我国首例肌曲霉病及其试验研究

目的报道国内首例肌曲霉病,对所分离的黄曲霉进行形态、药敏、rDNA序列分析研究。方法对患者病变肌组织行B超和病理检查;将分离菌株接种于察氏培养基观察形态学特征;微量法测定MIC值;酚氯仿法提取DNA,扩增ITS间区序列并进行多序列分析。结果B超示左腓肠肌不规则回声,病理示肌细胞变性、坏死,肌组织内见分枝分隔菌丝。表型及基因型特征为黄曲霉;分离菌株对多种抗真菌药物耐药;多基因序列分析显示所分离菌株与标准株及自然和临床分离株具有100%的相似性。给予特比萘芬治疗3个月后痊愈。结论黄曲霉可致肌肉感染;药敏试验对临床治疗具有指导意义;环境中普遍存在的真菌可引起免疫低下患者致死性感染。

First case report and molecular studies of muscle aspergillosis in China

Objective To report a case of Aspergillus myositis caused by Aspergillus flavus in a liver grafting patient.Methods A 43-year old man who underwent liver transplantation because of end-stage hepatic cirrhosis got a pain in the left calf two month later,which exacerbated gradually.Color ultrasonic examination showed uneven resonance in the left gastrocnemius.A biopsy specimen from the muscle tissue revealed septate hyphae consistent with Aspergillus species,and local necrosis of the muscle cells with inflammatory cell infiltration.The isolate was subcultured in Czapek agar.DNA was isolated and ITS was sequenced and analysied subsequently.Three-month of terbinafine was applied to the treatment of this patient.Results Aspergillus flavus was confirming both by morphological and genetic characteristics.MIC results showed the isolate was resist to itraconazole and amphotericin B while succesble sensitive to terbinafine.Multiple sequence analysis showed identical ITS regions to several other A.flavus.Conclusions A.flavus may cause muscle aspergillosis.An antifungal susceptibility test is helpful for therapy.Aspergillus,a genus of ubiquitous mold,may cause invasive or even fatal disease in immunosuppressed patients.