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目的:通过报道1例急性淋巴细胞白血病患者侵袭性头状地霉感染的临床资料,并结合文献探讨头状地霉感染的临床特点、有效的诊断及治疗方法。方法:报道国内首例急性淋巴细胞白血病患者化疗后骨髓抑制期感染头状地霉病例,并对该病的诊断及治疗等进行系统文献回顾。结果:该白血病患者经血培养证实为头状地霉感染,并累及肺脏、肝脏和皮肤,治疗过程中先后采用卡泊芬净、脂质体两性霉素B和脂质体两性霉素B联合伏立康唑等治疗,虽然脂质体两性霉素B联合伏立康唑治疗患者体温正常,临床症状稍有改善,但是患者在化疗后40天放弃治疗并死于心肺功能衰竭。结论:头状地霉感染的发病率低,临床症状不够典型,诊断困难,预后差。根据患者的临床表现,结合血培养、GM实验、G实验和CT扫描等检查,可有助于诊断。头状地霉感染尚无非常有效的治疗方式,采用脂质体两性霉素B或两性霉素B联合伏立康唑或其他新的抗真菌药物可能获得一定的疗效,早期诊断、早期联合治疗和患者早期脱离粒缺状态是治疗成功的关键。
OBJECTIVE: To report the clinical data of one invasive case of Acremonium solani in one case of acute lymphoblastic leukemia, and to discuss the clinical features, effective diagnosis and treatment of Acremonium scab by literature review. Methods: The first case of acute lymphoblastic leukemia in China was reported to be infected with Mycosis acuminatum during myelosuppression after chemotherapy, and the systematic literature reviews of the diagnosis and treatment of the disease were made. Results: The leukemia patients were identified as head-shaped gem infection in the blood and involved the lung, liver and skin. During the treatment, caspofungin, liposomal amphotericin B and liposomal amphotericin B were combined with voriconazole Although the body temperature was normal and the clinical symptoms were slightly improved in patients treated with liposomal amphotericin B and voriconazole, patients were given up their treatment 40 days after chemotherapy and died of cardiopulmonary failure. Conclusion: The incidence of Gemcitabine head infection is low, the clinical symptoms are not typical enough, the diagnosis is difficult and the prognosis is poor. According to the patient’s clinical manifestations, combined with blood culture, GM experiments, G experiments and CT scans and other tests, can contribute to the diagnosis. There is no very effective treatment for Gemcitabine infection, and some effects may be obtained by using liposomal amphotericin B or amphotericin B in combination with voriconazole or other new antifungal drugs. Early diagnosis, early combination therapy and early stage of patients Detachment of granulosa is the key to successful treatment.