Two Cases of Candida inconspicua Infection in Neutropenic Patients with Acute Leukemia
1
조회
0
다운로드
1
인용
0
참고문헌
초록
최근 진균이 면역약화환자의 기회감염의 원인으로 그 빈도가 증가하고 있다. 그 중에서 Candida albicans가 중증 진균 감염의 흔한 원인이지만, 최근에는 암 환자에서, 특히 치료과정에서 예방적으로 azole계 항진균제를 투여 받는 환자에게서 azole을 포함한 통상적인 항 진균 제재에 잘 반응하지 않는 non-albicans Candida 종에 의한 기회감염이 증가하고 있다. Candida inconspicua는 fluconazole에 내성인 non-albicans Candida 종 중 하나로 최근 칸디다혈증의 원인으로 드물게 보고 되었고 아직 국내에서는 그 보고 예가 없었다. 저자들은 항진균 예방화학요법으로 fluconazole을 경구 투여 받았던 급성 백혈병 환자에게 발생한 C. inconspicua 칸디다혈증 2예를 보고하고자 한다. 두 증례 모두 급성백혈병 항암치료 시 fluconazole을 예방적으로 경구 투여한 환자로, 호중구감소성 발열이 발생하여 광범위 항생제를 사용하였으나 발열이 지속되어 경험적 항진균제를 투여하였으며, 혈액배양에서 C. inconspicua가 배양되었다. 두 증례 모두 C. inconospicua의 감염경로는 위장관 감염으로 추정되었으며, amphotericin B deoxycholate 정주 후에 임상 양상의 호전을 보였다.
Abstract
Non-albicans Candida species which are resistant to azole are emerging as important pathogens in patients with hematological malignancies who received antifungal prophylaxis. C. inconspicua is one of rare Candida spp. and resistant to fluconazole and deep infection due to C. inconspicua has not been reported in Korea so far. We reported here two cases of candidemia due to C. inconspicua in neutropenic patients with acute leukemia. C. inconspicua were presumed to be originated from gastrointestinal tract in both cases. The antifungal susceptibility test of C. inconspicua in case 1 showed resistance to fluconazole and itraconazole. Both cases were successfully treated by amphotericin B deoxycholate. Clinicians should keep in mind that non-albicans Candida species would be emerging pathogen in immunocompromised hosts and early recognition and appropriate use of antifungal agents is necessary.
참고문헌 (18)
- "Infectious complications in leukemic patients", 19, pp.193~226 (1982)
- "Risk factors for candidemia in cancer patients:a case-control study", 26, pp.429~32 (1988)
- "Epidemiology and susceptibility to antifungal agents of fungi isolated from clinical specimens from patients hospitalized in the Department of General and Liver Surgery of the Medical University of Warsaw", 35, pp.2298~2303 (2003)
- "A nosocomial cluster of Candida inconspicua infections in patients with hematological malignancies", 36, pp.792~795 (1998)
- "Fluconazole-resistant pathogens Candida inconspicua and C. norvegensis : DNA sequence diversity of the rRNA intergenic spacer region, antifungal drug susceptibility, and extracellular enzyme production", pp.761~766 (2004)
- "Multiple-species candidemia in patients with cancer", 101, pp.1860~1865 (2004)
- "In-vitro activity of five antifungal agents against uncommon clinical isolates of Candida spp", 43, pp.295~299 (1999)
- "Presumptive identification of Candida species other than C tropicalis with the chromogenic medium CHROMagar Candida", 5 (2006)
- "Reference method for broth dilution antifungal susceptibility testing of yeasts" (2002), National Committee for Clinical Laboratory Standards
- "Comparison of visual 24- hour and spectrophotometric 48-hour MICs to CLSI reference microdilution MICs of fluconazole, itraconazole, posaconazole, and voriconazole for Candida spp. : a collaborative study", 43, pp.4535~4540 (2005)
- "The spectrum of infection in patients with acute leukemia", 17, pp.45~52 (1985)
- "The Spectrum of Infection in Patients with Acute Leukemia", pp.496~504 (1994)
- "Infectious features in patients with acute leukemia", 31, pp.217~224 (1999)
- "Infections in patients with acute leukemia Comparison of induction chemotherapy group and reinduction chemotherapy group", 35, pp.78~85 (2003), Infct Chemotherapy Group
- "Lethal infection by Candida(Torulopsis)incospicua complicating orthotopic liver transplantation", 36, pp.2778~2781 (2004)
- "Fatal systemic candidiasis of gastrointestinal origin:an experimental model in mice compromised by anti- cancer treatment", 30, pp.219~31 (1992)
- "Characterization of the sequence of colonization and nosocomial candidemia using DNA fingerprinting and a DNA probe", 28, pp.2733~8 (1990)
- "Management of central venous catheters in patients with cancer and candidemia", 38, pp.1119~1127 (2004)