两年间临床分离念珠菌耐药情况分析

目的 了解我院住院患者临床分离的念珠菌分布及耐药现状.方法 收集近两年我院临床分离的念珠菌,测定常用抗真菌药物的敏感性.结果 两年内分别分离出念珠菌585株和1030株,分离率分别为11.76%和16.21%.白色念珠菌是最常见的分离菌,但热带念珠菌分离率上升.受检药物均有较高的抗菌活性,仅克柔念珠菌对氟康唑的耐药率分别为66.7%和77.1%,剂量依赖性敏感的比例分别为16.7%和20.0%.结论 白色念珠菌仍是分离出最常见的念珠菌,其次为热带念珠菌,建议白色念珠菌和热带念珠菌感染时使用氟康唑,克柔念珠菌感染者应用伊曲康唑.     

肝衰竭患者并发念珠菌感染的临床特征分析

目的 研究肝衰竭患者并发念珠菌感染的临床特征,为临床治疗提供参考。方法 对1985年1月—2011年9月解放军第三〇二医院收治的肝衰竭并发念珠菌感染的393例患者的临床资料进行回顾性研究。结果 393例以中年男性为主,慢加(亚)急性和慢性肝衰竭患者共379例(96.44%),且病毒性肝炎为主要病因,HBV感染所占比例最大,为74.05%。137例并发念珠菌感染前存在细菌感染,腹腔多见(42.06%),致病菌以革兰阴性杆菌为主。念珠菌感染最常见于口咽部,共244例次(43.03%),其次是肺部、消化道等。真菌培养及鉴定结果提示,76.54%为白色念珠菌感染,热带念珠菌及光滑念珠菌所占比例分别为8.64%和4.69%。结论 肝衰竭患者病情危重,并发症多,治疗难度大。尤其是并发念珠菌感染后,多为"二重感染",抗真菌治疗疗效差,患者病死率高。     

肺结核合并白色念珠菌感染64例临床分析

目的　探讨肺结核合并白色念珠菌感染的临床特点及治疗。方法 回顾并分析5年来我科收治的肺结核合并肺部白色念珠菌感染64例的资料。结果 肺结核合并肺部白色念珠菌感染的特点:结核病史长,年龄偏大;以浸润型和慢性纤维空洞型肺结核为主;肺部病变广泛,空洞多,病情较重;多有继发真菌感染的诱因可寻;确诊有赖于病原学检查。结论 肺结核合并肺部白色念珠菌感染有增多趋势,了解其临床特点可提高对两病并存的诊治水平。     

Evaluation of a new method for antifungal drugs susceptibility testing to yeasts

We compared the Etest with a broth microdilution method (FP panel), performed according to the National Committee for modified Clinical Laboratory Standards (NCCLS) document M27-P guidelines, for determining the MICs of 81 clinical isolates of yeasts (7 Candida albicans, 8 Candida glabrata, 10 Candida parapsilosis, 6 Pichia anomala, 10 Candida tropicalis, 4 Candida guilliermondii, 4 Candida krusei, 6 Trichosporon cutaneum, 5 Candida ciferrii, 3 Candida famata, 4 Candida norvegensis, 2 Rhodotorula rubra, 3 Candida lusitaniae, 2 Candida curvata, 1 Candida inconspicua, 1 Candida intermedia, 1 Candida colliculosa, 1 Cryptococcus spp, 1 Tricosporon capitatum, 1 Pichia ohmeri, 1 Saccharomyces cerevisiae). The Etest results for 6 ATCC standard strains correlated well with reference MICs except those of flucytosine (5-FC) for C. krusei, which tended to be 1 to 2 log2 dilution higher than the MIC range determined by NCCLS guidelines. However, the best agreement between the results for clinical isolates was seen with 5-FC (100% agreement [Within +/- 2 log2 dilutions] between the results of the two methods). There was a 91.4% agreement between the results of the two methods with amphotericin B (Etest MICs tended to be 1 to 2 log2 dilution lower than those of the FP panel). The Etest results with litraconazole for clinical isolates except C. tropicalis were similar to MICs of the FP panel (Etest for C. tropicalis showed 1 to 2 log2 dilution lower than FP panel). Also, the Etest results with fluconazole for clinical isolates except C. tropicalis were similar of 1 log2 dilution higher than MICs of the FP panel (Etest for C. tropicalis showed more than 2 log2 dilution lower than FP panel). These results showed a good level of overall agreement between the Etest method and the broth microdilution test (FP panel). Since the Etest is a less laborintensive and much simpler method, it appears to be a useful procedure for testing the susceptibility of yeasts to antifungal agents.     

