重症烧伤念珠菌病的诊断与治疗

由于烧伤后外用抗菌药物的广泛应用,真菌感染在烧伤患者较为多见,且有增长趋势。尤其在严重大面积深度烧伤合并免疫系统功能受损,长时间采用侵袭性治疗,以及大量病原菌从创面入侵等情     

念珠菌病诊断与治疗:专家共识

中华医学会第二届感染与抗微生物治疗论坛:念珠菌病诊治策略高峰论坛于2010年9月26日在上海举行.50余位来自血液病、重症医学、感染、呼吸、肾病、普外、烧伤、眼科、皮肤、妇科、儿科等各临床学科以及从事K学真菌实验研究的资深专家就如何规范念珠菌病的诊断和合理进行抗真菌治疗进行了深人的讨论,拟定了"念珠菌病诊断与治疗:专家共识"的内容纲要,并通过了由全体专家起草"念珠菌病诊治专家共识"总则,由各学科专家分别负责撰写本学科涉及的念珠菌病诊治细则的建议.经数月的稿件交流、意见反馈和相互审阅形成了本文,供各科医师临床实践中参照.     

侵袭性念珠菌病的实验室诊断研究进展

现代医学日益发展,广谱抗生素、免疫制剂及肿瘤放化疗等的广泛应用延长并改善了许多重症患者的生命,但同时也使得真菌感染日渐增多,特别是在免疫抑制疾病、恶性血液系统疾病、干细胞移植和器官移植中。念珠菌是侵袭性真菌病的主要病原体。据报道,在美国,念珠菌是引起院内血源性     

侵袭性念珠菌病的实验室诊断研究进展

现代医学日益发展,广谱抗生素、免疫制剂及肿瘤放化疗等的广泛应用延长并改善了许多重症患者的生命,但同时也使得真菌感染日渐增多,特别是在免疫抑制疾病、恶性血液系统疾病、干细胞移植和器官移植中。念珠菌是侵袭性真菌病的主要病原体。据报道,在美国,念珠菌是引起院内血源性感染（BSI）的第4位最常见病原体,使得BSI死亡率高达49％ 。在过去的40年中,白念珠菌引起的感染数量有所下降,而其他少见的念珠菌种如光滑念珠菌、热带念珠菌、克鲁念珠菌和近年新发现的都柏林念珠菌等感染显著增多。另外,不同种的念珠菌对抗真菌药物的敏感性和耐药性也有所不同。因此,提高念珠菌病诊断方法的敏感性,并对致病念珠菌鉴定到种的水平十分必要。目前,念珠菌的鉴定方法已由传统的培养法发展到非培养法,包括血清学方法和分子生物学技术等。     

消化道念珠菌病

消化道念珠菌病是由念珠菌感染口腔、食管及胃肠道所引起的疾病,包括口腔黏膜念珠菌病、念珠菌性食管炎、念珠菌性胃肠炎等。一、病原学70%的正常人群口腔和胃肠道中有真菌定植,大部分是念珠菌属。     

腹腔念珠菌病诊疗进展

<正>侵袭性念珠菌病(IC)是一种与医疗技术进步相关的真菌感染性疾病,根据念珠菌侵袭部位的不同,可分为念珠菌血症和深部念珠菌病(包括腹腔、肝脾、脑、眼、心脏、关节)^[1-2]。腹腔念珠菌病(IAC)是一类特殊的腹腔真菌感染疾病,腹腔真菌感染占腹腔感染的10%～15%,致病真菌中70%～90%为念珠菌,在重症监护病房(ICU)中由念珠菌导致的腹腔感染比例更高,     

播散性念珠菌病综合征和念珠菌菌血症1例

患儿,男,3个月,主因左膝肿胀半个月、发热5天于2009年7月6日入院。患儿半个月前不明原因出现左膝肿胀,触之哭闹,无呕吐、腹泻,未给予用药。5天前出现发热,体温37.8～38.5℃,无咳嗽、抽搐。患儿系孕31周剖宫早产第二胎,无生后窒息,出生体质量1 300 g,生后因早产曾应用呼吸机治疗,住院半个月出院。出生后20天患肺炎,应用抗生素治疗半个月痊愈。出生后2个半月患营养不良,给予氨基酸、脂肪乳、水溶性维生素静脉滴注,输血1次,住院20天好转出院。     

皮肤念珠菌病诊治

一、定义皮肤念珠菌病是由念珠菌属的某些病原菌种引起的皮肤真菌病,可表现为急性、亚急性、慢性炎症或肉芽肿病变。最常见的病原体是白念珠菌,其他已知可以致病的有光滑念珠菌、热带念珠菌、近平滑念珠菌、克     

中枢神经系统念珠菌感染的诊断与治疗

侵袭性念珠菌病为目前最常见的深部真菌病之一.中枢神经系统念珠菌感染报道并不多见,然而早期一项尸体解剖研究结果　显示,在侵袭性念珠菌病死亡的患者中,半数患者有明确的中枢神经系统累及.中枢神经系统念珠菌感染主要有以下3种类型:①脑膜脑炎型,主要由血行播散所致,常继发于消化道或呼吸道感染,经血循环或深静脉导管引起,好发于低体重早产儿,以及有严重免疫功能低下基础疾病患者.常累及脑实质,呈弥漫性改变,并伴有多发性微小脓肿形成.     

