气相色谱-质谱选择离子法评价系统性念珠菌感染与尿液中D/L阿拉伯糖醇比值的关系

真菌代谢产物的检测在深部真菌感染诊断上的重要意义正成为近年关注的热点^[1].阿拉伯糖醇是真菌代谢产物之一,与系统性念珠菌感染关系密切.它包括两种同分异构体:D-阿拉伯糖醇(D-arabinitol)和L-阿拉伯糖醇(L-arabinitol).两者均可存在于正常人血液和尿液中,其中D-阿拉伯糖醇是大多数念珠菌的主要代谢产物.在系统性念珠菌感染时,血、尿中D-阿拉伯糖醇浓度会增高,L-阿拉伯糖醇并无明显增高,所以D/L-阿拉伯糖醇比值相应增高,可作为预测系统性念珠菌感染的一个指标^[2].本研究采用气相色谱-质谱选择离子法检测系统性念珠菌感染和疑似感染者尿液中的D/L-阿拉伯糖醇比值,探讨临床系统性念珠菌感染与尿液中D/L-阿拉伯糖醇比值的关系.     

儿童皮肤念珠菌病的临床研究

儿童皮肤念珠菌病十分常见,根据临床表现以及真菌学检查诊断不困难,但是,在临床实践中将皮肤念珠菌感染误诊为尿布皮炎或痱子,治疗不当导致病情加重者却不少见.为此,我们针对其发病因素、诊断与治疗进行研究,以便对临床实践有所借鉴.     

皮肤与系统性真菌感染

将真菌感染分成系统性、皮下性或浅表性是一种简便的分类方法."系统性"这一名词的一种根本含义,即:感染侵及深部器官,如肺、脑、淋巴结或其他内脏.可局限于上述脏器之一,常位于肺,在某种条件下也可能广泛散播到其他器官(包括皮肤),即一种播散性感染.引起系统性真菌感染的病原菌常从肺进入(如组织胞浆菌病),但也可见到其他侵入途径,如系统性念珠菌病可通过胃肠道     

气相色谱诊断播散性念珠菌病的研究

本文报告用气相色谱法检测血清甘露糖醋酸醛糖腈乙酯衍生物诊断深部念珠菌病.实验显示播散性念珠菌病血清甘露糖浓度最高,平均为925.24±73.64μg/ml.系统性(非播散性)病例较低,平均为654.58±31,19μg/ml.而健康人最低,平均502.76±76.83μg/ml.3者有显著差异(P<0.01).兔感染白念珠菌一天后血清甘露糖浓度迅速增高(267.36-1053.57μg/ml).而新型隐球菌、烟曲霉、裴氏着色霉菌及几种常见细菌培养标本均未检测到甘露糖.此法对诊断系统性和播散性念珠菌病有实用价值,特别对后者的早期感染提供了有效方法.     

系统性念珠菌病的保护性免疫与免疫调节

系统性念珠菌病的保护性免疫是由体液免疫、细胞免疫共同参与并交织有天然免疫的一种复杂反应,宿主血流中白念珠菌抗原成分及多种细胞因子具有免疫调节作用,免疫治疗已成为抗真菌药物治疗系统性念珠菌病的重要辅助手段。     

特比萘芬与氟康唑或伊曲康唑联合治疗系统性耐药性白念珠菌感染小鼠模型研究

目的研究特比萘芬与氟康唑或伊曲康唑联合治疗系统性耐药性白念珠菌病的疗效。方法建立小鼠系统性白念珠菌感染模型,应用特比萘芬与氟康唑或伊曲康唑联合治疗系统性白念珠菌感染。结果联合用药组小鼠的存活时间比单用药组明显延长(P<0.05),肾组织真菌计数显示联合治疗组明显低于单用药组(P<0.05)。结论特比萘芬与氟康唑或伊曲康唑联合疗法可增强抗白念珠菌效能,具有临床应用的潜能。     

白念珠菌的表面抗原及其抗体

近二十余年来,由于皮质类固醇激素、广谱抗生素和免疫抑制剂的广泛应用,静脉高营养等治疗手段的增加,系统性念珠菌病的发病率明显提高,但其早期诊断仍然困难.目前,关于念珠菌的研究日渐增多.随着免疫学渗透到医学、生物学的各个领域,有关念珠菌抗原和抗体的研究也方兴未艾.     

89例婴幼儿念珠菌病临床观察

婴幼儿皮肤念珠菌病在临床实践中常误诊为尿布皮炎或痱子,治疗不当导致病情加重.笔者对门诊就诊婴幼儿念珠菌病患儿进行了临床观察,报道如下.     