白念珠菌的生物形态分型研究

本文报道了首先建立的白念珠菌（白念）的生物形态分型法－型别由５个数字组成的编码表示。１７５株临床分离的白念被分为８５个型,以编码００００２为最常见（占７．４％）,分辨指数为０．９８２。并分析了型别与临床的关系,初步表明菌落条纹与毒力可能有一定关系。该法具有简单、经济、重复性好和分辨率高等优点,适于病原学研究和流行病学调查。     

Candida epiglottitis in immunocompromised patients

Candida seldom has been reported to be a cause of epiglottitis. The clinical manifestations and management of three patients with Candida epiglottitis complicating their neoplastic disease are described. All patients were granulocytopenic. Candida epiglottitis occurred either as a localized infection, as a source of Candida bronchopneumonia, or as a manifestation of disseminated infection. Candida epiglottitis may be under-diagnosed and should be considered, especially in immunocompromised patients with symptoms of refractory pharyngitis. Treatment of Candida epiglottitis with intravenous amphotericin B is warranted in patients with sustained granulocytopenia. Prompt endotracheal intubation is indicated if the airway patency cannot be maintained.     

院内念珠菌感染的药敏分析及临床分析

目的了解并对比白色念珠菌与非白色念珠菌的临床分布、药敏情况。方法分析411株念珠菌的来源、科室分布,对比白色念珠菌与非白色念珠菌的药敏结果、危险因素等。结果 411株念珠菌的标本以痰液最多;ICU分离率最高;呼吸系统疾病最多;年龄≥65岁及侵袭性操作、药物使用,分别为感染白色念珠菌与非白色念珠菌的独立危险因素;念珠菌对两性霉素B最敏感;白色念珠菌对氟康唑、氟胞嘧啶、伊曲康唑、伏立康唑敏感性高于非白色念珠菌,对氟康唑、伊曲康唑的耐药率低于非白色念珠菌。结论加强对念珠菌耐药性的监测有助于减少耐药菌株的产生。     

Diagnosis of normal and abnormal delayed hypersensitivity to Candida albicans. Importance of evaluating lymphocyte activation by flow cytometry

Delayed type hypersensitivity (DTH) to Candida albicans is commonly observed in human. Abnormal DTH has already been described but its diagnosis is difficult to ascertain. We present now a clinical and biological study in 60 patients with a clear distinction between these two kind of Candida albicans DTH. Clinical abnormal Candida albicans DTH was characterized by a syndromic reaction 24 to 48 hours after intradermal injection. This reaction was characterized by an exacerbation of clinical symptoms. In vitro, activation of whole blood with Candida albicans antigen was detected by using flow cytometry after staining for activating markers. CD 25 positive T cells were detected in a 7 days culture in all patients. Percentage of CD 25 positive T cells was correlated to the intensity of the local cutaneous DTH reaction. CD 69 positive T cells were detected after a one day culture only in patient who presented a syndromic reaction to intradermal injection.     

Impact of real-time fungal susceptibility on clinical practices

PURPOSE OF REVIEW: In the past two decades standardized in-vitro antifungal susceptibility tests have been developed in response to increasing invasive fungal infections. Our purpose is to review the utility of real-time Candida antifungal susceptibility testing and its effects on clinical outcomes in the context of the new antifungal agents, existing antifungal susceptibility testing methods, and the changing epidemiology and susceptibilities of Candida spp. RECENT FINDINGS: New antifungal agents active against Candida spp. are now available. Caspofungin is approved for the treatment of invasive candidiasis but standardized antifungal susceptibility testing has not been developed. The newer triazoles, such as voriconazole, posaconazole and ravuconazole, are not yet approved for invasive candidiasis. As infections caused by non-albicans Candida spp. with growing resistance to fluconazole increase, antifungal susceptibility testing may be important to guide therapy. Unfortunately, few studies exist describing the impact of real-time antifungal susceptibility testing on the treatment of invasive fungal infections. SUMMARY: Newer antifungal agents with broader anti-Candida activity, fewer adverse events and minimal resistance are currently available. The challenge clinicians face is choosing when to use these agents appropriately, while considering the changing Candida epidemiology and susceptibility trends without over-treating fluconazole-sensitive pathogens. Unfortunately, the correlation of antifungal susceptibility testing results by any method and clinical outcome is mostly lacking. We suggest that a concerted examination of the utility of real-time antifungal susceptibility testing and its effect on clinical outcomes by guiding appropriate antifungal therapy for high-risk patients with invasive candidiasis is warranted.     

