继发肺结核合并两株不同表型烟曲霉感染病例1例

患者,男,69岁,因反复咳嗽、咳痰8个月,加重伴咯血4 d就诊。患者7年前曾患肺结核,抗痨治疗1年后治愈。就诊后第1次纤支镜灌洗液标本宏基因组二代测序检出结核分枝杆菌,血清和纤支镜灌洗液曲霉抗原半乳甘露聚糖试验阳性,第2次纤支镜灌洗液真菌培养出两种形态的烟曲霉(白色株和蓝绿色典型株),两株烟曲霉药敏试验结果相同且具有高度同源性。临床诊断继发肺结核合并侵袭性烟曲霉感染,予抗痨、伏立康唑抗真菌治疗,出院后继续抗痨,抗真菌治疗,定期随访复查胸部CT及痰涂片查抗酸杆菌。

Pulmonary tuberculosis combined infection with two strains of Aspergillus fumigatus with different phenotypes

The patient was a 69-year-old male patient.He had recurrent coughing and sputum production for 8 months,with aggravated hemoptysis for 4 days.The patient had pulmonary tuberculosis 7 years ago,he was cured after 1 year of anti-tuberculosis treatment.Mycobacterium tuberculosis was detected by metagenomic second-generation sequencing of bronchoscopy lavage samples.Serum and bronchoscopy lavage fluid Aspergillus antigen galactomannan tests were positive.Two forms of Aspergillus fumigatus(white strain and typical smoke-green strain)were cultured from bronchoscopy lavage fluid.The two strains had the same susceptibility test results and high degree of homology.The patient was diagnosed as tuberculosis combined with invasive Aspergillus fumigatus infection.Anti-tuberculosis and voriconazole were given.Regular follow-up review of chest CT and sputum smear for acid-fast bacilli were recommended after discharged.