Candida orthopsilosis에 의한 치명적 진균혈증 1예
A Fatal Case of Candida orthopsilosis Fungemia
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Candida orthopsilosis는 최근에 새롭게 분류된 칸디다균종으로서 표현형으로는 Candida parapsilosis와 구분되지 않으며,분자생물학적 기법을 통해서만 동정이 될 수 있다. 저자들은 위암수술 후 문합부 누출로 인한 복막염으로 입원 중이던75세 남자에서 C. orthopsilosis에 의한 균혈증을 경험하였기에 보고하는 바이다. 입원 16일째 발열이 있어 시행한 혈액배양에서 Candida species가 분리된 후, 입원 68일까지 동일한 균이 지속적으로 분리되었다. 이 균은 Vitek 2 (bioMerieux,Inc., Hazelwood, MO, USA) 및 API 20C system (bioMerieux, Marcy-l'Etoile, France)에 의해 동정되지 않았다. 정확한 균동정을 위해 시행한 rDNA D1/D2, internal transcribed spacer 영역의 유전자 염기서열분석 결과 C. orthopsilosis와 100%의 일치율을 보였다. 환자의 칸디다혈증은 fluconazole과 caspofungin 등의 전신적인 항진균제 치료에도 불구하고 50일 이상 지속되었고, 환자는 결국 패혈증 및 다장기부전으로 사망하였다. 본 증례는 C. orthopsilosis 치명적인 균혈증을 유발할 수 있음을 보여주며, 국내에서 발생한 C. orthopsilosis에 의한 칸디다균혈증의 첫 보고이다. [대한임상미생물학회지 2010;13:140-143]
Abstract
Candida orthopsilosis is a recently described Candida species phenotypically indistinguishable from Candida parapsilosis. This new species can be identified only by using molecular methods. We describe here a fatal case of fungemia caused by C. orthopsilosis in a 75-year-old male patient who had panperitonitis after total gastrectomy with Roux-en-Y esophagojejunostomy. All 18 blood cultures obtained from admission day 16 to day 68 yielded the same Candida species. Both Vitek 2 (bioMerieux, Inc., Hazelwood,MO, USA) and API 20C (bioMerieux, Marcy-l'Etoile,France) failed to identify these isolates. However,DNA sequencing analysis of both D1/D2 domain and internal transcribed spacer region of rDNA showed 100% identity with C. orthopsilosis. The fungemia was persistent over 50 days despite of systemic antifungal therapy including fluconazole and caspofungin,and the patient expired on day 73 of his hospital stay. This represents the first reported case of fatal fungemia by C. orthopsilosis in Korea. (Korean J Clin Microbiol 2010;13:140-143)
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