重症流感合并侵袭性肺曲霉菌病20例临床分析

重症流感合并侵袭性肺曲霉菌病20例临床分析重症流感合并侵袭性肺曲霉菌病20例临床分析

摘要

目的：探讨重症流感合并侵袭性肺曲霉菌病的病因、诊断和治疗方法，提高临床医生对该病的识别和治疗水平。

方法：选择2019年1月至2020年12月收治的20例重症流感合并侵袭性肺曲霉菌病患者作为研究对象，分别从临床资料、实验室检查、病理学检查等方面进行分析。

结果：20例患者中14例未接种流感疫苗，均在流感高发季节发病。除去呼吸衰竭的基础疾病外，更容易发生流感合并侵袭性肺曲霉菌病的危险因素包括年龄≥60岁、接受免疫抑制剂治疗、糖尿病、恶性肿瘤等。发病前期高热、咳嗽、呼吸急促等是病情的主要表现。血常规和炎症反应指标异常，胸部X线和CT表现为双肺实变，鉴别诊断有困难。病原菌主要为曲霉属真菌，经药敏试验后选用伏立康唑等抗真菌药物，疗效良好。

结论：重症流感合并侵袭性肺曲霉菌病的发病率较高，临床医生应当提高警惕，及早进行综合治疗，降低病死率。

关键词：重症流感、侵袭性肺曲霉菌病、病原学、诊断、治疗

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