肾病综合征应用免疫抑制剂治疗并发肺及皮肤隐球菌感染一例报道并文献复习
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摘要
侵袭性真菌感染常见于免疫功能受损的免疫宿主,确诊困难,病死率高,肾病综合征患者应用免疫抑制剂治疗可导致其成为侵袭性真菌感染的免疫宿主。隐球菌感染是由隐球菌引起的一种全球性的真菌病,发病率呈上升趋势,但肾病综合征隐球菌感染相对少见,特别是经血液播散至皮肤更少见,误诊率高。本文报道1例肾病综合征患者应用免疫抑制剂治疗并发肺及皮肤隐球菌感染的病例,并结合国内外相关文献进行分析。
Invasive fungal infections are common in immunocompromised hosts with difficult diagnosis and high fatality.Nephrotic syndrome patients receiving immunosuppressive agent treatment are probably susceptible to invasive fungal infections due to decreased immune functions caused by the treatment.Cryptococcal infections is a global fungal disease caused by cryptococcus whose incidence rate is rising in recent years.However,nephrotic syndrome with cryptococcal infections is relatively rare,in particular,cryptococcus spreads to the skin via the bloodstream is more rare,which is often misdiagnosed.In this paper,we reported a case of nephrotic syndrome with cryptococcal pulmonary and skin infections following immunosuppressive agent treatment on the basis of reviewing adequate studies pertinent to the case.
Invasive fungal infections are common in immunocompromised hosts with difficult diagnosis and high fatality.Nephrotic syndrome patients receiving immunosuppressive agent treatment are probably susceptible to invasive fungal infections due to decreased immune functions caused by the treatment.Cryptococcal infections is a global fungal disease caused by cryptococcus whose incidence rate is rising in recent years.However,nephrotic syndrome with cryptococcal infections is relatively rare,in particular,cryptococcus spreads to the skin via the bloodstream is more rare,which is often misdiagnosed.In this paper,we reported a case of nephrotic syndrome with cryptococcal pulmonary and skin infections following immunosuppressive agent treatment on the basis of reviewing adequate studies pertinent to the case.
引文
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[4]ESPINEL-INGROFF A,KIDD S E.Current trends in the prevalence of cryptococcus gattii in the United States and Canada[J].Infect Drug Resist,2015,8:89-97.DOI:10.2147/IDR.S57686.
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[8]汪群智,郭安,盛美玲.免疫抑制和非免疫抑制患者肺隐球菌病临床特征分析[J].中国全科医学,2017,20(15):1839-1844.DOI:10.3969/j.issn.1007-9572.2017.15.011.WANG Q Z,GUO A,SHENG M L.Clinical features of pulmonary cryptococcosis in immunocompromised and immunocompetent patients[J].Chinese General Practice,2017,20(15):1839-1844.DOI:10.3969/j.issn.1007-9572.2017.15.011.
[9]WANG H,YUAN X,ZHANG L.Latex agglutination:diagnose the early cryptococcus neoformans test of capsular polysaccharide antigen[J].Pak J Pharm Sci,2015,28(1 Suppl):307-311.
[10]吕沛华,赵蓓蕾,施毅,等.1,3-β-D葡聚糖检测诊断侵袭性真菌感染的临床价值[J].中华结核和呼吸杂志,2007,30(1):31-34.DOI:10.3760/j:issn:1001-0939.2007.01.008.LYU P H,ZHAO B L,SHI Y,et al.The diagnostic value ofdetectingplasma1,3-β-Dglucanforinvasivefungal infections[J].Chinese Journal of Tuberculosis and Respiratory Diseases,2007,30(1):31-34.DOI:10.3760/j:is sn:1001-0939.2007.01.008.
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[13]HAYASHIDAMZ,SEQUECA,PASINVP,etal.Disseminated cryptococcosis with skin lesions:report of a case series[J].An Bras Dermatol,2017,92(5 Suppl 1):69-72.DOI:10.1590/abd1806-4841.20176343.
[14]吴庆,陈栎江,徐春泉,等.皮下组织新型隐球菌感染一例[J].中华临床感染病杂志,2015,8(4):363-364.DOI:10.3760/cma.j.issn.1674-2397.2015.04.021.WU Q,CHEN L J,XU C Q,et al.Subcutaneous cryptococcus neoformans infection:report of one case[J].Chinese Journal of Clinical Infectious Diseases,2015,8(4):363-364.DOI:10.3760/cma.j.issn.1674-2397.2015.04.021.
