiàn)為雙肺實變，鑒別診斷有困難。病原菌主要為曲霉屬真菌，經(jīng)藥敏試驗后選用伏立康唑等抗真菌藥物，療效良好。

結(jié)論：重癥流感合并侵襲性肺曲霉菌病的發(fā)病率較高，臨床醫(yī)生應(yīng)當(dāng)提高警惕，及早進行綜合治療，降低病死率。

關(guān)鍵詞：重癥流感、侵襲性肺曲霉菌病、病原學(xué)、診斷、治療

Abstract

Objective:Toexploretheetiology,diagnosisandtreatmentofsevereinfluenzacombinedwithinvasivepulmonaryaspergillosis,andtoimprovetherecognitionandtreatmentlevelofclinicaldoctorsforthisdisease.

Methods:TwentypatientswithsevereinfluenzacombinedwithinvasivepulmonaryaspergillosiswhowereadmittedfromJanuary2019toDecember2020wereselectedastheresearchobjects,andwereanalyzedfromtheaspectsofclinicaldata,laboratorytests,pathologicalexaminations,etc.

Results:Amongthe20patients,14werenotvaccinatedagainstinfluenzavaccine,andalldevelopedthediseaseduringthepeakseasonofinfluenza.Inadditiontorespiratoryfailure,riskfactorsthataremorelikelytodevelopinfluenzacombinedwithinvasivepulmonaryaspergillosisincludeage≥60years,receivingimmunosuppressivetherapy,diabetes,andmalignanttumors.Highfever,cough,andshortnessofbreathintheearlystageofthediseasearethemainmanifestationsofthedisease.Abnormalitiesinbloodroutineandinflammatoryreactionindicators,aswellaschestX-rayandCTshowingbilateralinfiltrates,makeitdifficulttodiagnose.ThepathogenicbacteriaaremainlyAspergillusfungi.Afterdrugsensitivitytest,antifungaldrugssuchasvoriconazolewereselected,andthetherapeuticeffectwasgood.

Conclusion:Theincidenceofsevereinfluenzacombinedwithinvasivepulmonaryaspergillosisisrelativelyhigh.Clinicaldoctorsshouldbevigilant,andearlycomprehensivetreatmentshouldbecarriedouttoreducethemortalityrate.

Keywords:severeinfluenza,invasivepulmonaryaspergillosis,pathogenesis,diagnosis,treatmentInvasivepulmonaryaspergillosis(IPA)isaseverecomplicationofsevereinfluenzaandisassociatedwithhighmortalityrates.ThepathogenesisofIPAinpatientswithsevereinfluenzaisnotwellunderstood,butitisthoughttoberelatedtothesuppressionoftheimmunesystemcausedbytheinfluenzavirus,whichallowsAspergillusfungitoinvadethelungs.

ThediagnosisofIPAinpatientswithsevereinfluenzaischallengingbutessentialforearlyintervention.Symptomssuchasfever,cough,dyspnea,andchestpainarenon-specificandcanalsobeobservedinsevereinfluenza.Therefore,itisnecessarytoconductimagingexaminationssuchaschestCT,aswellaspathogenicexaminationssuchasAspergillusantigendetectionandmicroscopicexaminationofbronchoalveolarlavagefluid.

TreatmentofsevereinfluenzacombinedwithIPArequirescomprehensivetherapy,includingantiviralandantifungaldrugs,oxygentherapy,andsupportivetherapy.AntifungaldrugssuchasvoriconazolehaveshowngoodtherapeuticeffectsinpatientswithIPA.

Inconclusion,severeinfluenzacombinedwithIPAisasevererespiratorydiseasethatrequiresearlyandcomprehensivetreatmenttoreducemortalityrates.ClinicaldoctorsshouldbeawareofthehighincidenceofIPAinpatientswithsevereinfluenzaandtakeappropriatemeasurespromptlyMoreover,preventionstrategiesshouldbeemphasized,particularlyforindividualswhoareathighriskforsevereinfluenzaandIPA.Annualinfluenzavaccinationisrecommendedfortheseindividuals,includingtheelderly,pregnantwomen,individualswithcompromisedimmunesystems,andindividualswithexistingmedicalconditions.

AnotheressentialwaytopreventIPAistomaintaingoodhygienepractices,suchasfrequenthandwashing,avoidingclosecontactwithindividualswhoaresick,andwearingamaskwhenincrowdedplaces.PatientswithsevereinfluenzashouldalsoreceiveearlyempiricalantifungaltherapytopreventtheoccurrenceofIPA.

Finally,furtherstudiesarenecessarytodevelopbetterdiagnosticmethodsandtreatmentoptionsforpatientswithsevereinfluenzaandIPA.Inparticular,moreresearchisneededtounderstandtheunderlyingmechanismsoftheimmuneresponseandfungalpathogenesisinthesepatients,whichcanhelptoidentifypotentialtherapeutictargets.

Insummary,severeinfluenzacombinedwithIPAisasevererespiratorydiseasethatrequirespromptdiagnosisandcomprehensivetreatment.HealthcareprovidersshouldbeawareofthehighincidenceofIPAinpatientswithsevereinfluenzaandtakeappropriatemeasurestopreventandtreatthiscondition.Withappropriatecareandmanagement,theprognosisofpatientswithsevereinfluenzaandIPAcanbesignificantlyimprovedInadditiontotimelydiagnosisandtreatment,therearesomemeasuresthatcanbetakentopreventsevereinfluenzaandIPA.Themosteffectivewaytopreventinfluenzaisthroughannualvaccination.Thefluvaccinehasbeenshowntoreducetheriskofgettingtheflubyabout50%to60%.Itisrecommendedthatallindividualsovertheageof6monthsreceivethefluvaccineeveryyear.

PreventingIPAismorechallengingbecauseittypicallyaffectspatientswhoalreadyhavecompromisedimmunesystems.However,therearesomestrategiesthatcanbeusedtoreducetheriskofdevelopingthecondition.Oneapproachistouseantifungalprophylaxisinhigh-riskpatients,suchasthosewithacuteleukemiaorundergoinghematopoieticstemcelltransplantation.ThisinvolvesadministeringantifungaldrugstopreventthedevelopmentofIPA.Anotherstrategyistoreducetheuseofcorticosteroids,whichcansuppre