近平滑念珠菌引起真菌性膝关节炎：病例报告及文献回顾

报告1例由近平滑念珠菌引起的膝关节炎并进行相关骨关节真菌感染的文献回顾.患者,男,53岁,有糖尿病史及左侧腘窝皮肤浅表小肿瘤切除史,因左膝关节反复疼痛7 a,逐渐加重伴跛行6个月入院.临床表现为左膝关节明显红肿,影像学发现关节腔内滑膜增生,临近胫骨上端及股骨下端有灶性骨破坏、吸收,关节腔积液查见真菌,鉴定为近平滑念珠菌.经关节镜清理术及静脉用氟康唑治疗后症状改善,随访2 a无复发,已恢复日常活动.本文结合本例患者进行了骨关节真菌感染的相关文献复习,对骨关节感染的相关因素及治疗等内容进行了回顾,其结果对临床相关医生具有重要参考价值.     

白念珠菌对宿主的黏附机制

白念珠菌对宿主的黏附是白念珠菌感染过程的关键的第一步,因此阐明白念珠菌对宿主的黏附机制对探索新的方法预防和治疗白念珠菌感染至关重要。近年来,研究者们从白念珠菌的表面结构、黏附素以及黏附相关基因等方面对白念珠菌与宿主的黏附机制进行了大量研究。该文就白念珠菌对宿主的黏附机制进行综述。     

A novel role for the NLRC4 inflammasome in mucosal defenses against the fungal pathogen Candida albicans

Candida sp. are opportunistic fungal pathogens that colonize the skin and oral cavity and, when overgrown under permissive conditions, cause inflammation and disease. Previously, we identified a central role for the NLRP3 inflammasome in regulating IL-1β production and resistance to dissemination from oral infection with Candida albicans. Here we show that mucosal expression of NLRP3 and NLRC4 is induced by Candida infection, and up-regulation of these molecules is impaired in NLRP3 and NLRC4 deficient mice. Additionally, we reveal a role for the NLRC4 inflammasome in anti-fungal defenses. NLRC4 is important for control of mucosal Candida infection and impacts inflammatory cell recruitment to infected tissues, as well as protects against systemic dissemination of infection. Deficiency in either NLRC4 or NLRP3 results in severely attenuated pro-inflammatory and antimicrobial peptide responses in the oral cavity. Using bone marrow chimeric mouse models, we show that, in contrast to NLRP3 which limits the severity of infection when present in either the hematopoietic or stromal compartments, NLRC4 plays an important role in limiting mucosal candidiasis when functioning at the level of the mucosal stroma. Collectively, these studies reveal the tissue specific roles of the NLRP3 and NLRC4 inflammasome in innate immune responses against mucosal Candida infection.     

抗系统性白念珠菌感染的先天性免疫

白念珠菌是引起浅部、深部真菌感染常见的病原菌.先天免疫反应在宿主抗系统性白念珠菌感染中起主导作用.介导宿主抗念珠菌感染的先天性免疫包括一系列真菌识别受体及免疫效应细胞.宿主对系统性白念珠菌感染的免疫反应是决定患者预后的关键.本文就宿主抗系统性白念珠菌感染的先天性免疫机制进行综述.     

儿童重症监护病房医院感染暴发白色念珠菌血流感染4例分析

摘要 目的：探讨儿童重症监护病房白色念珠菌血流感染暴发的临床表现、危险因素、控制措施等,为预防和控制院内白色念珠菌血流感染暴发提供科学依据。方法：以2018年7月我院儿童重症监护病房发生的4例白色念珠菌血流感染暴发患儿为研究对象,分析患儿临床情况、临床特征、危险因素、暴发原因以及采取的预防控制措施。结果：4例医院感染暴发白色念珠菌血流感染患儿均存在基础疾病、有机械通气史、存在中心静脉或动脉置管、静脉或动脉置管前后均使用碘伏消毒、曾使用广谱抗生素、输血制品,白色念珠菌血流感染后最突出的临床表现均是发热。药敏方面,医院感染暴发的4例白色念珠菌感染患儿对唑类及5-氟胞嘧啶均耐药,但对两性霉素B均敏感。经拔除血管置管、减少或者避免广谱抗菌药的应用,根据药敏使用卡泊芬净及两性霉素B抗真菌等积极治疗,1例患儿放弃治疗后死亡,3例患儿顺利出院。通过Fisher确切概率法分析可知,留置中心静脉或动脉置管是儿童重症监护病房发生医院感染暴发白色念珠菌血流感染的危险因素（P<0.05）。结论：留置中心静脉或动脉置管是儿童重症监护病房发生医院感染暴发白色念珠菌血流感染的危险因素,医院感染暴发白色念珠菌血流感染患儿最突出的临床表现是发热,唑类及5-氟胞嘧啶耐药的患儿使用卡泊芬净及两性霉素B可能获得较好的治疗效果。     

Case-control study to evaluate the link between immunosuppression and Candida spp. infection

Candidiasis is one of the fungal infections with the highest incidence in the immunosuppressed host. The evolution of infection and the increase of antifungal medical drugs resistance could both contribute to the mortality attributable to Candida infection in the immunosuppressed host. Even though the data from international studies are well known, few studies have been published in Romania on this subject. In the case-control study we demonstrated the link between the immunosuppression and the presence of Candida infection. Further studies are to be carried out in order to identify more accurately this link and to extend the study to other fungi. There is a need to increase the microbiological diagnosis use at least at the hospital laboratory level in order to better identify the real situation of fungal infections and the link between them and the concrete status of different hosts. Continued surveillance for infections caused by C. albicans and other species of Candida among hospitalized patients is recommended. Control of antimicrobial resistance among nosocomial infections caused by C. albicans and other species of Candida requires rational policies for use of both antifungal and antibacterial agents and appropriate surveillance for the emergence of resistant strains and species.     