系统性念珠菌病的保护性免疫与免疫调节

系统性念珠菌病的保护性免疫是由体液免疫，细胞共同参与并交织有天然免疫的一种复杂反应，突主血流中白念珠菌抗原成分及多种细菌因子有免疫调节作用，免疫治疗已成为抗真菌药物治疗系统性念珠菌病的重要辅助手段。     

ABC—ELISA检测白色念珠菌芽管特异性抗原的临床研究

本文制备了白色念珠菌芽管特异性抗体,采用ABC-ELISA法对系统性念珠菌病临床患者血清中的相应抗原进行检测,结果表明:该检测方法的敏感性为92.9％,检测的最低敏感浓度约为15—15.6ng/ml,在对照组患者和正常人血清中均未测出芽管特异性抗原。作者认为此检测方法对该病的诊断有重要价值。     

Cutaneous Congenital Candidiasis: A Case Report

Abstract: Candida albicans is a frequent pathogen of the female genital tract, especially during pregnancy. Congenital candidiasis can occur as cutaneous or disseminated infection. We report a case of congenital cutaneous candidiasis, which may occur more frequently than is indicated by the literature. This is followed by a discussion of the pathogenesis. clinical presentation, diagnosis, and treatment of this infection.     

系统性白念珠菌感染小鼠IL-12和IL-23的表达

目的了解系统性白念珠菌感染小鼠IL-12和IL-23的表达特征,探讨IL-23在抗白念珠菌系统感染中的作用,并重新认识和评价IL-12的作用。方法通过尾静脉接种白念珠菌建立小鼠白念珠菌系统感染模型,观察小鼠肾脏的病理变化,RT-PCR法检测小鼠肾脏IL-23及IL-12mRNA的相对表达水平,平皿稀释法检测肾脏内菌落形成单位(CFU)。结果IL-12mRNA表达水平在初次感染后第1、3天明显升高(P<0.05),感染后第7天基本正常。IL-23mRNA水平在初次感染后的第1天无明显改变(P>0.05),感染后第3、7天明显升高(P<0.05),而再次感染中其mRNA始终呈现高表达(P<0.05)。结论IL-12和IL-23均参与I型免疫反应,有效抵御白念珠菌系统感染,IL-12可能在炎症反应的早期发挥重要作用,而IL-23可能在炎症反应的后期发挥重要作用。     

白念珠菌保护性单抗的研究

目的 探讨抗白念珠菌单克隆抗体在系统性念珠菌感染动物中的保护作用。方法 制备抗白念珠菌单抗,观察单抗对系统性念珠菌感染小鼠存活时间,组织病理改变以及组织中菌落形成单位的影响。结果 制备出3株抗白念珠菌胞壁外膜抗原单克隆抗体-1B5、3E8、4C7;1B5、3E8两株单抗能显著延长致死量白念珠菌感染小鼠存活时间,减少感染小鼠主要脏器组织中白念珠菌菌落形成单位,减轻组织病理改变;1B5单抗能识别白念珠菌胞壁外膜上相对分子质量约为32000抗原;并在体外能抑制白念珠菌孢子对人颊粘膜上皮细胞,胎儿脐静脉内皮细胞的粘附。结论 1B5、3E8是具有保护作用的抗白念珠孢子对人颊粘膜上皮细胞,胎儿脐静脉内皮细胞的粘附。结论 1B5、3E8是具有保护作用的抗白念珠菌单抗;其中1B5是抗白念珠菌胞壁外膜上相对分子质量为32000的抗原的单抗;1B5单抗可通过抑制白念珠菌对上皮细胞,内皮细胞的粘附,降低该菌的侵袭力。     

Congenital cutaneous candidiasis: a rare and unpredictable disease

Congenital cutaneous candidiasis (CCC) is an extremely rare disorder that presents within the first 6 days of life. The manifestations ranges from diffuse skin eruption without any systemic symptoms to respiratory distress, hepatosplenomegaly, sepsis, and death. We report a neonate who presented with generalized skin eruptions at birth, characterized by erythematous macules and papules. The eruption involved head, face, neck, trunk, and extremities. Candida albicans was demonstrated on direct KOH smear, skin biopsy. The disease implies a congenital intrauterine infection and is different from neonatal candidiasis, which manifests as thrush or diaper dermatitis. The infection is acquired from the maternal genital tract in an ascending fashion. Clinical features, direct smear examination of specimen, and appropriate cultures are useful in differentiating the lesions from other more common dermatoses of the neonatal period. Topical antifungal therapy is sufficient unless systemic candidiasis is present. Prognosis for congenital cutaneous candidiasis is good.     

