Chinese Medical E-ournals Database
Adv Search
中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2018, Vol. 14 ›› Issue (04): 406 -412. doi: 10.3877/cma.j.issn.1673-5250.2018.04.006

Special Issue: ； ；

Original Article

Hematologic malignancies combined with invasive fusariosis: a case report and literatures review

Xiongyu Liao1, Kunyin Qiu1, Ruohao Wu1, Ke Huang1, Jianpei Fang1, Dunhua Zhou1,†()   

  1. 1. Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, Guangdong Province, China
  • Received:2018-03-12 Revised:2018-06-15 Published:2018-08-01
  • Corresponding author: Dunhua Zhou
  • About author:
    Corresponding author: Zhou Dunhua, Email:
  • Supported by:
    Science and Technology Developmental Project of Department of Science and Technology of Guangdong Province(2017A020215086)
HTML ( ) PDF ( )
Objective

To investigate clinical features and treatment of hematological malignancies combined with invasive fusariosis in children, and to review the literatures.

Methods

On July 15, 2016, a 13-year-old girl with myelodysplastic syndromes (MDS) and invasive fusariosis who was hospitalized in the Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University was chosen as study subject, and its clinical features were analyzed. With the following key words of " malignant" " blood system disease" and " invasive fusariosis" as Chinese key words, and " malignant, hematologic disease" and " invasive fuasriosis" as English key words, the literature of hematological malignancies combined with invasive fusariosis were searched from Pubmed database, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and VIP database. Literature retrieval time ranged from Janury 1, 2010 to December 31, 2016, and clinical features of searched literatures were summarized. This study was consistent with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

Results

①This was a case report of MDS with invasive fusariosis based on clinical manifestations and related laboratory findings. After chemotherapy, there were pulmonary infiltrates and limbs, purple-red nodules on the trunk with central necrosis, followed by multiple subcutaneous fluid masses on the extremities. Skin biopsy, bone marrow culture, and mass drainage culture all indicated Fusarium infection. Amphotericin B combined with posaconazole were given to the child. The child was followed up until April 5, 2017, her families gave up treatment and discharged because the primary basic disease could not be relieved. ② The results of setting a retrieval strategy to search relevant literatures showed that a total of 7 domestic and foreign literatures reported a total of 21 children with hematologic malignancies and invasive fusariosis. Among them, 12 were male and 9 were female. The main clinical manifestations were persistent fever, ineffective active anti-infection treatment and poor prognosis. Of the 21 children, 14 died and 7 were cured.

Conclusions

Children with hematological malignancies combined with invasive fusariosis should be diagnosed early and given effective and sufficient antifungal treatment. Amphotericin B combined with posaconazole may be one of the options for the treatment of invasive fusariosis..

