造血干细胞移植及易感血液系统疾病中的暗色真菌感染：一项系统综述

文献信息

中文摘要

背景： 暗色真菌可在血液系统恶性肿瘤患者和造血干细胞移植（HSCT）受者中引起侵袭性疾病。
方法： 为描述这些人群中的疾病谱，我们对PubMed和Scopus数据库进行了系统综述（检索日期为2026年8月16日），并纳入包含成人HSCT受者和具有易感血液系统疾病患者暗色真菌感染个体化数据的报告。对报告应用了四域偏倚评估，并使用描述性统计对数据进行总结。
结果： 我们确定了74份报告，涉及88例患者。中位年龄为58岁，61%为男性，35%（31/88）为HSCT受者。最常见的属为Exophiala（18/88；20%）。在有信息可用的30例患者中，25/30（83%）接受了抗真菌预防，64%（16/25）突破了抗霉菌活性预防。最常见的临床综合征为皮肤黏膜感染（40/88；45%），其次为肺部感染（12/88；14%）和鼻窦炎（11/88；13%）。92%（81/88）的感染接受了全身抗真菌治疗。在有信息可用的75例患者中，63%在报告时已死亡。
结论： 尽管受病例报告固有偏倚的限制，本综述发现了高全因死亡率和频繁的突破性感染。未使用资金来源，且本方案未注册。

英文摘要

BACKGROUND: Dematiaceous fungi can cause invasive disease in patients with hematological malignancies and hematopoietic stem cell transplant (HSCT) recipients.
METHODS: To characterize the spectrum of disease in these populations, we performed a systematic review of PubMed and Scopus databases (searched 16 August 2026) and included reports with individualized data on dematiaceous fungal infections in adult HSCT recipients and patients with predisposing hematological conditions. A four-domain bias assessment was applied to reports, and data were summarized with descriptive statistics.
RESULTS: We identified 74 reports on 88 patients. The median age was 58 years, 61% were male, and 35% (31/88) were HSCT recipients. The most common genus was Exophiala (18/88; 20%). For 30 patients with information available, 25/30 (83%) received antifungal prophylaxis, and 64% (16/25) broke through mold-active prophylaxis. The most common clinical syndrome was mucocutaneous infection (40/88; 45%), followed by pulmonary (12/88; 14%) and sinusitis (11/88; 13%). Systemic antifungal therapy was administered in 92% (81/88) of infections. For 75 patients with information available, 63% were deceased at the time of reporting.
CONCLUSIONS: Although limited by biases inherent to case reports, this review identified high all-cause mortality and frequent breakthrough infections. No funding sources were used, and this protocol was not registered.