DNA探针原位杂交对念珠菌病的诊断研究

本文报道以蜗牛酶破壁、氯化铯密度梯度超速离心的初步纯化白念珠菌 DNA 制备探针以 Southern 转膜,点杂交及原位杂交法与标准念珠菌属各种及临床分离 11 株酵母样菌(初步疑为念珠菌)作分子杂交,结果仅有白念珠菌阳性,热带念珠菌为弱阳性,其它念珠菌及红色毛癣菌均为阴性,与常规鉴定法相同。提示念珠菌探针可以作为临床快速诊断鉴定菌种的一个方法。     

不同免疫功能患者合并热带念珠菌败血症的危险因素及疗效分析

目的探讨不同免疫功能患者合并热带念珠菌败血症的危险因素及疗效。方法回顾性分析44例经血培养证实为热带念珠菌败血症的患者的临床资料。结果44例热带念珠菌败血症患者中,基础疾病存在免疫功能低下者30例（68．2％）,免疫功能正常者14例（31．8％）;免疫功能低下患者合并热带念珠菌败血症的危险因素主要是中性粒细胞缺乏、广谱抗生素的应用,免疫功能正常患者主要是留置导管;免疫功能低下组和免疫功能正常组抗真菌治疗的总有效率分别为60．9％、78．6％,两组比较差异有统计学意义（P〈0．05）;免疫功能低下组感染相关死亡率为43．3％,明显高于免疫功能正常组（7．1％,P〈0．05）。结论热带念珠菌败血症的预后与患者的免疫功能密切相关。     

Clinical significance of untreated Candida species isolated from ascites in cirrhotic patients

The clinical significance of Candida species isolated from cirrhotic ascites is still unknown. We reviewed the clinical and laboratory features of all cirrhotic patients whose ascites samples were positive for Candida species. A total of 21 cirrhotic patients was identified. Patients were regarded as having peritonitis if they had 1 or more clinical symptom(s) or sign(s) in the absence of any other possible explanation. 10 patients (47.6%) were classified into the spontaneous Candida peritonitis (SCP) group, and the remaining 11 patients (52.4%) were classified into asymptomatic candidascites. Mortalities were higher in the SCP group at discharge (50.0% vs 27.3%), 6-month (90% vs 45.5%) and 1-y (100% vs 54.5%) (p=0.007). Receiver-operating characteristic curve analysis revealed that the cut-off value of ascitic fluid polymorphonuclear cell count of 315/mm(3) (0.315 x 10(9)/l) had the highest diagnostic accuracy with both sensitivity and specificity of 1.0. In conclusion, Candida species are associated with a grave outcome when manifested with peritonitis.     

Determination and kinetics of antibody response to Candida albicans in ulcerative colitis

Levels of antibody against the mannan component of Candida albicans cell wall were determined and followed in 57 ulcerative colitis patients. The appearance of higher titers suggests an intermittent (benign) clinical course of the disease. Lower titer values at repeated checks are associated with a continuous (severe) clinical course. Our data suggest that Candida albicans antibody titer values may be used as an indicator of the clinical outcome of ulcerative colitis.     

白念球菌感染的机体防御研究——对IL_1产生及其活性的研究

本文报道了白念珠菌及其抗原不论在体内或体外均可明显抑制同系小鼠腹腔巨噬细胞(Mφ)产IL_1的活性,同时探讨了正常小鼠腹腔Mφ产IL_1的有关因素,并对此抑制作用的可能机理及临床意义作了分析。     

Treatment of Candida infection: a view from the trenches!