[15]ARJONA-AGUILERA C,JIMENEZ-GALLO D,COLLANTESRODRIGUEZ C,et al.Primary cutaneous cryptococcosis:a new case of this rare entity[J].Open Forum Infect Dis,2017,4(1):276.DOI:10.1093/ofid/ofw276.
[16]HENDERSON G P,DREYER S.Ulcerative cellulitis of the arm:a case of primary cutaneous cryptococcosis[J]. Dermatol Online J,2018,24(2):13030.
[17]WANGAY,MACHICADOJD,KHOURYNT,etal.Community-acquired meningitis in older adults:clinical features,etiology,and prognostic factors[J].J Am Geriatr Soc,2014,62(11):2064-2070.DOI:10.1111/jgs.13110.
[18]PERFECT J R,DISMUKES W E,DROMER F,et al.Clinical practice guidelines for the management of cryptococcal disease:2010 update by the Infectious Diseases Society of America[J].ClinInfectDis,2010,50(3):291-322.DOI:10.1086/649858.
[19]《中国真菌学杂志》编辑委员会.隐球菌感染诊治专家共识[J].中国真菌学杂志,2010,5(2):65-68,86.DOI:10.3969/j.issn.1673-3827.2010.02.001.EditorialBoardofChineseJournalofMycology.Chinese expert consensus statement on management of cryptococcal infection[J].Chinese Journal of Mycology,2010,5(2):65-68,86.DOI:10.3969/j.issn.1673-3827.2010.02.001.
[20]陈乐波,董建华,许书添,等.肾病综合征合并重症感染的临床特征与危险因素[J].肾脏病与透析肾移植杂志,2018,27(1):18-23.DOI:10.3969/cndt.j.issn.1006-298X.2018.01.004.CHEN L B,DONG J H,XU S T,et al.Clinical characteristics and risk factors of severe infections in hospitalized adult patients with primary nephrotic syndrome[J].Chinese Journal of Nephrology Dialysis&Transplantation,2018,27(1):18-23.DOI:10.3969/cndt.j.issn.1006-298X.2018.01.004.
[21]CALAROTASA,ZELINIP,DESILVESTRIA,etal.Kinetics of T-lymphocyte subsets and posttransplant opportunistic infections in heart and kidney transplant recipients[J].Transplantation,2012,93(1):112-119.DOI:10.1097/TP.0b013e318239e90c.
[22]姚秀娟,陈愉生.29例不同免疫状态肺隐球菌病临床分析[J].临床肺科杂志,2012,17(3):415-417.DOI:10.3969/j.issn.1009-6663.2012.03.013.YAO X J,CHEN Y S.Clinical analysis of pulmonary cryptococci infection in 29 patients under different immune states[J].Journal of Clinical Pulmonary Medicine,2012,17(3):415-417.DOI:10.3969/j.issn.1009-6663.2012.03.013.
[23]MODY C H,TOEWS G B,LIPSCOMB M F.Cyclosporin A inhibits the growth of cryptococcus neoformans in a murine model[J].Infect Immun,1988,56(1):7-12.
[24]NEUVILLE S,DROMEI F,MORIN O,et al.Primary cutaneous cryptococcosis:a distinct clinical entity[J].Clin Infect Dis,2003,36(3):337-347.DOI:10.1086/345956.
[25]KELLEYJL,STRUMM,RICHEDM,etal.Sodium glucose transporter 2 inhibitors and diabetic ketoacidosis in three patients with diabetes:underlying causation[J].J Pharmacol Pharmacother,2017,8(3):137-139.DOI:10.4103/jpp.JPP_20_17.
[26]陈秋莎,曹亚玲,冯早明,等.糖尿病泌尿系统感染患者多重耐药菌感染的病原菌分布及耐药性分析[J].中国医学前沿杂志(电子版),2017,9(10):141-144.DOI:10.12037/YXQY.2017.10-30.CHEN Q S,CAO Y L,FENG Z M,et al.Analysis of the distribution of pathogenic bacteria and drug resistance of multidrugresistantbacteriainpatientswithdiabeticurinarysystem infection[J].Chinese Journal of the Frontiers of Medical Science(Electronic Version),2017,9(10):141-144.DOI:10.12037/YXQY.2017.10-30.
[27]GULCAN A,GULCAN E,OKSUZ S,et al.Prevalence of toenail onychomycosis in patients with type 2 diabetes mellitus and evaluation of risk factors[J].J Am Podiatr Med Assoc,2011,101(1):49-54.
