季也蒙念珠菌肺炎1例并文献复习  

Candida guilliermondii pneumonia:a case report and literature review

作　　者：李倩 曲娜 马佑平 张伟华[2] 韩国敬[2] LI Qian;QU Na;MA You-ping;ZHANG Wei-hua;HAN Guo-jing(The Ningria Armed Police Corps Hospital,Yinchuan,Ningria 75000l,China;不详)

机构地区：[1]武装警察部队宁夏回族自治区总队医院内科,宁夏银川750001 [2]解放军总医院第一医学中心呼吸与危重症科,北京100853

出　　处：《中华医院感染学杂志》2024年第6期852-856,共5页Chinese Journal of Nosocomiology

基　　金：首都卫生发展科研专项基金资助项目(首发2022-1-5091)。

摘　　要：目的 总结季也蒙念珠菌肺炎的病因、临床表现、影像学特点、诊断、治疗,提高对肺部真菌病的警觉和认知,减少漏诊、误诊。方法 回顾性分析2023年3月解放军总医院第一医学中心收治的1例季也蒙念珠菌肺炎患者的临床资料(主要临床症状、用药及治疗史、影像学表现、基础疾病、主要阳性体征),对诊疗经过进行总结分析,并结合文献检索进行病例复习。结果 患者有2型糖尿病、冠状动脉粥样硬化性心脏病、甲状腺功能减退症、阵发性房颤病史。主要症状表现为咳嗽、咳痰、喘憋。实验室检查提示真菌(1,3)-β-D-葡聚糖增高,3次痰培养、1次肺泡灌洗液培养及灌洗液宏基因二代测序(mNGS)均检出季也蒙假丝酵母。胸部CT可见双肺散在多发斑片状磨玻璃影及条索状密度增高影。经氟康唑治疗后症状不缓解,复查胸部CT病灶未见吸收,更换为伏立康唑治疗,症状减轻,复查胸部CT双肺感染明显好转,患者病情稳定出院。结论 季也蒙念珠菌肺炎少见,主要发生在免疫功能低下的患者,治疗上对三唑类、两性霉素B、氟胞嘧啶敏感,对棘白菌素类敏感性较差,推荐根据药敏用药。OBJECTIVE To summarize the pathogenesis,clinical manifestations,imaging characteristics,diagnosis and treatment of Candida guilliermondii pneumonia so as to boost the awareness of pulmonary mycosis and re-duce the incidence of missed diagnosis and misdiagnosis.METHODS The clinical data were collected from 1 patient with C.guilliermondii pneumonia who was treated in the First Medical Center of Chinese PLA General Hospital in Mar 2023,the clinical data included the major clinical symptoms,history of medication and treatment,imaging manifestations,underlying diseases and major positive signs.The diagnosis and treatment processes were summa-rized and analyzed,and the case review was carried out based on literature search.RESULTS The patient had type 2 diabetes mellitus,coronary atherosclerotic heart disease,hypothyroidism and paroxysmal atrial fibrillation.Cough,expectoration and asthma were the major symptoms.The result of clinical laboratory test showed that the level of fungal(1,3)-β-D-glucan was elevated,C.guilliermondii was detected positive by 3 times of sputum cul-ture,1 time of alveolar lavage fluid culture and metagenomic next generation sequencing(mNGS)for lavage fluid.The chest CT showed multiple patchy ground glass shadows and increased cord density in both lungs.Fluconazole did not relieve the symptoms,the reexamination of chest CT showed no absorption of focus,and the symptoms were alleviated by voriconazole;the reexamination of chest CT showed remarkable improvement of infection of both lungs,and the patient was discharged for stable condition.CONCLUSION The C.guilliermondii pneumonia is less common and is prevalent among the immunocompromised patients.Those patients are sensitive to triazoles,amphotericin B and fluorocytosine but are less sensitive to echinocandins.It is necessary to use antibiotics based on the result of drug susceptibility testing.

关 键 词：真菌性肺炎 季也蒙假丝酵母 肺部感染 氟康唑 伏立康唑 宏基因二代测序 

分 类 号：R519.3[医药卫生—内科学]