PURPOSE OF REVIEW: To provide an overview of the treatment of Candida infections from the perspective of the infectious disease clinician in the community. An insight is given into relevant issues as they apply to clinical practice. As community hospitals strive to provide state-of-the-art medical care to critically ill patients, effective infection control programs and the infectious disease consultation availability become indispensable. RECENT FINDINGS: Candida infections rank as the fourth most common cause of nosocomial bloodstream infections. Although C. albicans remains the most common pathogen, emerging trends in invasive candidiasis are notable for a dramatic increase in infections due to non-albicans Candida species, reflecting changes in clinical practice. These trends affect our practice because infections with non-albicans species raise concerns for inherent decreased antifungal susceptibility, ultimately impacting our preventive, empirical and therapeutic approaches. It seems inevitable for most acutely ill patients today to be admitted to the intensive care unit, thus increasing their risk for nosocomial infections. In addition, cost containment efforts may force patients receiving intravenous therapy into less supervised environments, potentially increasing their risk for candidemia. SUMMARY: Potentially fatal Candida infections are commonplace in seriously ill hospitalized patients. The infectious disease physician is challenged to develop expertise in using the newly introduced antifungal agents, applying evidence-based guidelines developed from quality randomized clinical trials. The infectious disease specialist is called to play a multidisciplinary role formulating infection control policies, developing drug formularies, educating the staff and treating the sickest patients. Infection surveillance in local communities coupled with available antifungal agents may improve our management of Candida infections.     

Spondylodiskitis caused by Candida albicans. Report of two new cases

Recently, candidiasis infection is on the increase and several factors have been associated, such us immunodepression, catheters, weakening diseases, prolonged antibiotherapy, HIV infection and IDU. Spondylodiskitis due to Candida sp. is a rare entity. Two cases of spondylodiskitis due to Candida albicans were diagnosed: a 29 year old man and a 35 year old woman. Both were IDUs with a previous history of HIV infection. The most prominent clinical features in both cases were pain, fever and constitutional syndrome. We describe the clinical, diagnostic, and therapeutic features of both cases.     

Alternative Pathway of Complement Activation by Candida Albicans

Summary: Alternative pathway of complement activation by Candida albicans. Y. H. Thong and A. Ferrante, Aust. N.Z. J. Med. 1978, 8 , pp. 620–622.
Activation of the alternative pathway of complement by Candida albicans was examined using a chemotactic assay. Two serologically defined strains and eight clinical isolates of Candida albicans were used in these experiments. The results showed that all ten strains of Candida albicans were capable of alternative complement pathway activation. These findings may provide an insight into host resistance to this infection.     

Candida arthritis in a patient with chronic myelogenous leukemia (CML) in blastic transformation,unresponsive to fluconazole,but treated effectively with liposomal amphotericin B

Candida arthritis is quite rare and might be caused either by direct intra-articular inoculation of Candida or secondary to hematogeneous seeding of Candida in immunocompromised hosts. Until now less than 50 cases of Candida arthritis have been reported in the literature. We report a case of Candida arthritis, which occurred in a patient with chronic myelogenous leukemia (CML) in blastic transformation. Aggressive chemotherapy and broad-spectrum antibiotics for a prolonged period for febrile neutropenia had been given to the patient. Arthritis of the left knee appeared during the recovery phase of leukopenia. Despite treatment with fluconazole, no clinical or microbiological improvement was obtained. Thus, administration of liposomal amphotericin B was started and after 3 days there was improvement. We can conclude that fluconazole might not be sufficient in some Candida arthritis cases and liposomal amphotericin B might be a good alternative in these resistant cases.     

Pulmonary disease caused by Candida species.

Candida species are often found in sputum specimens. Their role as a possible cause of pulmonary disease is a frequent consideration, particularly in patients receiving immunosuppressive or long-standing antimicrobial therapy. At Memorial Hospital and New York Hospital, 30 patients with histologic evidence of Candida pulmonary infection were identified over a two year period. These infections reached the lungs by hematogenous spread in 10 patients and by aspiration in 16 patients. Most the patients had malignant neoplastic disease. The Candida pulmonary disease appeared to be significant clinical factor in only three cases. Experience from our institutions and from the literature indicates that Candida species rarely cause significant pulmonary disease. When such involvement is extensive, the patient is usually terminally ill from multiple other factors.     

Candida albicans meningitis: clinical case

Candida spp. meningitis is still a rare clinical situation, although it is becoming more frequent. Literature references to it and therapeutic options are scarce. We present a case of a young male, HIV-positive drug addict, with Candida albicans meningitis which was treated with oral fluconazole, having a good outcome.