A 61-year-old man with prolonged neutropenia as a result of salvage chemotherapy for acute myeloid leukemia was evaluated on hospital day 37 for persistent neutropenic fever despite treatment with broad-spectrum antimicrobial agents. Physical exam was notable for a lesion with central necrosis on the chest and a similar lesion on the left palm. A serum 1,3-β-D-glucan level was elevated, and a galactomannan was negative. Computed tomography of the chest, abdomen, and pelvis was performed. Gram’s staining of blood culture revealed septate, hyaline hyphae. Which of the following is the most likely causative organism?
一名 61 岁男性因急性髓系白血病接受挽救性化疗后出现持续性中性粒细胞减少。在使用广谱抗菌药物治疗的情况下，患者仍持续发热，于住院第 37 天接受评估。体格检查发现胸部有一处中央坏死性病变，左手掌也有类似病变。血清 1,3-β-D-葡聚糖水平升高，而半乳甘露聚糖检测结果为阴性。随后进行了胸部、腹部和盆腔计算机断层扫描（CT）。血培养革兰氏染色显示有隔、透明菌丝。以下哪种病原体最可能是致病菌？
A. Aspergillus fumigatus烟曲霉
B. Rhizopus arrhizus少根根霉
C. Blastomyces dermatitidis皮炎芽生菌
D. Fusarium keratoplasticum角蛋白镰刀菌
E. Cryptococcus neoformans新型隐球菌
答案解析：
分子测序确定病原体为角蛋白镰刀菌，确诊为播散性镰刀菌病。镰刀菌病是长期中性粒细胞减少症患者中最常见的侵袭性霉菌感染之一。与其他侵袭性霉菌感染不同，其显著特征是与真菌血症密切相关。一线治疗方案为伏立康唑联合脂质体两性霉素B。播散性感染的死亡率仍然很高。
正确答案：D
原创文章（本站视频密码：66668888），作者：xujunzju，如若转载，请注明出处：https://zyicu.cn/?p=22180
微信扫一扫 
支付宝扫一扫 
