Noyola D E, Fernandez M, Moylett E H, Baker C J
Section of Infectious Diseases, Department of Pediatrics, Houston, TX 77030, USA.
Clin Infect Dis. 2001 Apr 1;32(7):1018-23. doi: 10.1086/319601.
A retrospective review of 86 neonates with candidemia hospitalized from January 1989 through June 1999 was conducted to determine the frequency of ophthalmologic, visceral, or cardiac involvement. Retinal abnormalities were observed in 4 (6%) of the 67 infants in whom indirect ophthalmoscopy examination was performed. Abdominal ultrasound abnormalities were detected in 5 (7.7%) of 65 infants. Echocardiogram revealed thrombi or vegetations in 11 (15.2%) of 72 infants. Age at onset, presence of central venous catheters, and species of Candida were not predictors for involvement at these sites. Infants with candidemia that lasted > or =5 days were more likely to demonstrate ophthalmologic, renal, or cardiac abnormalities than those with a shorter duration. Infants with involvement of these organs received larger cumulative doses of amphotericin B than those without detectable abnormalities. Because complication of disseminated candidiasis by eye, renal, or cardiac involvement has therapeutic implications, and because risk factors for candidemia inadequately predict these complications, evaluations are indicated for all neonates with candidemia.
对1989年1月至1999年6月期间住院的86例念珠菌血症新生儿进行回顾性研究，以确定眼部、内脏或心脏受累的频率。在接受间接检眼镜检查的67例婴儿中，4例（6%）观察到视网膜异常。65例婴儿中5例（7.7%）检测到腹部超声异常。超声心动图显示72例婴儿中有11例（15.2%）有血栓或赘生物。发病年龄、中心静脉导管的存在以及念珠菌种类并非这些部位受累的预测因素。念珠菌血症持续≥5天的婴儿比病程较短的婴儿更有可能出现眼部、肾脏或心脏异常。这些器官受累的婴儿比未发现异常的婴儿接受了更大累积剂量的两性霉素B。由于眼部、肾脏或心脏受累引起的播散性念珠菌病并发症具有治疗意义，且念珠菌血症的危险因素不能充分预测这些并发症，因此建议对所有念珠菌血症新生儿进行评估。
