尖端赛多孢子菌引起的真菌性鼻窦炎1例并文献复习

目的 探讨尖端赛多孢子菌的实验室检测方法,了解其对5种常用抗真菌药物的体外敏感性.通过对相关文献的复习,熟悉真菌性鼻窦炎的临床表现和诊治方法.方法 将1例尖端赛多孢子菌引起的真菌性鼻窦炎患者经鼻内腔镜手术切除的团块用10％ KOH压片镜检、涂片革兰染色镜检、沙堡弱培养基培养、分子生物学方法鉴定到种.分离株应用E-test进行体外药敏试验.结果 鉴定为尖端赛多孢子菌.5种药物对其MIC范围分别为:伏立康唑0.064 μg/mL,卡泊芬净1.500 μg/mL,氟康唑16.000 μg/mL,两性霉素B＞32.000 μg/mL,5-氟胞嘧啶＞32.000 μg/mL.结论 尖端赛多孢子菌引起的真菌性鼻窦炎国内少见报道,易与肿瘤相混淆；实验室检测对正确诊断起决定性作用；行鼻内腔镜下手术治疗效果较好.了解该菌的耐药性对指导抗真菌治疗尤为关键.

Fungal rhinosinusitis casused by Scedosporium apiospermum:a case report and literature review

Objective To report a case of rhinosinusitis caused by Scedosporium apiospermum and to study the laboratory methods and the in vitro sensitivity to five kinds of antifungal drugs.Methods The mass cut off from the rhinosinusitis patient was prepared for microscopy（10%KOH and Gram dying）,fungal culture（SDA） and molecular biological identification.In vitro drug sensitivity was determined by E-test.Results The isolate was identified as Scedosporium apiospermum.The MICs of five kinds of drugs were 0.064 μg/mL（voriconazole）,1.500 μg/mL（caspofungin）,16.000 μg/mL（fluconazole）,32 μg/mL（amphotericin B） and 32.000 μg/mL（5-flucytosine） respectively.Conclusions Fungal rhinosinusitis caused by Scedosporium apiospermum is rare in China and easily confused with tumor.Laboratory examination is important for correct diagnosis.Nasal endoscopic operation with antifungal treatment based on drug resistance test has therapeutic effect.