[2]余爱荣,辛华雯,吴笑春,等.肾移植术后肺部感染患者的药学监护[J].中国药师,2012,15(9):1304-1306.DOI:10.3969/j.issn.1008-049X.2012.09.035.YU A R,XIN H W,WU X C,et al.Pharmaceutical care for renal transplantation recipient with pulmonary infection[J].China Pharmacist,2012,15(9):1304-1306.DOI:10.3969/j.issn.1008-049X.2012.09.035.
[3]中国侵袭性肺部真菌感染工作组.侵袭性肺部真菌感染的诊断标准与治疗原则[J].中华内科杂志,2006,54(8):697-700.DOI:10.3760/j.issn:0578-1426.2006.08.035.Working Group on Invasive Pulmonary Fungal Infection in China.Diagnostic criteria and principles of treatment for invasive pulmonary fungal infections[J].Chinese Journal of Internal Medicine,2006,54(8):697-700.DOI:10.3760/j.issn:0578-1426.2006.08.035.
[4]ESPINEL-INGROFF A,KIDD S E.Current trends in the prevalence of cryptococcus gattii in the United States and Canada[J].Infect Drug Resist,2015,8:89-97.DOI:10.2147/IDR.S57686.
[5]MAY R C,STONE N R,WIESNER D L,et al.Cryptococcus:fromenvironmentalsaprophytetoglobalpathogen[J].NatRevMicrobiol,2016,14(2):106-117.DOI:10.1038/nrmicro.2015.6.
[6]VILCHEZ R A,FUNG J,KUSNE S.Cryptococcosis in organ transplant recipients:an overview[J].Am J Transplant,2002,2(7):575-580.
[7]EINOLLAHI B,LESSAN-PEZESHKI M,POURFARZIANI V,et al.Invasive fungal infections following renal transplantation:a review of 2410 recipients[J].Ann Transplant,2008,13(4):55-58.
[8]汪群智,郭安,盛美玲.免疫抑制和非免疫抑制患者肺隐球菌病临床特征分析[J].中国全科医学,2017,20(15):1839-1844.DOI:10.3969/j.issn.1007-9572.2017.15.011.WANG Q Z,GUO A,SHENG M L.Clinical features of pulmonary cryptococcosis in immunocompromised and immunocompetent patients[J].Chinese General Practice,2017,20(15):1839-1844.DOI:10.3969/j.issn.1007-9572.2017.15.011.
[9]WANG H,YUAN X,ZHANG L.Latex agglutination:diagnose the early cryptococcus neoformans test of capsular polysaccharide antigen[J].Pak J Pharm Sci,2015,28(1 Suppl):307-311.
[10]吕沛华,赵蓓蕾,施毅,等.1,3-β-D葡聚糖检测诊断侵袭性真菌感染的临床价值[J].中华结核和呼吸杂志,2007,30(1):31-34.DOI:10.3760/j:issn:1001-0939.2007.01.008.LYU P H,ZHAO B L,SHI Y,et al.The diagnostic value ofdetectingplasma1,3-β-Dglucanforinvasivefungal infections[J].Chinese Journal of Tuberculosis and Respiratory Diseases,2007,30(1):31-34.DOI:10.3760/j:is sn:1001-0939.2007.01.008.
[11]刘旭春,蒋国华.肺隐球菌病二例误诊分析[J].临床误诊误治,2011,24(3):45-46.LIU X C,JIANG G H.Misdiagnosis of pulmonary cryptococcosis:two cases report[J].Clinical Misdiagnosis&Mistherapy,2011,24(3):45-46.
[12]CHIANG K,LI C.Atypical presentation of pulmonary cryptcoccosis mimicking lung cancer in an immune competent case[J].Am J Respir Crit Care Med,2011,183:5707.
[13]HAYASHIDAMZ,SEQUECA,PASINVP,etal.Disseminated cryptococcosis with skin lesions:report of a case series[J].An Bras Dermatol,2017,92(5 Suppl 1):69-72.DOI:10.1590/abd1806-4841.20176343.
[14]吴庆,陈栎江,徐春泉,等.皮下组织新型隐球菌感染一例[J].中华临床感染病杂志,2015,8(4):363-364.DOI:10.3760/cma.j.issn.1674-2397.2015.04.021.WU Q,CHEN L J,XU C Q,et al.Subcutaneous cryptococcus neoformans infection:report of one case[J].Chinese Journal of Clinical Infectious Diseases,2015,8(4):363-364.DOI:10.3760/cma.j.issn.1674-2397.2015.04.021.