Evaluation of the Adherence of Candida Species to Urinary Catheters

Catheter-associated urinary tract infections (CAUTIs) are the most common kind of nosocomial infection. Recent years have seen a significant increase in numbers of infections caused by yeasts of the genus Candida. The adherence of a microorganism to the host surface is a decisive factor in the success of colonization and the pathogenesis of infection. The objective of this work was to evaluate the adherence of species of the genus Candida to urinary catheters. In vitro adherence to the sections of latex and silicon catheters of Candida albicans and Candida parapsilosis were studied. Adherence was measured by counting the number of adhering viable cells and the results were expressed as Colonies Forming Units per mL. The results demonstrated that the latex catheter facilitated adherence more than the silicon catheter (p < 0.01). The adherence of the C. albicans was significantly greater than C. parapsilosis on latex, but it was similar on silicon.     

重型肝炎患者肝移植术后真菌感染临床分析

目的分析重型肝炎肝移植受体术后真菌感染情况,进一步探讨其易感因素和防治措施。方法回顾性分析我院器官移植中心2003年3月至2006年2月间89例重型肝炎肝移植患者的临床资料并进行讨论。结果89例重型肝炎肝移植患者中21例出现术后真菌感染,感染率为23.6%,较其他病种肝移植更高,其中12例为白念珠菌(57.1%),6例为光滑念珠菌(28.6%),1例为近平滑念珠菌,1例为克柔念珠菌,1例为热带念珠菌。真菌感染多发生在术后1周内,感染部位以呼吸系统为主。结论重型肝炎肝移植患者术后真菌感染以念珠菌属的早期呼吸道感染为主。术前肝性脑病与术后发生真菌感染之间存在相关关系。而一般的白念珠菌感染不会显著地影响重型肝炎肝移植患者的预后。预防性使用抗真菌药物在重型肝炎肝移植术后真菌感染的治疗中具有重要意义。     

Candida glabrata-Induced Refractory Infectious Arthritis: A Case Report and Literature Review

Mycopathologia - The incidence of deep fungal infection due to non-albicans Candida species (especially Candida glabrata) has significantly increased in recent decades. Candida glabrata is an...     

Candida infected ascites caused by perforated ulcer

Summary A case is presented of ascites infected with Candida in a cirrhotic patient. Candida infection of the ascitic fluid and candidemia were found 24 hours after perforation of a gastric ulcer. Combined intravenous therapy with Amphotericin B and 5-Fluorocytosine eradicated the infection within two weeks. The need for comprehensive therapeutic approach in the debilitated patient prone to fungal and bacterial infection is emphasized.     

Microbiological non-culture methods for the diagnosis of invasive candidiasis: usefulness of surrogate markers

The usefulness of surrogate markers in the diagnosis of invasive candidiasis is based on their ability to detect the infection caused by the different Candida spp. and to differentiate when the fungus is a colonizer or it is causing an invasive disease. This differentiation has been tried by detecting antigens, antibodies and other Candida components in the patient's sera. In this paper we will review the antigens, antibodies and other Candida components which may be useful in the laboratory diagnosis of invasive candidiasis in the non-neutropenic critically ill patient.     

妊娠期外阴阴道假丝酵母菌病发病机制的研究概述

外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)是由假丝酵母菌引起的常见外阴阴道炎症。VVC在妊娠期有较高的发病率。妊娠期VVC的常见病原体主要是白色假丝酵母菌,其发病机制包括菌体本身的致病因素、妊娠期激素的升高及免疫功能下降。菌体的致病因素包括粘附力、细胞外酶及形态转换。同时VVC对妊娠有一定影响,主要导致宫内感染、胎膜早破、早产、低体质量儿出生、流产、死胎、假丝酵母菌性肺炎等疾病。本文就国内外妊娠期外阴阴道假丝酵母菌病的发病机制进行综述。     

