在机械通风免疫受损患者中,通过支气管检查诊断出快速进展的伪膜性阿斯伯吉尔菌 (Aspergillus tracheobronchitis):病例报告
Ryusuke Maruta1,2, Genki Yoshimura2, Kazuya Okada2
1Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
IDCases
|October 27, 2025
概括
阿斯珀吉勒斯气管支柱炎 (AT),一种严重的侵入性阿斯珀吉洛症,可以发生在手术后. 早期的支气管镜检查和抗真菌治疗对于诊断和改善进展性肺炎病例的结果至关重要.
科学领域:
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
- 关键护理医学 关键护理医学
背景情况:
- 阿斯珀吉勒斯气管支柱炎 (AT) 是一种罕见的,严重的侵入性阿斯珀吉洛症,在伪膜形式时通常是致命的,特别是在通风患者中.
- 免疫受损状态是主要的风险因素,但AT可以在不同的临床环境中表现出来.
- 大型手术后的渐进性肺炎需要广泛的差异诊断,包括真菌感染.
研究的目的:
- 在接受免疫抑制剂的老年患有性综合征的老年患者中报告Aspergillus tracheobronchitis (AT) 的病例.
- 突出诊断挑战和伪膜性AT的临床过程.
- 在疑似病例中强调早期支气管镜检查和实证抗真菌治疗的重要性.
主要方法:
- 一个86岁的患有性综合征的女性患者在皮质类固醇和环素治疗中的病例报告.
- 临床表现包括呼吸衰竭后的sigmoid结肠穿孔手术.
- 诊断工作包括胸部CT,血清β-D-葡萄糖和细胞学和微生物学连续支气管镜检查.
主要成果:
- 最初的症状模仿了Pneumocystis肺炎,具有双边磨砂玻璃不透明度和升高的β-D-葡萄糖.
- 重复的支气管镜检查显示了广泛的气管伪膜和内支气管斑块,被证实为Aspergillus fumigatus.
- 尽管接受了伏利康纳治疗,但患者出现了渐进的呼吸衰竭,并因感染而死亡.
结论:
- 在重大手术后患有耐火性肺炎的患者中,无论免疫状况如何,都应考虑Aspergillus tracheobronchitis.
- 及时诊断取决于早期和重复的支气管镜评估.
- 及时的实证抗真菌治疗对于可能改善疑似AT病例的结果至关重要.
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