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儿童血液肿瘤造血干细胞移植后合并侵袭性真菌感染的诊治与挑战

Diagnostic Treatment and Challenges of Combined Invasive Fungal Infections After Hematopoietic Stem Cell Transplantation for Hematological Neoplasms in Children

  • 摘要: 侵袭性真菌病(IFD)是血液肿瘤及造血干细胞移植后患儿中的严重并发症,病死率高,临床诊治面临严峻挑战。曲霉菌、念珠菌和木霉菌是儿童血液肿瘤合并IFD的主要病原体,感染多表现为发热、呼吸困难等非特异性症状,早期诊断困难。侵袭性念珠菌感染可表现为念珠菌血症或慢性播散性感染(如肝脾受累),后者可伴有右上腹压痛和腹痛等局部表现,进一步增加了IFD早期诊断的复杂性。因此,儿童血液肿瘤造血干细胞移植后,IFD的早期诊断和有效治疗需要采用多种诊断方法联合的策略,以实现早期干预和有效治疗并改善预后。

     

    Abstract: Invasive fungal disease (IFD) has a high incidence in patients with hematologic malignancies who have undergone hematopoietic stem cell transplantation, particularly in children. IFD increases mortality and presents multiple challenges in diagnosis and treatment. Among these fungi, Aspergillus, Candida, and Trichoderma are the main pathogens. Infections caused by these fungi usually present with nonspecific symptoms such as fever and dyspnea, further complicating the diagnosis. Invasive Candida infections can manifest as candidemia or chronic disseminated candidiasis (eg. involving the liver and spleen). The latter condition can be accompanied by localized symptoms such as right upper quadrant tenderness and abdominal pain, which further complicates the early diagnosis of IFD. The early diagnosis and effective treatment of IFD after hematopoietic stem cell transplantation for pediatric hematologic neoplasms require multiple tools to overcome clinical challenges and improve patient prognosis.

     

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