Clinicopathologic review of 19 patients with systemic candidiasis with skin lesions

BACKGROUND: A diagnosis of systemic candidiasis is often delayed or missed owing to the absence of sensitive, specific, and timely diagnostic tools. Skin lesions are not common, but they can help to rapidly establish a diagnosis. We report on a 14-year experience of systemic candidiasis with skin lesions in our institution. We report the prevalence, clinical findings, histologic findings, etiologic Candida species, underlying conditions, treatment modalities, and outcomes of the cases and compare them with the previous reports. METHODS: We reviewed the medical records and laboratory data of patients diagnosed with systemic candidiasis from June 1989 to September 2002 at Asan Medical Center, Seoul, Korea. We thoroughly reviewed the data on those patients with characteristic skin lesions. We included the cases in which Candida organisms were either shown or cultured from the skin. We also included the patients who had developed the characteristic rash at the onset of infection if there was no other possible explanation for the rash. RESULTS: Of 53 documented systemic candidiasis cases, 19 (35.8%) had the characteristic skin lesions. Fifteen patients (78.9%) had hematologic problems and were neutropenic. The skin lesions were a maculopapular or nodular rash and plaques. In addition to the trunk and proximal extremities, the rash also involved the face and distal extremities. The rashes were mostly purpuric, not consistently associated with underlying thrombocytopenia but also associated with underlying vascular damage as a result of Candida organisms. The underlying vascular damage also caused intraepidermal necrotic and vesicular change. One case of transepidermal elimination of organisms was newly found. The most common causative species was Candida tropicalis in the 19 patients with skin lesions, in contrast with Candida albicans in a total of 53 patients. The mortality rate was 84.2%. CONCLUSIONS: The prevalence of systemic candidiasis-associated skin lesions may be higher than previously reported. Dermatologists should be familiar with the clinical appearance of skin lesions and suspect this fatal infection when seeing neutropenic patients with a resistant fever and accompanying rash.     

Invasive fungal dermatitis in extremely premature newborns: a specific clinical form of systemic candidiasis

BACKGROUND: Fungal agents, chiefly Candida albicans, are the cause of rising morbidity and mortality in newborn infants weighing less than 1500 g. We studied the particular cutaneous effects during the course of these infections. PATIENTS AND METHODS: This was a retrospective 3-year study in premature infants weighing less than 1500 g and hospitalized in the neonatal department of the Lille University Teaching Hospital. The patients included in the study presented sepsis with isolation of Candida in blood and/or urine culture. RESULTS: Twelve infants were included (1.8%). The risk factors seen are those described in literature (broad-spectrum antibiotics, prolonged mechanical ventilation and parenteral nutrition, corticosteroids and central venous catheters). Infection occurred early (mean: D12) and affected extremely premature infants (mean: 25 weeks' amenorrhea) of low birth weight (mean: 758 g) generally born by vaginal delivery (9 of 12 infants). The sole fungal agent isolated was Candida albicans. In 10 of the 12 patients, a characteristic skin disorder was observed (erythema with erosion and desquamation). In 10 of the 12 patients, too, Candida was isolated from skin and/or mucosal samples. DISCUSSION: Although it is now universally accepted that antifungal treatment should be initiated without delay for candidemia in septic newborn infants at risk, diagnosis of systemic candidiasis remains delicate. However, a specific pattern of skin involvement is very commonly seen that is atypical for candidiasis, but which in addition to its diagnostic value indicates early colonization with Candida (first 2 weeks of life). In this setting of immaturity of the skin and immune system, colonization and proliferation in skin and/or mucosa appear to constitute the first stage of systemic infection and we may speak of invasive cutaneous-mucosal candidiasis in extremely premature infants and initiate treatment designed to prevent the disease becoming systemic..     

DIFFUSE CHRONIC GRANULOMATOUS MUCOCUTANEOUS CANDIDIASIS

A 3-year-old Thai boy with diffuse chronic granulomatous mucocutaneous candidiasis, recurrent bacterial skin infection and adrenal insufficiency is reported. Candida albicans was demonstrated in the dermal granuloma. He had a defect in cell-mediated immunity and was anemic. Although therapy with topical clotrimazole, oral iron, systemic antibiotic and low-dose of prednisone gave a dramatic result, he died of disseminated cryptococcosis.     

白念珠菌抗体疫苗研究进展

白念珠菌是免疫力低下患者黏膜和系统的真菌致病源,侵袭性念珠菌感染有很强的致死性.即使是健康的个体,也容易感染阴道念珠菌病和其他皮肤黏膜念珠菌病.传统抗真菌药的疗效有一定的局限性和毒副作用,并且容易产生耐药.近年来,一些新型抗体疫苗已经研发并应用于动物模型和临床,表现出很好的对抗白念珠菌和协同传统抗真菌药物的作用.尽管其疗效和安全性还需要进一步验证,念珠菌抗体疫苗仍具有较好的临床应用前景,有望成为念珠菌病的辅助治疗手段.