شناسایی عفونت های قارچی مهاجم در مبتلایان به بدخیمی های خونی با روش Real-time PCR

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشیار گروه انگل شناسی و قارچ شناسی، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران

2 دانشجوی کارشناسی ارشد قارچ شناسی پزشکی، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران

3 دانشیار گروه اطفال، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران

4 دانشیار گروه پزشکی اجتماعی، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران

5 گروه اطفال، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران

6 استاد مرکز تحقیقات میکروب شناسی بالینی استاد البرزی، دانشگاه علوم پزشکی شیراز، شیراز، ایران،

چکیده

مقدمه: عفونتهای قارچی تهاجمی  ناشی از دو جنس آسپرژیلوس و کاندیدا اغلب در بیماران لوسمی و پیوند  بدلیل کاهش شدید سیستم دفاعی بدن بروز می‌کند. تشخیص سریع و شروع درمان در مراحل اولیه بیماری باعث کاهش مرگ و میر ناشی از عفونتهای قارچی می شود.  هدف از این مطالعه تشخیص عفونت قارچی مهاجم بوسیله Real-time PCR در بیماران مبتلا به بدخیمی های خونی و پیوند مغز استخوان بود.
روش‌ کار: بیماران با نقص سیستم ایمنی بستری در بیمارستانهای مشهد بین فروردین تا آبان ماه 1397، جهت وجود عفونت قارچی مهاجم به روش  TaqMan Real-time PCR  با پروب فلورسنس و پرایمرهای اختصاصی جهت شناسایی DNA  قارچ در نمونه خون محیطی ارزیابی شدند.
نتایج: 75 نفر بیمار در این مطالعه شرکت کردند. نسبت زن به مرد (3/45 %) 34 به (7/54 %) 41 نفر بود.  بیشترین بیماری زمینه ای لوسمی لمفوبلاستیک حاد (3/45 %)  و لوسمی میلوئیدی حاد  (32 %)  و کمترین مربوط به بیماران  هموفاگوسیتیک لمفوهیستوسیتوزیز (3/1 %) بود. نتایج کشت خون جداسازی کاندیدای غیرآلبیکنس (3/13 %)  و کاندیدا آلبیکنس (3/1 %)  را نشان داد.  آسپرژیلوس از کشت خون جدا نشد. آزمایش مولکولی در(7/6 %)  5 بیمار  از نظر کاندیدا آلبیکنس  و(12 %)  9 بیمار از نظر آسپرژیلوس مثبت شد و (3/81 %) 61 بیمار از نظر عفونت قارچی مهاجم منفی بودند.
نتیجه گیری: قارچها یکی از بزرگترین عوامل عفونت در بیماران مبتلا به ناهنجاریهای خونی هستند. تکنیک مولکولی Real-time PCR  میتواند بعنوان روشی قابل‌اعتماد و سریع  برای تشخیص این عفونتها و مدیریت بیماری در افراد در معرض خطر ‌باشد.

کلیدواژه‌ها

عنوان مقاله [English]

Identification of invasive fungal infections in patients with hematologic disorders by Real-time PCR

نویسندگان [English]

  • Mohammad Javad Najafzadeh 1
  • Mohsen Dashti 2
  • , Mohammad Hasan Aelami 3
  • , Monavvar Afzalaghaee 4
  • Zahra Badiei 5
  • Parisa Badiee 6
  • Ali Ghasemi, 3
  • Hamid Harhangi 3
1 Associate Professor, Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Master of Sciences, Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 Associate Professor, Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
4 Associate Professor, Department of Social Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
5 , Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
6 Professor, Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
چکیده [English]

Introduction: Invasive fungal infections due to Aspergillus and Candida often occur in leukemia and transplantation patients because of a severe compromised in their immune systems. Rapid identification and initiation of treatment in the early stages of the disease can reduce mortality from fungal infection. The aim of this study was the identification of invasive fungal infections by Real-time PCR in patients with hematologic disorders and bone marrow transplantation.
Methods and Materials: patients with immunodeficiency hospitalized in Mashhad hospitals between March to November 2018 were evaluated for invasive fungal infections using TaqMan Real-time PCR with fluorescence probes and specific primers to identify fungal DNA in peripheral blood samples.
Results: Seventy-five patients participated in this study. The female/ male ratio was 34 (45.3%)/ 41 (54.7%). The most common underlying disease was acute lymphoblastic leukemia (45.3%) and acute myeloid leukemia (32%) and the lowest was related to haemophagocytic patients with lymphohistiocytosis (1.3%). Blood culture results showed isolation of non-albicans Candida (13.3%) and Candida albicans (1.3%). Aspergillus species was not isolated from the blood culture. Real-time PCR were positive for Candida albicans and Aspergillus species in 5 (6.7%) and 9 patients (12%), respectively and 61 patients (81.3%) had negative results for invasive fungal infections.
Conclusion: Fungi are one of the major cause of infections in the patients with hematologic disorders. Real-time PCR techniques can be a reliable and fast way to diagnose these infections and manage the disease in high-risk individuals.

کلیدواژه‌ها [English]

  • Invasive Candidiasis
  • Invasive Aspergillosis
  • Real Time PCR
  • Mashhad
  • Iran

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مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
دوره 65، شماره 2
خرداد و تیر 1401
صفحه 505-513

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