65例血液病患者感染毛霉菌病的胸部CT表现及诊治分析

doi:10.16150/j.1671-2870.2024.05.005

诊断学理论与实践 ›› 2024, Vol. 23 ›› Issue (05): 494-499.doi: 10.16150/j.1671-2870.2024.05.005

65例血液病患者感染毛霉菌病的胸部CT表现及诊治分析

李英¹^,²(), 蒋晗¹^,², 王晓雪¹^,², 魏浩楠¹^,²

¹ 中国医学科学院血液病医院(中国医学科学院血液学研究所)，实验血液学国家重点实验室，国家血液系统疾病临床医学研究中心，细胞生态海河实验室，天津 300020
² 天津医学健康研究院，天津 301600，放射科

收稿日期:2024-03-20 接受日期:2024-08-08 出版日期:2024-10-25 发布日期:2025-02-25
通讯作者: 李英 E-mail:liying@ihcams.ac.cn

Analysis of chest CT findings, diagnosis, and treatment of mucormycosis infection in 65 hematologic disease patients

LI Ying¹^,²(), JIANG Han¹^,², WANG Xiaoxue¹^,², WEI Haonan¹^,²

¹ Department of radiology,State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
² Tianjin Institutes of Health Science,Tianjin 301600, China

Received:2024-03-20 Accepted:2024-08-08 Published:2024-10-25 Online:2025-02-25

摘要/Abstract

摘要：

目的：分析血液病合并毛霉菌病临床诊治特点，供临床参考。方法：纳入2018年10月至2023年12月我院经临床综合诊断为血液病合并毛霉菌病的连续病例65例。所有患者均接受胸部CT检查，其中14例行头颅MRI检查。8例接受肺组织活检，57例行血、肺泡灌洗液或组织宏基因二代测序，分析其CT表现及总结诊断过程。结果：肺毛霉菌占我院同期确诊真菌感染的5.30%（65/1233例）。本组58例为肺毛霉菌病，7例为累及多器官的播散性毛霉菌病。肺毛霉菌病患者CT表现为单发肺内斑片状实变（23/65）、混合型（11/65）、多发结节（28/65）或弥漫渗出（3/65），伴有反晕征29例、晕征25例、胸腔积液20例、结节数目大于10个者11例，2例患者CT增强检查显示血管截断征。播散性毛霉菌病患者表现为肺内多发结节7例，同时伴脑内单发或多发结节6例、脑内弥漫性梗死灶1例、脾内和肾内结节2例。首次胸部CT到临床确诊平均时间（4.3±1.8）d，CT怀疑真菌感染后进行，血或组织、肺泡二代测序检查，经两性霉素B等抗真菌治疗后好转58例，手术切除肺组织2例，家属放弃治疗失访2例，死亡3例。结论：肺毛霉菌约占血液病住院患者合并真菌感染的5%；肺部CT影像主要表现为单发大片突出和多发结节。近45%患者CT影像出现反晕征，38.5%的患者晕征，可为诊断提供提示性参考，二代测序在临床诊断中发挥重要作用。

关键词: 血液病, 毛霉菌病, 计算机体层成像

Abstract:

