간 이식 환자에서 발생한 파종성 Scedosporium apiospermum 감염 1예
A Case of Disseminated Scedosporium apiospermum Infection in a Liver Transplant Patient
2
조회
0
다운로드
1
인용
0
참고문헌
초록
저자들은 다발성 뇌 농양을 동반한 치명적인 파종성 S. apiospermum 감염이 발생한 간 이식 환자를 경험하였다. 본 증례의 환자는 voriconazole로 치료하는 호전경과를 보이다가 진균성 뇌 동맥류 파열로 사망하였다. S. apiospermum은 비교적 드문 진균으로 병리학적으로 Aspergillus spp.와 매우 유사하고 amphotericin B에 내성을 나타내므로 진단과 치료가 적절하게 이루어지지 못할 가능성이 많고 면역 기능 저하 환자에서 혈행성 전파를 통한 파종성 감염이 용이하게 발생하므로 높은 사망률을 나타낸다. 이식 환자를 비롯한 면역 기능 저하 환자에서 진균 감염이 의심될 때 S. apiospermum과 같은 드문 진균에 의한 감염증도 감별진단에 포함해야 하겠다.
Abstract
Sedosporium apiospermum is a saprophytic fungus commonly found in soil and polluted water. This organism is known as a cause of mycetoma, which may occur in immunocompetent hosts following trauma. However, in immunocompromised patients, S. apiospermum can also cause life-threatening invasive disease, including central nervous system infection or disseminated infection. We report a fatal case of disseminated S. apiospermum infection in a 46-year-old woman after liver transplantation. Eight days postoperatively, she developed pneumonia, followed by altered mentality in the 15 days. A head CT demonstrated multiple brain abscesses. Sputum and stereotactic-aspirated brain abscess culture yielded S. apiospermum. Despite treatment with voriconazole, the patient died of intracranial hemorrhage.
참고문헌 (19)
- "Opportunistic mycelial fungal infections in organ transplant recipients emerging importance of non-Aspergillus mycelial fungi", 37, pp.221~229 (2003)
- "Infections due to Scedosporium apiospermum and Scedosporium prolificans in transplant recipients:clinical characteristics and impact of antifungal agent therapy on outcome", 40, pp.89~99 (2005)
- "A Case of Cutaneous Abscess Due to Scedosporium apiospermum", 39, pp.812~815 (2001)
- "Report of Four Cases of Pulmonary Pseudallescheriasis from Korea", 18, pp.99~110 (1983)
- "Aspergillus, Fusarium, and other opportunistic moniliaceous fungi", pp.1726~1760 (2003), American Society for Microbiology
- "Clinical significance of Pseudallescheria boydii:a review of 10 years' experience", 60, pp.531~7 (1985)
- "Scedosporium apiospermum(Pseudallescheria boydii)endocarditis", 44, pp.189~192 (2002)
- "Breakthrough Scedosporium apiospermum (Pseudallescheria boydii) brain abscess during therapy for invasive pulmonary aspergillosis following high-risk allogeneic hematopoietic stem cell transplantation. Scedosporiasis and recent advances in antifungal therapy.", 4, pp.212~217 (2002)
- "Pseudallescheria boydii (Anamorph Scedosporium apiospermum). Infection in solid organ transplant recipients in a tertiary medical center and review of the literature", 81, pp.333~348 (2002)
- "Clinical significance of Scedosporium apiospermum in patients with cystic fibrosis", 19, pp.53~56 (2000)
- "Infection of the CNS by Scedosporium apiospermum after near drowning Report of a fatal case and analysis of its confounding factors", 57, pp.205~207 (2004)
- "Meningitis caused by Pseudallescheria boydii treated with voriconazole", 30, pp.981~982 (2000)
- "Fungal mycotic aneurysms and multiple cerebral abscesses caused by Scedosporium apiospermum.Apropos of a case with review of the literature", 66, pp.321~6 (1985)
- "True fungal mycotic aneurysm of the basilar artery:a clinical and surgical dilemma", 9, pp.50~53 (1999)
- "Pseudallescheria boydii knee arthritis in a young immunocompetent adult two years after a compound patellar fracture", 68, pp.517~520 (2001)
- "Pseudallescheria boydii infections treated with ketoconazole.Clinical evaluations of seven patients and in vitro susceptibility results", 86, pp.219~24 (1984)
- "In vitro activities of four novel triazoles against Scedosporium spp", 45, pp.2151~2153 (2001)
- "Scedosporium apiospermum brain abscess treated with surgery and voriconazole.Case report", 103, pp.83~87 (2005)
- "Pseudallescheria boydii brain abscess successfully treated with voriconazole and surgical drainage:case report and literature review of central nervous system pseudallescheriasis", 31, pp.673~677 (2000)