1例多器官损伤继发茄病镰刀菌血症的真菌学研究

目的 对车祸致多器官损伤继发茄病镰刀菌血症的真菌学研究.方法 以我院收治的l例多器官损伤的患者为研究对象,采集患者深静脉血液进行血培养,对培养出的真菌进一步行表型分析、分子鉴定,并行E-test真菌药敏实验.结果 血液标本细菌培养阴性,但真菌培养3次呈现丝状真菌生长,对菌丝的表型和分子鉴定检测结果均提示为“茄病镰刀菌”.E-test真菌药敏实验结果提示该菌株对两性霉素（AMB）和伏立康唑（VOZ）敏感,对伊曲康唑（ITZ）、卡泊芬净（CS）和氟康唑（FCZ）耐药.结论 镰刀菌可引起人体局限性或播散性感染,对多种抗真菌药物呈现耐药,常危及生命.因此对车祸后经清创、抗感染等治疗后仍发热者,有必要做血液真菌培养.菌株的鉴定可采用表型分析、分子鉴定.

Mycological research of fungemia caused by Fusarium solani after multiple organ injury

Objective To isolate and identify the phenotype of pathogenic fungus, to get molecular diagnosis and in vitro drug sensitivity of Fusarium in a patient with fungemia after multiple organs injury. Methods A young patient diagnosed as muhiple or- gans injury, and his blood was collected from deep veins and cultured for both bacterium and fungi. The isolated fungus from the blood culture were identified further with phenotype and molecular methods. Finally, E-test was used to detect the antifungal suscep- tibility. Results The blood culture was negative for bacteria, but positive for fungi. The isolate was confirmed as ＂ Fusarium solani ＂ according to the morphology of the fungus and the results of phenotypic and molecular identification. The isolate was sensitive to AMB and VOZ, hut resistant to ITZ, CS and FCZ. Conclusion Fusarium could cause local and disseminated infections in hu- mans, and it was always vital and negative to most of antifungal drugs. It is necessary to perform blood fungal culture for the patients who were still febrile even after the debridement and antibiotic therapy. The fnngal strain could be identified by the phenotype and molecular analysis.