临床儿科杂志 ›› 2023, Vol. 41 ›› Issue (8): 571-577.doi: 10.12372/jcp.2023.23e0416
沈楠, 杜白露
收稿日期:
2023-05-14
出版日期:
2023-08-15
发布日期:
2023-08-10
作者简介:
沈楠,医学博士,ORCID:0000-0003-3923-3488 毕业于德国海德堡大学儿科学专业,现就职于上海儿童医学中心感染科,双聘为主治医师和副研究员。主要从事儿童感染性疾病病原精准诊治、EB 病毒感染等临床问题和组蛋白单胺类修饰在儿童疾病中的作用机制研究。先后主持承担国家级、省部级等课题项目6项,以第一或通讯含共同)作者在Science Advances、Genetics in Medicine 等期刊上发表SCI 论著19篇,累计影响因子70 余分,获得国家发明专利授权2项。现担任上海市医学会感染与化疗学会青年委员,World Journal of Pediatrics 和《临床儿科杂志》青年编委。获2022 年度上海市卫生健康行业青年五四奖章、2020 年上海市医苑新星青年医学人才等多项荣誉。
基金资助:
SHEN Nan, DU Bailu
Received:
2023-05-14
Published:
2023-08-15
Online:
2023-08-10
摘要:
侵袭性真菌病(IFD)是血液肿瘤治疗过程中最常见的感染类型之一,对于血液肿瘤患儿预后具有重要影响。近年来随着病原分子检测技术的发展以及新型抗真菌药物的应用,血液肿瘤患儿IFD的预后已经得到很大的改善,但是仍面临诊断困难、病情复杂以及治疗药物选择难的挑战。文章根据目前的研究进展和最新的诊疗指南,阐述血液肿瘤患儿IFD的风险因素、临床特征、治疗方案、预后情况等,以期更好地帮助广大儿科医师了解血液肿瘤患儿IFD的预防、管理及治疗。
沈楠, 杜白露. 血液肿瘤患儿侵袭性真菌感染诊治和管理策略[J]. 临床儿科杂志, 2023, 41(8): 571-577.
SHEN Nan, DU Bailu. Strategies for the diagnosis, treatment, and management of invasive fungal infections in children with hematologic neoplasms[J]. Journal of Clinical Pediatrics, 2023, 41(8): 571-577.
表2
儿童侵袭性真菌病推荐用药"
病原体 | 一线治疗 | 替代方案 |
---|---|---|
念珠菌病 | ||
念珠菌血症 | 棘白菌类、两性霉素B脂质体 | 伏立康唑、伊曲康唑、氟康唑 |
播散性念珠菌病 | 中性粒细胞缺乏:棘白菌类、两性霉素B脂质体、伏立康唑 无中性粒细胞缺乏:氟康唑、伊曲康唑 | — ? |
中枢神经系统念珠菌病 | 两性霉素B脂质体、伏立康唑 | 氟康唑 |
曲霉菌病 | ||
初始治疗 | 伏立康唑 | 两性霉素 B 脂质体 |
挽救治疗 | 两性霉素 B 脂质体、泊沙康唑、伊曲康唑 | 卡泊芬净、米卡芬净 |
预防治疗 | 泊沙康唑、伏立康唑、伊曲康唑 | 卡泊芬净、米卡芬净 |
毛霉病 | ||
初始治疗 | 两性霉素B脂质体、两性霉素B脂质体联合泊沙康唑 | 泊沙康唑静脉制剂 |
挽救治疗 | 泊沙康唑静脉制剂 | 泊沙康唑肠溶片或口服混悬液 |
其他少见真菌 | ||
耶氏肺孢子菌 | 复方磺胺甲噁唑 | 克林霉素联合伯氨喹、卡泊芬净 |
马尔尼菲篮状菌 | 两性霉素B脂质体联合/不联合伊曲康唑 | 伏立康唑 |
镰刀菌病 | 伏立康唑、伏立康唑联合两性霉素B脂质体、伏立康唑联合两性霉素B脂质复合物 | 两性霉素B脂质体、两性霉素B脂质复合物 |
赛多孢子菌病 | 伏立康唑 | 伏立康唑联合两性霉素B脂质体或两性霉素B脂质复合物 |
播散性暗色丝孢霉病 | 泊沙康唑、伏立康唑联合棘白菌类、伏立康唑联合特比萘芬 | 两性霉素B脂质体联合/不联合棘白菌类或特比萘芬 |
帚霉感染 | 伏立康唑 | 两性霉素B脂质体联合/不联合伏立康唑 |
播散性青霉菌病 | 两性霉素B脂质体(联合/不联合其它抗真菌药物) | — |
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