外阴阴道念珠菌病的诊治策略

一、外阴阴道念珠菌病的流行病学在所有的阴道炎症中,外阴阴道念珠菌病(vulvovaginal candidiasis,VVC)罹患率一直居首位,主要感染育龄期妇女。大约75%妇女一生中至少经历1次VVC,大约40%~50%的妇女一生将要经历多次     

SCH-39304 in prevention and treatment of disseminated candidiasis in persistently granulocytopenic rabbits.

To investigate the potential use of SCH-39304 for the prevention and treatment of disseminated candidiasis in granulocytopenic patients, we studied its in vivo antifungal activity as preventive, early, and late treatments in three models (acute, subacute, and chronic) of disseminated candidiasis in persistently granulocytopenic rabbits. SCH-39304 was an effective as amphotericin B alone and fluconazole alone for the prevention of disseminated candidiasis. SCH-39304 alone and fluconazole alone were as effective as amphotericin B plus flucytosine for early treatment of subacute disseminated candidiasis. When treatment was delayed for 5 days to establish chronic disseminated candidiasis, SCH-39304 was less effective than amphotericin B plus flucytosine. In comparison with different treatment regimens, SCH-39304 was more effective in early and preventive treatment. Thus, SCH-39304 was comparable to treatment control regimens in prevention and early treatment of subacute disseminated candidiasis. SCH-39304 also was most effective in granulocytopenic rabbits with disseminated candidiasis when used for prevention or early treatment.     

Treatment of experimental disseminated candidiasis with cilofungin.

The efficacy of cilofungin treatment of experimental disseminated candidiasis in rabbits was examined. Cilofungin treatment reduced yeast counts, especially in the kidney, with activity comparable to that of amphotericin B. The peak level of cilofungin in serum was measured at 5 min after administration of a single dose, with no drug detectable after 90 min.     

Comparison of fluconazole and amphotericin B for treatment of disseminated candidiasis and endophthalmitis in rabbits.

We compared the efficacy of intravenous fluconazole (80 mg/kg of body weight per day) with that of amphotericin B (1 mg/kg/day) for the long-term treatment of endophthalmitis in rabbits with disseminated candidiasis. After 17 days of therapy, fluconazole decreased the fungal colony counts of the choroid-retinas significantly more than did the saline control (P less than 0.05); however, after 24 days of fluconazole therapy, this treatment effect was lost and fluconazole was no more effective than saline. In contrast, treatment for 24 days with amphotericin B reduced the vitreous and choroid-retina fungal colony counts significantly more than either fluconazole or saline (P less than 0.05 for both treatment groups). After 17 days of therapy, indirect ophthalmoscopy revealed less severe eye involvement in both antifungal treatment groups than in saline controls; however, this difference reached statistical significance only for the amphotericin B-treated rabbits (P less than 0.05). Also, there was a trend towards worsening eye lesions, as seen by indirect ophthalmoscopy, in the fluconazole-treated rabbits after 24 days of therapy, which roughly paralleled the quantitative culture results. Despite the presence of negative choroid-retina cultures, some rabbits in all treatment groups had persistently visible eye lesions, indicating that ophthalmoscopic resolution of Candida endophthalmitis may lag behind lesion sterilization. Amphotericin B was superior to fluconazole in the treatment of Candida endophthalmitis in this model.     

Efficacy of aminocandin in the treatment of immunocompetent mice with haematogenously disseminated fluconazole-resistant candidiasis

OBJECTIVES: The objective of this study was to compare the activity of aminocandin, a new echinocandin with broad-spectrum activity against Candida spp., with that of amphotericin B, caspofungin and fluconazole, in an immunocompetent murine model of haematogenously disseminated candidiasis caused by a fluconazole-resistant Candida albicans. METHODS: Mice were infected with a fluconazole-resistant strain of C. albicans and treated with aminocandin 5 and 10 mg/kg intravenously (iv) once and twice weekly, amphotericin B 0.5 mg/kg iv every other day for 5 days, fluconazole 20 mg/kg orally (po) once a day for 5 days and caspofungin 0.5 mg/kg intraperitoneally (ip) once daily for 5 days. RESULTS: Treatment with aminocandin, given iv twice a week, resulted in 100% survival. Further, the tissue fungal burden of the aminocandin group was equivalent to that of amphotericin B (administered every other day) and caspofungin (administered daily). CONCLUSIONS: Aminocandin may be an effective addition to the arsenal of antifungal compounds for the treatment of candidiasis caused by fluconazole-resistant C. albicans.     

Effect of neutropenia and treatment delay on the response to antifungal agents in experimental disseminated candidiasis

Disseminated candidiasis is associated with a high rate of morbidity and mortality. The presence of neutrophils and the timely administration of antifungal agents are likely to be critical factors for a favorable therapeutic outcome of this syndrome. The effect of neutropenia on the temporal profile of the burden of Candida albicans in untreated mice and those treated with amphotericin B was determined using a pharmacodynamic model of disseminated candidiasis. A mathematical model was developed to describe the rate and extent of the C. albicans killing attributable to neutrophils and to amphotericin B. The consequences of a delay in the administration of amphotericin B, flucytosine, or micafungin were studied by defining dose-response relationships. Neutrophils caused a logarithmic decline in fungal burden in treated and untreated mice. The combination of amphotericin B and neutrophils resulted in a high rate of Candida killing and a sustained anti-C. albicans effect. In neutropenic mice, 5 mg/kg of body weight of amphotericin B was required to prevent progressive logarithmic growth. An increased delay in drug administration resulted in a reduction in the maximum effect to a point at which no drug effect could be observed. Neutrophils and the timely initiation of antifungal agents are critical determinants in the treatment of experimental disseminated candidiasis.