[15]ARJONA-AGUILERA C,JIMENEZ-GALLO D,COLLANTESRODRIGUEZ C,et al.Primary cutaneous cryptococcosis:a new case of this rare entity[J].Open Forum Infect Dis,2017,4(1):276.DOI:10.1093/ofid/ofw276.
[16]HENDERSON G P,DREYER S.Ulcerative cellulitis of the arm:a case of primary cutaneous cryptococcosis[J]. Dermatol Online J,2018,24(2):13030.
[17]WANGAY,MACHICADOJD,KHOURYNT,etal.Community-acquired meningitis in older adults:clinical features,etiology,and prognostic factors[J].J Am Geriatr Soc,2014,62(11):2064-2070.DOI:10.1111/jgs.13110.
[18]PERFECT J R,DISMUKES W E,DROMER F,et al.Clinical practice guidelines for the management of cryptococcal disease:2010 update by the Infectious Diseases Society of America[J].ClinInfectDis,2010,50(3):291-322.DOI:10.1086/649858.
[19]《中国真菌学杂志》编辑委员会.隐球菌感染诊治专家共识[J].中国真菌学杂志,2010,5(2):65-68,86.DOI:10.3969/j.issn.1673-3827.2010.02.001.EditorialBoardofChineseJournalofMycology.Chinese expert consensus statement on management of cryptococcal infection[J].Chinese Journal of Mycology,2010,5(2):65-68,86.DOI:10.3969/j.issn.1673-3827.2010.02.001.
[20]陈乐波,董建华,许书添,等.肾病综合征合并重症感染的临床特征与危险因素[J].肾脏病与透析肾移植杂志,2018,27(1):18-23.DOI:10.3969/cndt.j.issn.1006-298X.2018.01.004.CHEN L B,DONG J H,XU S T,et al.Clinical characteristics and risk factors of severe infections in hospitalized adult patients with primary nephrotic syndrome[J].Chinese Journal of Nephrology Dialysis&Transplantation,2018,27(1):18-23.DOI:10.3969/cndt.j.issn.1006-298X.2018.01.004.
[21]CALAROTASA,ZELINIP,DESILVESTRIA,etal.Kinetics of T-lymphocyte subsets and posttransplant opportunistic infections in heart and kidney transplant recipients[J].Transplantation,2012,93(1):112-119.DOI:10.1097/TP.0b013e318239e90c.
[22]姚秀娟,陈愉生.29例不同免疫状态肺隐球菌病临床分析[J].临床肺科杂志,2012,17(3):415-417.DOI:10.3969/j.issn.1009-6663.2012.03.013.YAO X J,CHEN Y S.Clinical analysis of pulmonary cryptococci infection in 29 patients under different immune states[J].Journal of Clinical Pulmonary Medicine,2012,17(3):415-417.DOI:10.3969/j.issn.1009-6663.2012.03.013.
[23]MODY C H,TOEWS G B,LIPSCOMB M F.Cyclosporin A inhibits the growth of cryptococcus neoformans in a murine model[J].Infect Immun,1988,56(1):7-12.
[24]NEUVILLE S,DROMEI F,MORIN O,et al.Primary cutaneous cryptococcosis:a distinct clinical entity[J].Clin Infect Dis,2003,36(3):337-347.DOI:10.1086/345956.
[25]KELLEYJL,STRUMM,RICHEDM,etal.Sodium glucose transporter 2 inhibitors and diabetic ketoacidosis in three patients with diabetes:underlying causation[J].J Pharmacol Pharmacother,2017,8(3):137-139.DOI:10.4103/jpp.JPP_20_17.
[26]陈秋莎,曹亚玲,冯早明,等.糖尿病泌尿系统感染患者多重耐药菌感染的病原菌分布及耐药性分析[J].中国医学前沿杂志(电子版),2017,9(10):141-144.DOI:10.12037/YXQY.2017.10-30.CHEN Q S,CAO Y L,FENG Z M,et al.Analysis of the distribution of pathogenic bacteria and drug resistance of multidrugresistantbacteriainpatientswithdiabeticurinarysystem infection[J].Chinese Journal of the Frontiers of Medical Science(Electronic Version),2017,9(10):141-144.DOI:10.12037/YXQY.2017.10-30.
[27]GULCAN A,GULCAN E,OKSUZ S,et al.Prevalence of toenail onychomycosis in patients with type 2 diabetes mellitus and evaluation of risk factors[J].J Am Podiatr Med Assoc,2011,101(1):49-54.