Key words: Hematologic neoplasms, Myelodysplastic syndromes, Fusarium, Biopsy, Antifungal agents, Child
图1 患儿(13岁，女性)皮肤硬结活组织检查和培养结果[图1A：真皮深层及皮下脂肪组织内大片陈旧性出血，灶状淋巴细胞、组织细胞浸润(HE染色，低倍)；图1B：病灶内见疑似真菌菌丝(HE染色，高倍)；图1C：病灶培养出真菌菌丝，符合深部真菌病诊断，有镰刀菌生长(D-PAS染色，高倍)]
图2 患儿(13岁，女性)2016年9月12日进行的胸部CT检查结果(图2A：右侧肺叶、左肺下叶外基底段，可见多发性大片状浸润影；图2B：右侧肺叶、左肺上舌段和左肺下舌段散在结节影和肿物影，可见空气支气管征；图2C：双侧胸腔内见弧状水密度影，右肺上叶及中叶体积明显缩小)
图4 患儿13岁，女性足背近拇趾部一处皮下液性包块
图5 患儿(13岁，女性)2016年11月9日的胸部CT检查结果(图5A：与2016年9月12日的CT检查结果比较，双肺病变范围缩小，双肺尖多发片状浸润影，边界不清；图5B：双肺部分病灶见充气支气管影；图5C：右侧胸腔少量积液，左侧胸腔积液增多)
图6 患儿(13岁，女性)2016年11月29日的胸部CT检查结果(图6A：右侧肺叶、左肺下叶外基底段状浸润影较前2次(2016年9月12日、2016年11月9日)CT检查结果比较，明显吸收；图6B：右侧肺叶、左肺上舌段和左肺下舌段散在结节影和肿物影消失，未见空气支气管征；图6C：双肺病灶较前2次(2016年9月12日、2016年11月9日)CT检查结果比较，吸收好转，病灶范围较前2次缩小)
表1 7篇血液系统恶性疾病合并侵袭性镰刀菌病文献报道的21例患者临床特点
文献(第一作者，文献发表年) 年龄(岁) 性别 基础疾病 感染部位 抗真菌治疗方案 结局
Aquino，2010[2] 18 男 ALL 皮肤 AMB＋VOR 死亡
Aquino，2010[2] 21 男 ALL 鼻窦 AMB 死亡
Aquino，2010[2] 81 女 MM 血液系统 CAP＋VOR 治愈
Aquino，2010[2] 15 女 ALL 皮肤 AMB＋VOR 死亡
Aquino，2010[2] 38 女 AA 鼻窦 AMB 死亡
Aquino，2010[2] 57 女 淋巴瘤 血液系统 AMB 死亡
Hsiue，2010 [3] 30 男 白血病 肺部 AMB＋FLU 死亡
Hsiue，2010 [3] 20 女 白血病 肺部 AMB＋FLU 死亡
Hsiue，2010 [3] 45 男 白血病 肺部 AMB＋FLU 死亡
Hsiue，2010 [3] 19 女 白血病 血液系统 AMB＋FLU 治愈
Hsiue，2010 [3] 56 男 白血病 皮肤 AMB＋VOR 治愈
Hsiue，2010 [3] 42 女 淋巴瘤 皮肤 AMB＋VOR 治愈
Hsiue，2010 [3] 39 女 MDS 肺部 AMB＋ITR 死亡
谭俊峰，2011 [4] 53 女 AML 皮肤 AMB 死亡
Muhammed，2013 [5] 59 男 AML 皮肤 AMB＋VOR 死亡
Muhammed，2013 [5] 52 男 淋巴瘤 血液系统 AMB＋VOR 死亡
Muhammed，2013 [5] 63 男 AML 血液系统 NA 治愈
Muhammed，2013 [5] 53 男 AML 血液系统 AMB＋VOR 治愈
黄玲玲，2013 [6] 4 男 ALL 皮肤、肺部、血液系统 AMB 治愈
Chan，2014 [7] 31 男 ALL 肺部、皮肤 AMB＋VOR 死亡
马永超，2016 [8] 22 男 AML 肺部、血液系统 VOR 死亡
[1]
中华医学会儿科学分会血液学组. 儿童骨髓增生异常综合征诊断与治疗中国专家共识(2015年版) [J]. 中华儿科杂志，2015, 53(11): 804-809.
[2]
Aquino VR, Verçosa EB, Falhauber G, et al. Distribution of filamentous fungi causing invasive fungal disease at the Haematological Unit, Hospital de Clínicas de Porto Alegre, Brazil [J]. Braz J Infect Dis, 2010, 14(3): 277-280.
[3]
Hsiue HC, Ruan SY, Kuo YL, et al. Invasive infections caused by non-Aspergillus moulds identified by sequencing analysis at a tertiary care hospital in Taiwan, 2000-2008 [J]. Clin Microbiol Infect, 2010, 16(8): 1204-1206.
[4]
谭俊峰，钱申贤，高大泉，等. 急性髓性白血病合并镰刀菌感染1例临床观察[J]. 中华医院感染学杂志，2011, 21(22)：4729-4730.
[5]
Muhammed M, Anagnostou T, Desalermos A, et al. Fusarium infection: report of 26 cases and review of 97 cases from the literature [J]. Medicine (Baltimore), 2013, 92(6): 305-316.
[6]
黄玲玲，王宁玲，牛曼曼. 儿童急性淋巴细胞白血病并发镰刀菌败血症[J]. 中国小儿血液与肿瘤杂志，2013, 18(5): 237.
[7]
Chan TS, Gill H, Hwang YY, et al. Breakthrough invasive fungal diseases during echinocandin treatment in high-risk hospitalized hematologic patients [J]. Ann Hematol, 2014, 93(3): 493-498.
[8]
马永超，张晓艳，陈传欣，等. 血液病并发突破性真菌血症患儿九例临床特点及文献复习[J]. 中华临床感染病杂志，2016, 9(3): 270-273.
[9]
Cho CT, Vats TS, Lowman JT, et al. Fusarium solani infection during treatment for acute leukemia [J]. J Pediatr, 1973, 83(6): 1028-1031.
[10]
Marom EM, Holmes AM, Bruzzi JF, et al. Imaging of pulmonary fusariosis in patients with hematologic malignancies [J]. AJR Am J Roentgenol, 2008, 190(6): 1605-1609.
[11]
Tortorano AM, Richardson M, Roilides E, et al. ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others [J]. Clin Microbiol Infect, 2014, 20(Suppl 3): 27-46.
[12]
史俊艳，徐英春. 镰刀菌感染的流行病学及其诊治进展[J]. 中国真菌学杂志，2009, 4(2): 124-128.
[13]
Nucci M, Anaissie E. Fusarium infections in immunocompromised patients [J]. Clin Microbiol Rev, 2007, 20(4): 695-704.
[14]
金玲娟，朱倩，陈海飞，等．原发免疫性血小板减少症患者继发感染的相关因素研究[J]. 国际输血及血液学杂志，2017，40(2) : 125-132.
[15]
Fanci R, Pini G, Bartolesi AM, et al. Refractory disseminated fusariosis by Fusarium verticillioides in a patient with acute myeloid leukaemia relapsed after allogeneic hematopoietic stem cell transplantation: a case report and literature review [J]. Rev Iberoam Micol, 2013, 30(1): 51-53.
[16]
Marcio N, Elias JA, Flavio Q, et al. Outcome predictors of 84 patients with hematologic malignancies and Fusarium infection[J]. Cancer, 2003, 98(2): 315-319.
[17]
García-Ruiz JC, Olazábal I, Adán Pedroso RM, et al. Disseminated fusariosis and hematologic malignancies, a still devastating association. Report of three new cases [J]. Rev Iberoam Micol, 2015, 32(3): 190-196.