Objective This study aims to analyze the clinical diagnosis and treatment characteristics of hematologic diseases combined with mucormycosis for clinical reference. Methods A total of 65 consecutive cases of hematologic diseases combined with mucormycosis, clinically diagnosed at our hospital from October 2018 to December 2023, were included. All patients underwent chest CT examination, and 14 of them underwent cranial MRI examination. Eight patients underwent lung tissue biopsy, and 57 underwent blood, alveolar lavage fluid, or tissue metagenomic next-generation sequencing. The CT findings were analyzed and the diagnostic process was summarized. Results Pulmonary mucormycosis accounted for 5.30% (65/1 233 cases) of all fungal infections diagnosed in our hospital during the same period. Among these patients, 58 had pulmonary mucormycosis, and 7 had disseminated mucormycosis involving multiple organs. Chest CT of patients with pulmonary mucormycosis showed single patchy consolidation (23/65), multiple nodules (28/65), mixed nodules (11/65), or diffuse exudation (3/65) in the lungs, with 29 cases showing reverse halo sign, 25 cases showing halo sign, 20 cases with pleural effusion, 11 cases with more than 10 nodules, and 2 cases with vessel truncation sign on enhanced CT examination. In patients with disseminated mucormycosis, there were 7 cases of multiple nodules in the lung, 6 cases of single or multiple nodules in the brain, 1 case of diffuse infarction in the brain, and 2 cases of nodules in the spleen and kidney. The average time from the first chest CT to clinical diagnosis was (4.3±1.8) days. After CT suspected fungal infection, blood or tissue and alveolar second-generation sequencing were performed. After antifungal treatment, such as amphotericin B, 58 patients improved, 2 patients underwent surgical resection of lung tissue, 2 patients were lost to follow-up after their families decided to stop treatment, and 3 patients died. Conclusions Pulmonary mucormycosis accounts for about 5% of fungal infections in hospitalized patients with hematological diseases. Chest CT mainly shows single large consolidation and multiple nodules, with 45% showing reverse halo sign and 38.5% showing halo sign. These signs can provide reference for diagnosis, and second-generation sequencing plays an important role in clinical diagnosis.

Key words: Hematologic diseases, Mucormycosis, Computed tomography

中图分类号:

R519

李英, 蒋晗, 王晓雪, 魏浩楠. 65例血液病患者感染毛霉菌病的胸部CT表现及诊治分析[J]. 诊断学理论与实践, 2024, 23(05): 494-499.

LI Ying, JIANG Han, WANG Xiaoxue, WEI Haonan. Analysis of chest CT findings, diagnosis, and treatment of mucormycosis infection in 65 hematologic disease patients[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(05): 494-499.

