【作者】 王焕玲； 范洪伟； 王爱霞； 于洪泉； 谢秀丽； 张文； 李雪梅； 邓国华； 盛瑞媛；

【Author】 WANG Huan-ling, FAN Hong-wei, WANG Ai-xia, YU Hong-quan, XIE Xiu-li, LI Xue-mei, ZHANG Wen, DENG Guo-hua, SHENG Rui-yuan.

【机构】 北京协和医院感染内科；

【摘要】 目的探讨真菌性心内膜炎(FE)的临床特点,以提高对FE的认识。方法分析我院确诊的6例FE的临床资料,并进行相关文献复习。结果 (1)6例患者中,4例为男性,年龄26～51岁, 病程15 d～9个月;(2)3例患者存在心脏基础病(其中风湿性心脏病2例及先天性心脏病换瓣术后1 例),2例患者患有系统性红斑狼疮(SLE);(3)所有患者均存在真菌感染的易患因素,主要为长期使用广谱抗生素(5例次／6)、糖皮质激素使用(3例次／6)、狼疮活动(2例次／6)、心脏手术、呼吸机相关性肺炎、真菌性皮炎等(各1例次／6);(4)主要临床表现为发热(6／6)、栓塞(5／6);超声心动图(UCG) 检出瓣周漏及瓣周积脓1例、赘生物5例,并且所有赘生物最大直径均≥1．2 cm;(5)6例患者共检出致病真菌7株,其中念珠菌最多(4株),另有毛霉菌、隐球菌及青霉菌(各1株);(6)2例SLE患者接受了单纯抗真菌药物治疗,1例好转,1例死亡;另4例患者均接受了手术和药物联合治疗,痊愈2 例,复发后死亡2例;结论 FE是严重的深部真菌感染之一,多数患者存在诱因及基础疾病,临床具有起病隐匿、病程长、赘生物体积大、栓塞发生率高等特点,早期诊断及内外科联合治疗有利于改善预后。更多还原

【Abstract】 Objective To investigate the clinical characteristics, therapeutical approaches and outcome of fungal endocarditis (FE). Methods The clinical profiles, presumed risk factors, fungal organisms, therapeutic managements and outcome of 6 FE patients, who were treated in Peking Union Medical College Hospital from January 1988 to November 2004, were analyzed. All cases were definite infectious endocarditis (IE) according the Duke’s new criteria, and microbiological study revealed fungi. Results (1) Of the 6 FE cases, 4 patients were male and 2 patients were female. The average age was (38.3±9.4) years old (26-51 years old). The average duration before diagnosis was (3.75 ± 3.28) months (15 days-9 months). (2) Of the 6 cases, 3 patients had underlying organic valvular diseases (rheumatic heart diseases in 2 cases, valvular replacement in 1 case), 2 patients had systemic lupus erythematosus (SLE). 5 of the 6 patients developed FE while being hospitalized. (3) All patients had risk factors for FE. 5 of 6 cases had received long term broad-spectrum antibiotics therapy; 3 of the 6 patients had received corticosteroid treatment; other risk factors include active lupus (in 2 cases), chronic hepatitis B virus hepatitis (in 1 case), ventilator-related pneumonia (in 1 case), fungal dermatitis (in 1 case) and IE due to Burkholderia cepacia. (4) Fever (6/6) and embolism (5/6) were the most common clinical presentations, the echocardiogram findings were large vegetations (all vegetations had a diameter ≥ 1.2 cm) in 5 patients, peri-valvular empyema in 1 patients. (5) All but 1 had a single fungal pathogen. Of the 7 isolated fungi, 5 were yeast and revealed by blood culture; 2 were mold (mucormycosis and penicillium ) and were identified by pus from peri-valvular empyema, removed embolus and vegetations; non-albican Candida (4/5) was the most frequently identified yeast (each 2 were Candida parapsilosis and Candida tropicalis), the other yeast was Cryptococcus neoformans; (6) Of the 2 FE patients who had underlying SLE were treated by anti-fungal agents conservatively, 1 patient improved and 1 had sudden death; Among the 4 FE who received combined medical and surgical treatment, 2 were caused by Candida and got complete recovery; 2 were caused by molds, endocarditis recurred and died after valvular replacement. Conclusions FE is a rare but severe disease; it usually occurs in immuno-compromised patients with underlying diseases. Antibiotics abuse and long duration of hospitalization are the most common risk factors. Larger vegetation and early large vessel embolism are suggestive for FE.更多还原