[1] Xuan Zhang, Yutong Ma, Yuqian Miao, Yun Zhang, Shiwen Wu, Xiaochu Dang, Yingying Chen, Zhaoming Zhong, Xuejuan Wang, Miao Hu, Yanfeng Sun, Xiuzhu Ma, Faqin Lyu, Haiyan Kou. Ultrasound assessment of diaphragm function in pediatric patients with Duchenne muscular dystrophy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1068-1073.
[2] Baofu Zhang, Jin Yu, Jingjing Ye, Jiangen Yu, Xiaohui Ma, Xiwang Liu. Echocardioimagedata diagnosis of anomalous pulmonary venous connection caused by congenital malposition of the septum primum[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1074-1080.
[3] Dan Han, Ting Wang, Huan Xiao, Lirong Zhu, Jingyu Chen, Yi Tang. Diagnostic value of contrast enhanced ultrasound versus contrast enhanced computed tomography in benign and malignant liver lesions in children[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 939-944.
[4] Tingting Liu, Yanbing Lin, Shan Wang, Murong Chen, Zijian Tang, Dongling Dai, Bei Xia. Evaluation of metabolic dysfunction-associated fatty liver disease in children by ultrasound-guided attenuation parameter[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 787-794.
[5] Yuhan Zhou, Huan Xiao, Chunjiang Yang, Juan Zhou, Lirong Zhu, Juan Xu, Fangting Mou. Diagnostic value of ultrasound in children with temporary hip synovitis[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 795-800.
[6] Ye Fang, Xiaohong Xie, Hui Luo. Application of quality control circle in improving prostate cancer detection rate by puncture biopsy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 722-727.
[7] Jiu Wang, Jun Chen, Xia Zhu, Yangjin Mima, Sheng Zhao, Xinlin Chen, Jianhua Li, Shuang Wang. Effect of implementing fetal systemic ultrasound screening in Material and Child Health Hospital of Shannan[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 728-733.
[8] Jie Mi, Chen Chen, Jialing Li, Haina Pei, Hengbo Zhang, Fei Li, Dongjie Li. Analysis of the characteristics of children's head and face trauma[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(06): 511-515.
[9] Jun Li, Jianyun Peng, Wanbing Qiu, Qianyi Dou, Fushun Pan, Jinyu Liang. Risk stratification of malignant thyroid nodules (guidelines): A comparative study of diagnostic efficacy of ACR TI-RADS versus C-TIRADS and consistency of guideline application by different physicians[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 401-407.
[10] Tao Ma, Chunwei Ye, Tao Liu, Wenxi Peng, Zhipeng Li. Comparison of laparoscopic and open disconnected pyeloplasty in the treatment of ureteropelvic junction obstruction in children[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 605-610.
[11] Lei Lyu, Xiao Feng, Kaiming He, Kaining Zeng, Qing Yang, Haijin Lyu, Huimin Yi, Shuhong Yi, Yang Yang, Binsheng Fu. Value of revised King's score in evaluation of live transplantation timing for children with acute liver failure due to Wilson's disease and literature review[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 661-668.
[12] Zehui Huang, Jiexian Liang, Wei Zeng. Application of dexmedetomidine combined with esketamine in painless gastroscopy in children[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 510-513.
[13] Xiangyu Zhu, Jianmei Wang, Hui Zhang, Hongying Ye. Correlation analysis between left ventricular function parameters and liver cirrhosis using non-invasive left ventricular pressure-strain cycle[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 494-498.
[14] Shaohong Zhuo, Xiuling Lin, Cuimei Zhou, Weilian Xiong, Xingzao Ma. Application value of CD64 index combined with serum SAA/CRP and PCT in the diagnosis of children with infectious gastrointestinal diseases[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 505-509.
[15] Jing Li, Lingling Zhang, Wei Xing. Value of concept of interest induction before anesthesia induction in pediatric surgery and its effect on family satisfaction[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 812-817.
Viewed
Full text


Abstract

Copyright © Chinese Medical Association, Chinese Medical Multimedia Press  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号