SCID小鼠肠道菌群失调对深部白色念珠菌感染的影响研究

目的建立重度联合免疫缺陷（SCID）小鼠白色念珠菌感染模型,探讨肠道菌群失调与深部白色念珠菌感染的联系。方法SCID小鼠随机口服万古霉素水溶液7d,饥饿24h后给予白色念珠菌灌胃,建立小鼠白色念珠菌感染模型,观察小鼠死亡情况。荧光定量PCR检测肠道细菌总量、基质辅助激光解析电离飞行时间质谱仪鉴定肠道菌群种类,并应用扫描电镜观察肠壁黏膜组织超微结构的改变。结果应用万古霉素可致肠道菌群失调,肠道黏膜完整性受损。在万古霉素致肠道菌群失调的基础上,外源性白色念珠菌攻击可加重肠道菌群失调和肠壁黏膜损伤程度,促进深部白色念珠菌感染的发生。结论肠道菌群失衡可以导致深部白色念珠菌感染的发生,肠壁黏膜的完整性可能参与了肠道白色念珠菌播散过程。     

Ophtalmoscopic examination in critically ill non-neutropenic patients: Candida endophtalmitis

Invasive Candida (IC) infection is the most common cause of endogenous endophthalmitis. Ocular candidiasis develops within three days and at least two weeks of fungemia. There are two characteristic ocular signs: Candida chorioretinitis defined as retina and choroid lesions without vitreal involvement, and Candida endophthalmitis defined as chorioretinitis with extension into the vitreous with characteristic fluffy balls. The most common initial visual symptoms are blurred vision and floaters. Amphotericin B, fluconazole and voriconazole are effective in the treatment of chorioretinitis; however, when vitreous is involved vitrectomy seems necessary. Early antifungal systemic treatment at first evidence of infection in patients at risk of IC, appears to decrease dramatically the incidence of endogenous fungal endophthalmitis, probably healing minimal chorioretinal infections. Routine ophthalmoscopic examination seems of little value in patients with positive blood culture, with early implementation of antifungal treatment, without symptoms of ocular infection and without impairment of the level of consciousness during the episode. However, periodic ophthalmoscopic examination should be performed in children with candidemia and critically ill patients with documented deep Candida infection.     

A glucocorticoid antagonist, mifepristone affects anti-Candida activity of murine neutrophils in the presence of prednisolone in vitro and experimental candidiasis of prednisolone-treated mice in vivo

Abstract The effects of a glucocorticoid-antagonist, mifepristone on the suppressive action of prednisolone for anti- Candida activity of murine neutrophils were examined. Prednisolone suppressed inhibitory activity of neutrophils to mycelial growth of Candida albicans . This suppression was cancelled in the presence of 10⁻⁷–10⁻⁶ M of mifepristone in vitro. Corresponding to this in vitro action, mifepristone protected prednisolone-treated mice from lethal C. albicans infection in vivo. These results suggest that glucocorticoid-induced vulnerability to Candida infection may be recovered or normalized by application of mifepristone.     

大鼠白念珠菌支气管肺感染时肺组织Toll样受体2的表达及意义

目的 探讨Toll样受体2(TLR2)在白念珠菌支气管肺感染大鼠肺组织模型中的表达及意义.方法 建立白念珠菌支气管肺感染大鼠模型,观察感染后肺组织病理形态学改变,采用免疫组织化学法观察感染后不同时间(第3天、第7天)白念珠菌支气管肺感染大鼠肺组织TLR2的表达,并与未感染组进行比较.结果 大鼠白念珠菌支气管肺感染后肺组织TLR2表达水平明显升高.结论 白念珠菌支气管肺感染肺组织TLR2表达增高可能参与感染的炎症反应.     

肝移植患者真菌感染的流行病学特点及耐药性分析

目的了解肝移植术后真菌感染的种类及耐药特性,为临床治疗提供依据。方法分析2003年6月至2006年6月,我院67例肝移植患者术后感染的标本,鉴定真菌种类,分析其耐药性。结果67例肝移植患者有21例发生真菌感染,占肝移植患者的31.3%;共检出73株真菌,以酵母菌感染为主,占98.6%,其中近平滑念珠菌、白色念珠菌、热带念珠菌、季也蒙念珠菌、克柔念珠菌的检出率分别是53.4%、21.9%、9.6%、8.2%、2.7%。曲霉菌感染1例。药敏试验显示73株真菌对两性霉素B(AMB)、5-氟胞嘧啶(5-FC)、制霉菌素(MYS)、酮康唑(KTC)、益康唑(ECO)和咪康唑(MIC)的平均敏感率分别为98.6%、95.7%、87.1%、70.0%、65.7%和64.3%。结论加强肝移植术后真菌的鉴定和耐药性监测,对指导临床治疗具有重要意义。     

Impact of Cigarette Smoke Condensate on Adhesion-Related Traits and Hemolysin Production of Oral Candida dubliniensis Isolates

Mycopathologia - Cigarette smoke is associated with higher oral Candida carriage and possible predisposition and increased susceptibility to oral candidal infection. Candida dubliniensis is...     

院内患者深部真菌感染的流行病学调查

目的 了解长海医院院内患者深部真菌感染的流行病学情况。方法 对2000-2004年间在长海医院住院治疗患者的深部真菌感染进行调查和分析。结果 5年间院内深部真菌感染的发病率上升明显,院内深部真菌感染的主要部位是呼吸道和泌尿道,主要的致病菌为念珠菌。结论 院内深部真菌感染病例近年呈上升趋势。白念珠菌仍是院内深部真菌感染的主要病原菌。