再生障碍性贫血感染的研究进展

再生障碍性贫血是一种外周全血细胞减少的骨髓衰竭综合征。感染是再生障碍性贫血患者死亡的主要原因。再生障碍性贫血患者的免疫妥协状态与化疗导致的中性粒细胞减少的免疫妥协状态不同，其导致的感染也有所不同。长期粒细胞减少是发生侵袭性真菌病和细菌感染的最大危险因素。中性粒细胞减少的恢复能明显提高生存率，粒细胞减少期间的支持治疗可起到很大的保护作用。再生障碍性贫血患者合并侵袭性真菌病最常见的致病菌为曲霉菌属、假丝酵母菌属、接合菌属和镰刀菌属。合并细菌感染的致病菌包括：革兰阳性菌如凝固酶阴性的葡萄球菌属、肠球菌、凝固酶阳性的金黄色葡萄球菌、梭状芽胞杆菌、微球菌甲型溶血性链球菌、单核细胞增生李斯特菌、蜡样芽胞杆菌；革兰阴性菌如大肠埃希杆菌、沙门菌、脆弱拟杆菌、肺炎克雷伯杆菌、亲水性气单胞菌属、铜绿假单胞菌。再生障碍性贫血患者合并病毒感染相对少见，但可出现疱疹病毒科、社区获得性呼吸道病毒感染和甲型、乙型、丙型病毒性肝炎。

Advances on aplastic anemia infection

Aplastic anemia (AA) is a bone marrow failure syndrome with pancytopenia. Infection is the main cause of death in AA patients. As the immune compromise state in patients with AA is different from that of patients with neutropenia induced by chemotherapy, the infection caused by them is also different. Chronic granulocytic reduction is the most serious risk factor for invasive fungal and bacterial infections. The recovery of neutrophils can significantly improve survival. The supportive therapy during granulocytopenic period can play a significant role in protection. The most common invasive fungal infections are Aspergillus species, Candida spp., Zygomycetes, and Fusarium spp. Pathogenic bacteria associated with bacterial infection of AA patients include Staphylococcus species, Enterococcus, Staphylococus aureus, Clostridium spp,Micrococcus, alpha-hemolytic streptococci, Listeria monocytogenes and Bacillus cereus. Gram-negative bacteria include Escherichia coli, Salmonella, Bacteroides fragilis, Klebsiella oxytoca, Klebsiella pneumonia, Aeromonas hydrophilia,Pseudomonas aeruginosa, and Vibrio vulnificus. Viral infections are relatively rare, but herpes viruses, community-acquired respiratory virus infections and viral hepatitis A, B and C can occur in AA patients.