鐮刀菌的簡介與治療

10.6666/ClinMed.202108_88(2).0082

黃祥芬

鐮刀菌（fusarium） ； 白血球低下發燒（neutropenic fever） ； 突破性感染（breakthrough infection）

臨床醫學月刊

88卷2期（2021 / 08 / 27）

500 - 506

繁體中文

鐮刀菌（fusarium）為常見的環境真菌，在所有300多種鐮刀菌中，以茄病鐮刀菌群（F. solani complex, FSSC）、尖孢鐮刀菌群（F. oxysporum complex , FOSC）和藤黑鐮刀菌群（F. fujikuroi complex, FFSC）等3種物種群為常見的鐮刀菌致病菌種。鐮刀菌在免疫功能正常者常導致表淺感染，如灰指甲、真菌性角膜炎，且可以治癒。但是在免疫功能長期嚴重低下（例如嗜中性顆粒球過低）時，可造成嚴重的深部感染，或侵襲性鐮刀菌症，死亡率可高達70%。而嚴重的深部感染常來自於表淺感染，因此建議僅有表淺感染時仍需安排完整治療。目前對鐮刀菌抗真菌藥物的抗藥性機制不明確，但是大部份的鐮刀菌對fluconazole具有抗藥性，對三唑類（triazole）抗黴菌藥物的抗藥性不一，例如posaconazole和voriconazole使用在侵襲性鐮刀菌症的90天存活率約為50%。雖然淺層感染可以由polyene類抗真菌藥物治療，但是對於嚴重免疫力低下，侵襲性鐮刀菌患者，單獨使用amphotericin B相關的抗真菌藥物效果仍不佳，體外試驗則以voriconazole/ amphotericin B/anidulafungin的組合對F. solani complex有最高的加成效果。鐮刀菌的治療指引中仍缺乏動物模式或大規模的雙盲試驗，針對侵襲性鐮刀菌症，仍以voriconazole或脂質成分的amphotericin B為基礎的單一或抗黴菌藥物組合為治療建議，未來有待更新的隨機分派研究和藥物開發，提高患者的治癒率。

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