克柔念珠菌感染致脓胸一例并文献复习  

A case of empyema caused by Candida krusei infection and literatures review

作　　者：陈思锡 高天明[1] 朱成华[1] 李娟[1] 金霄 邵明玥 冯旰珠[1] Chen Sixi;Gao Tianming;Zhu Chenghua;Li Juan;Jin Xiao;Shao Mingyue;Feng Ganzhu(Department of Respiratory and Critical Care Medicine,The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院呼吸与危重症医学科,南京市210011

出　　处：《中华实验和临床感染病杂志（电子版）》2023年第2期138-142,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家自然科学基金面上项目(No.81870009)。

摘　　要：目的提高对克柔念珠菌感染所致脓胸相关特征、诊疗方法及预后的认识。方法回顾性分析南京医科大学第二附属医院2022年7月收治的1例克柔念珠菌感染致脓胸患者的临床资料,并检索国内外相关文献,对该病的发病、临床特征及诊疗进行探讨。结果本例患者有长期吸毒及支气管哮喘病史,入院初期存在严重低蛋白血症,克柔念珠菌脓胸诊断明确后,胸腔引流同时先后给予米卡芬净及伏立康唑治疗,脓胸完全吸收后出院;共检索到克柔念珠菌感染致脓胸病例个案报道文献6篇共计8例患者,其中食道穿孔患者4例、食管-气管瘘形成患者2例、心脏移植术后患者1例、动脉导管封堵术后患者1例;本例患者病程中伴支气管-胸膜瘘;本例及文献报道8例患者初始临床表现皆为咳嗽、咯痰、呼吸困难,脓胸病原学诊断均为常规培养;文献报道8例患者中死亡4例,1例使用两性霉素B、2例使用伏立康唑、1例使用棘白霉素类联合伏立康唑抗真菌治疗,存活4例患者中1例单独使用棘白霉素类、3例使用棘白霉素类联合伏立康唑抗真菌治疗。结论本例克柔念珠菌感染所致脓胸系国内首次报道;该病多见于食管-气管瘘形成及手术创伤后,其临床表现无特征性;确诊后使用棘白霉素类或联合三唑类伏立康唑治疗有助于提高其存活。Objective To improve the clinical understanding of the characteristics,diagnosis and treatment methods and prognosis of empyema caused by Candida krusei infection.Methods The clinical data of a patient with empyema caused by Candida krusei infection admitted to the Second Affiliated Hospital of Nanjing Medical University in July 2022 was analyzed,retrospectively.Relevant literatures at home and abroad were searched to explore the pathogenesis,clinical characteristics,diagnosis and treatment of the disease.Results This patient had a history of long-term drug abuse and bronchial asthma,and had severe hypoproteinemia at the initial stage of admission.After the diagnosis of Candida krusei empyema was confirmed,micafungin and voriconazole were given successively during chest drainage,and he was discharged after the empyema was completely absorbed.Total of 6 case reports(including 8 cases)of empyema caused by Candida krusei infection were retrieved,there were 4 patients with esophageal perforation,2 patients with esophageal-tracheal fistula formation,and 1 patient after heart transplantation,1 patient after occlusion of the ductus arteriosus;this patient had a bronchial-pleural fistula during the course of the disease;the initial clinical manifestations of this case and the 8 patients reported in the literature were cough,expectoration,and dyspnea,while the etiological diagnosis of empyema was all routine culture;according to the literatures,4 cases among the 8 patients died,1 patient was treated with amphotericin B,2 patients with voriconazole,and 1 patient with echinocandin combined with voriconazole,and 1 case among the 4 survived patients was treated with echinocandin alone,3 patients were treated with echinocandin combined with voriconazole.Conclusions This case of empyema caused by Candida krusei infection is the first reported case in China.Patients with this disease are more common inesophageal-tracheal fistula formation and surgical trauma,the clinical manifestations are not characteristic,treatment with echin

关 键 词：克柔念珠菌 脓胸 棘白霉素类 三唑类 食道穿孔 食管-气管瘘 

分 类 号：R714.251[医药卫生—妇产科学]