曲霉菌病

对于患移植物抗宿主病 (GVHD) 的异基因干细胞受者，应推荐其接受口服泊沙康唑进行抗真菌预防治疗。[2]Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63:e1-e60.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967602/http://www.ncbi.nlm.nih.gov/pubmed/27365388?tool=bestpractice.com Voriconazole and fluconazole [ ]In severely immunodepressed people, how does fluconazole compare with nystatin for improving outcomes?http://cochraneclinicalanswers.com/doi/10.1002/cca.1664/full显示答案 也可能有效。[49]Wingard JR, Carter SL, Walsh TJ, et al.; Blood and Marrow Transplant Clinical Trials Network. Randomized, double-blind trial of fluconazole versus voriconazole for prevention of invasive fungal infection after allogeneic hematopoietic cell transplantation. Blood. 2010;116:5111-5118.http://bloodjournal.hematologylibrary.org/content/116/24/5111.full.pdf+htmlhttp://www.ncbi.nlm.nih.gov/pubmed/20826719?tool=bestpractice.com

对于接受诱导化疗来治疗急性骨髓性白血病或骨髓增生异常综合征的患者，其患侵袭性曲霉菌病 (IA) 的风险将有所降低，若此患者口服泊沙康唑进行预防治疗，则可降低死亡率。[50]Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007;356:348-359.http://www.nejm.org/doi/full/10.1056/NEJMoa061094#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/17251531?tool=bestpractice.com[51]Ullmann AJ, Lipton JH, Vesole DH, et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med. 2007;356:335-347.http://www.nejm.org/doi/full/10.1056/NEJMoa061098#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/17251530?tool=bestpractice.com[2]Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63:e1-e60.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967602/http://www.ncbi.nlm.nih.gov/pubmed/27365388?tool=bestpractice.com证据 null降低患侵袭性曲霉菌病 (IA) 的风险：有高质量证据证明，对于接受诱导化疗来治疗急性髓性白血病或骨髓增生异常综合征的患者，若进行服用泊沙康唑进行预防治疗，其患 IA 的风险将减少。[50]Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007;356:348-359.http://www.nejm.org/doi/full/10.1056/NEJMoa061094#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/17251531?tool=bestpractice.com[51]Ullmann AJ, Lipton JH, Vesole DH, et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med. 2007;356:335-347.http://www.nejm.org/doi/full/10.1056/NEJMoa061098#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/17251530?tool=bestpractice.com

对于慢性肉芽肿性疾病 (CGD) 患者，一项随机研究的结果显示，使用伊曲康唑加常规的干扰素-γ 进行预防治疗可安全有效地预防 IA。[52]Gallin JI, Alling DW, Malech HL, et al. Itraconazole to prevent fungal infections in chronic granulomatous disease. N Engl J Med. 2003;348:2416-2422.http://www.nejm.org/doi/full/10.1056/NEJMoa021931#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/12802027?tool=bestpractice.com证据 null侵袭性曲霉菌病 (invasive aspergillosis, IA) 的预防：有高质量证据证明，对于慢性肉芽肿病患者，使用依曲康唑加常规的干扰素-γ 进行预防治疗的方法在预防 IA 时安全有效。[52]Gallin JI, Alling DW, Malech HL, et al. Itraconazole to prevent fungal infections in chronic granulomatous disease. N Engl J Med. 2003;348:2416-2422.http://www.nejm.org/doi/full/10.1056/NEJMoa021931#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/12802027?tool=bestpractice.com 对于其他高危人群，尚无证据证明化学预防有效。

对于高风险患者群，在其房间装配高效粒子空气过滤器，并进行频繁换气以及正压通气，可能对限制医院环境下曲霉菌属分生孢子的暴露机率有帮助。[53]Dykewicz CA; National Center for Infectious Diseases, Centers for Disease Control and Prevention; Infectious Diseases Society of America; American Society for Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: focus on community respiratory virus infections. Biol Blood Marrow Transplant. 2001;7:19S-22S.http://www.ncbi.nlm.nih.gov/pubmed/11777100?tool=bestpractice.com[54]Tablan OC, Anderson LJ, Arden NH, et al. Guideline for prevention of nosocomial pneumonia. The Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol. 1994;15:587-627.http://www.ncbi.nlm.nih.gov/pubmed/7989733?tool=bestpractice.com[55]Partridge-Hinckley K, Liddell GM, Almyroudis NG, et al. Infection control measures to prevent invasive mould diseases in hematopoietic stem cell transplant recipients. Mycopathologia. 2009;168:329-337.http://www.ncbi.nlm.nih.gov/pubmed/19859825?tool=bestpractice.com 此外，注意清洁沐浴和水系统可进一步减少对病原体的暴露。[56]Anaissie EJ, Costa SF. Nosocomial aspergillosis is waterborne. Clin Infect Dis. 2001;33:1546-1548.http://cid.oxfordjournals.org/content/33/9/1546.longhttp://www.ncbi.nlm.nih.gov/pubmed/11568850?tool=bestpractice.com

没有推荐关于曲霉球的预防措施。抗真菌预防的作用尚不明确。

侵袭性曲霉菌病 (IA) 和曲霉球不会以人传人的方式进行传播。无需进行公共健康报告。不需要在家庭成员、伴侣或社会接触者使用预防药物治疗/预防措施。

对于有高风险患侵袭性曲霉菌病 (IA) 的患者，应建议其避免与土壤接触（例如：进行园艺期间），这是由于土壤中的分生孢子/芽孢可通过空气传播并吸入体内。