摘要
目的报道1例黄曲霉致真菌性角膜炎病例及对该病原体展开的实验室检测流程。方法采集本院收治的1例角膜炎患者患处角膜刮片标本进行病原菌培养,并对分离到的菌株进行菌种鉴定及体外药敏试验。查阅既往文献整理汇总该病原菌致角膜炎的临床数据。结果角膜刮片标本培养后生长丝状真菌菌落,经形态学和MALDI-TOF MS鉴定为黄曲霉复合群;钙调蛋白基因测序鉴定为黄曲霉。Sensititre YeastOne显色真菌药敏试验显示该菌株对测试的7种抗真菌药物均体外敏感。尽管该病例在实验室检出黄曲霉致病菌后及时调整了抗真菌治疗方案,但实际临床治疗效果不佳,症状持续加重,最终摘除患侧眼球以遏制感染进一步扩散。既往相关文献报道曲霉菌性角膜炎症状较重,首选治疗药物为伏立康唑且需长疗程。结论曲霉菌性角膜炎的诊治过程较为棘手,实验室检查提供准确的菌种鉴定及体外药敏结果有助于曲霉菌性角膜炎的及早诊治。非培养的分子诊断技术有望作为真菌性角膜炎的补充检测手段。
Objective Here we reported a clinical case of fungal keratitis caused by Aspergillus flavus,and the relevant laboratory testing process about this pathogen.Methods A sample of infected corneal scrape from a hospitalized keratitis patient was cultured in our laboratory.The species identification and the in-vitro antimicrobial susceptibility of the isolated pathogen were performed.The general clinical data concerning keratitis caused by this pathogen in previous published researches were reviewed.Results Filamentous fungus colonies were obtained from the culture of the patient’s corneal scraping sample.The morphological method and MALDI-TOF MS both identified the mold colonies as A.flavi complex.The concrete species level information of this mold was reveled by calmodulin gene sequencing method was A.flavus.The in-vitro antifungal susceptibility profiles of this isolate to seven antifungal drugs commonly used in clinic were totally susceptible through the Sensititre YeastOne colorimetric plate method.The clinical outcome of this patient was poor with enucleation of the infected eyeball even the antifugal therapeutic regimen adjusted timely.The previously published studies generally suggest that the clinical symptoms of Aspergillus keratitis were severe,and voriconazole with long course was recommended as the first-line treatment.Conclusions The diagnosis and treatment of keratitis caused by Aspergillus is comparatively difficult;accurate species and in-vitro susceptibility information of the pathogen provided by clinical laboratory is helpful for diagnosis and treatment of fungal keratitis.Molecular diagnostic techniques independent of culture methods are promising in assisting the early clinical diagnosis of Aspergillus keratitis.
作者
李颖
曹敬荣
王岩
陈典典
闵嵘
王培昌
LI Ying;CAO Jingrong;WANG Yan;CHEN Diandian;MIN Rong;WANG Peichang(Department of Clinical Laboratory,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中国真菌学杂志》
CSCD
2024年第1期25-29,共5页
Chinese Journal of Mycology
基金
首都医科大学科研培育基金(PYZ23052)。
关键词
黄曲霉
真菌性角膜炎
实验室检测
文献回顾
Aspergillus flavus
fungal keratitis
laboratory testing
literature review