图/表 3

参考文献 18

[1]	VALENTINE J C, MORRISSEY C O, TACEY M A, et al. A population-based analysis of attributable hospitalisation costs of invasive fungal diseases in haematological malignancy patients using data linkage of state-wide regi-stry and costing databases: 2009-2015[J]. Mycoses, 2020, 63(2):162-171.
[2]	PETRIKKOS G, SKIADA A, LORTHOLARY O, et al. Epidemiology and clinical manifestations of mucormycosis[J]. Clin Infect Dis, 2012,54 Suppl 1:S23-34.
[3]	YANG N, ZHANG L, FENG S. Clinical features and treatment progress of invasive mucormycosis in patients with hematological malignancies[J]. J Fungi (Basel), 2023, 9(5):592.
[4]	DANION F, AGUILAR C, CATHERINOT E, et al. Mucormycosis: new developments into a persistently devastating infection. Semin Respir Crit Care Med, 2015, 36(5):692-705. doi: 10.1055/s-0035-1562896 pmid: 26398536
[5]	齐瑶, 赵明峰, 邓琦, 等. 血液病合并毛霉菌病七例报道并文献复习[J]. 中华血液学杂志, 2019, 40(11):943-947.
	QI Y, ZHAO M F, DENG Q, et al. Report of seven cases of hematological diseases combined with trichoderma and literature review[J]. Chin J Hematol, 2019, 40(11):943-947.
[6]	中国医药教育协会真菌病专业委员会, 中国毛霉病专家共识工作组. 中国毛霉病临床诊疗专家共识(2022)[J]. 中华内科杂志, 2023, 62(6):597-605.
	Fungal Disease Professional Committee of China Medical Education Association, Expert Consensus Working Group on Trichoderma in China. Consensus of clinical diagnosis and treatment experts on trichoderma in China (2022)[J]. Chin J Intern Med, 2023, 62(6):597-605.
[7]	吴挺, 周华, 顾海艇, 等. 肺毛霉菌病25例临床高危因素特征及预后分析[J]. 中华医学杂志, 2018, 98(32):2579-2582.
	WU T, ZHOU H, GU H T, et al. Clinical high-risk factors and prognosis analysis of 25 cases of pulmonary mucormycosis[J]. Natl Med J China, 2018, 98(32):2579-2582.
[8]	AGRAWAL R, YELDANDI A, SAVAS H, et al. Pulmonary mucormycosis: risk factors, radiologic findings, and pathologic correlation[J]. Radiographics, 2020, 40(3):656-666. doi: 10.1148/rg.2020190156 pmid: 32196429
[9]	许尚文, 陈自谦, 钟群, 等. 肺毛霉菌病的CT及正电子发射计算机体层成像-CT表现[J]. 中华放射学杂志, 2014, 48(7):551-554.
	XU S W, CHEN Z Q, ZHONG Q, et al. CT and positron emission computed tomography CT manifestations of pulmonary mucormycosis[J]. Chin J Radiol, 2014, 48(7):551-554.
[10]	HAMMER M M, MADAN R, HATABU H. Pulmonary mucormycosis: radiologic features at presentation and over time[J]. AJR Am J Roentgenol., 2018, 210(4):742-747.
[11]	JUNG J, KIM M Y, LEE H J, et al. Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis[J]. Clin Microbiol Infect, 2015, 21(7):684.e11-684.e18.
[12]	BOURCIER J, HEUDES P M, MORIO F, et al. Prevalence of the reversed halo sign in neutropenic patients compared with non-neutropenic patients: Data from a single-centre study involving 27 patients with pulmonary mucormycosis (2003-2016)[J]. Mycoses, 2017, 60(8):526-533. doi: 10.1111/myc.12624 pmid: 28429890
[13]	石玉铸, 王鹏飞, 宋杰, 等. 白血病造血干细胞移植后肺部毛霉菌病CT特征表现[J]. 实用放射学杂志, 2017, 33(6):851-853.
	SHI Y Z, WANG P F, SONG J, et al. CT features of pulmonary mucormycosis after leukemia hematopoietic stem cell transplantation[J]. J Pract Radiol, 2017, 33(6):851-853.
[14]	CHAMILOS G, MAROM E M, LEWIS R E, et al. Predictors of pulmonary zygomycosis versus invasive pulmonary aspergillosis in patients with cancer[J]. Clin Infect Dis, 2005, 41(1):60-66. doi: 10.1086/430710 pmid: 15937764
[15]	NAM B D, KIM T J, LEE K S, et al. Pulmonary mucormycosis: serial morphologic changes on computed tomography correlate with clinical and pathologic findings[J]. Eur Radiol, 2018, 28(2):788-795. doi: 10.1007/s00330-017-5007-5 pmid: 28812135
[16]	周红俐, 刘范林, 宋兰. 肺毛霉菌病的CT表现及动态随诊[J]. 实用放射学杂志, 2020, 36(8): 1216-1219.
	ZHOU H L, LIU F L, SONG L. CT manifestations and dynamic follow-up of pulmonary mucormycosis[J]. J Pract Radiol, 2020, 36(8): 1216-1219.
[17]	LERSY F, ROYER-LEBLOND J, LHERMITTE B, et al. Cerebral mucormycosis: neuroimaging findings and histopathological correlation[J]. J Neurol, 2022, 269(3):1386-1395.
[18]	KHABA M C, NEVONDO L M, MOROATSHEHLA S M, et al. Disseminated mucormycosis presenting as a renal mass in an human immunodeficiency virus-infected patient: a case report[J]. S Afr J Infect Dis, 2021, 36(1):202. doi: 10.4102/sajid.v36i1.202 pmid: 34485490

Thoracic CT manifestations	Cases	Reversed halo syndrome	Halo syndrome	Pleural effusion
Single shot large consolidation	23（35%）	18（78%）	0	10（43%）
Multiple nodules	28（43%）	0	25（89%）	20（71%）
Mixed	11（17%）	8（73%）	0	2（18%）
Diffuse exudative type	3（5%）	3（100%）	0	2（67%）

65例血液病患者感染毛霉菌病的胸部CT表现及诊治分析

Analysis of chest CT findings, diagnosis, and treatment of mucormycosis infection in 65 hematologic disease patients

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