3. 曲菌分类超过185种
约有20种可导致机会性感染
A. fumigatus烟曲霉(70%)
A. flavus黄曲霉(20%)
A. niger黑曲霉(低于10%)
A. clavatus棒曲霉
A. glaucus灰绿曲霉
A. nidulans构巢曲霉
A. oryzae米曲霉
A. terreus土曲霉
A. ustus焦曲霉
A. versicolor花斑曲霉
32. 曲霉菌培养阳性患者曲霉病类型Perfect JR, et al. Clinical Infectious Diseases 2001; 33:1824–33侵袭性曲霉菌感染相对容易培养阳性
33. 肺疾病与过敏性支气管肺曲菌病(ABPA)7-14%激素依赖型哮喘为ABPA
6%囊性纤维化伴有ABPA
Basich JE, Graves TS, Baz MN, et al. Allergic bronchopulmonary aspergillosis in corticosteroid-dependent asthmatics. J Allergy Clin Immunol 1981;68:98-102.
Schwartz HJ, Greenberger PA. The prevalence of allergic bronchopulmonary aspergillosis in patients with asthma, determined by serologic and radiologic criteria in patients at risk. J Lab Clin Med 1991;117:138-42.
Mroueh S, Spock A. Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis. Chest 1994;105:32-6.
39. 抗真菌药物治疗靶位细胞膜
真菌主要利用麦角固醇而非胆固醇
多烯类抗真菌药
吡咯类抗真菌药细胞壁
真菌有细胞壁
棘球白素 DNA 合成
氟胞嘧啶
40. 侵袭性(尤其是肺)曲霉菌病的治疗疗程(Practice Guidelines for Diseases Caused by Aspergillus in 2000)尚无理想的治疗疗程,主要取决于临床治疗反应而非任何人为拟定的总剂量
恰当地疗程应包括
清除微小病灶
临床和放射学检查证实病灶吸收
培养阴性
基础状况改善
Stevens AD, et al. Clinical Infectious Diseases 2000;30:696–709
41. Consecutive patients (n=103) with proven or probable IA (per EORTC/MSG criteria) were identified from 11 countries.
85 patients received caspofungin monotherapy; 18 patients did combination thearapy (85单药,18联合治疗)
Favorable response: monotherapy 56.5%; combination therapy 56.3%有效率(单药/联合)
42. Patient demographics and baseline characteristicsMaertens J. BMC Infectious Diseases 2010, 10:182
43. VariableFavorable response %(n/N)Overall总体56.4Probable aspergillosis疑诊56.3Proven aspergillosis确诊56.7Combination therapy单药56.3Monotherapy联合56.5First-line therapy一线治疗60.0Salvage therapy挽救治疗55.6Neutropenic status at start of caspofungin therapy
(ANC<500 cells/uL)粒缺小于50052.5Active malignancy肿瘤未缓解51.9Allogeneic HSCT异体移植56.5Favorable response (complete plus partial) by patient subgroup (N=101)Maertens J. BMC Infectious Diseases 2010, 10:182
44. A retrospective observational study as salvage therapy
55 patients with proven or probable IA ( EORTC criteria) were identified from 11 countries.
Most patients had haematological disease (76.4%).
Favorable response were observed in 45.5% of the patients.
Mycoses, Feb 2010 挽救治疗实验
45. Patient demographics and baseline characteristicsMycoses, Feb 2010
46. ReferenceStudy designPatients with IAI (N)Favourable Outcome N (%)Walsh et al., 2004Prospective blinded, multicentre125 (42%)Candoni et al., 2005Prospective open, single centre3216 (50%)Groetzner et al., 2008Prospective, single center1210 (83%)Lemieux et al., 2006Retrospective, single centre, 107 (70%) Bonini et al., 2006Retrospective, single centre, 2824 (86%)Caspofungin for 1st-line therapy of IAIMycoses, 2008;51 (Suppl. 1), 47–57
47. Total
n (%)Maertens et al.
2006 aKartsonis et al.
2005 bMorrissey et al.
2007 cTimespan2003-20041999-20022001-2002Evaluable for efficacy (n)152534554Haematol. Malignancy (n)132453354HSCT (n)3517810Non-HSCT (n)97282544Neutropenia at baseline (n)
Favorable response (n)8828
29 (55%)13
20 (44%)47
26 (48%)a: Caspo combined with AmB or Azoles; Cancer. 2006 Dec 15;107(12):2888-97
b&c: Caspo alone. J Infect. 2005 Apr;50(3):196-205. Mycoses. 2007;50 Suppl 1:24-37. Caspofungin for salvage therapy of IAIMycoses, 2008;51 (Suppl. 1), 47–57
57. Clinical Practice Guidelines for the Managementof Candidiasis:----2009 Update by the IDSA非危重患者和近期无唑类用药史患者推荐使用氟康唑(A-Ⅲ)
中--重度危重患者和近期有三唑类用药史患者选择棘白菌素
棘白菌素可作为念珠菌血症初始治疗、念珠菌病确诊治疗、经验性治疗(A-I,A-II)