Redding Spencer W, Kirkpatrick William R, Coco Brent J, Sadkowski Lee, Fothergill Annette W, Rinaldi Michael G, Eng Tony Y, Patterson Thomas F
Department of General Dentistry, Division of Infectious Diseases, The University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
J Clin Microbiol. 2002 May;40(5):1879-81. doi: 10.1128/JCM.40.5.1879-1881.2002.
Candida glabrata colonization is common in patients receiving radiation treatment for head and neck cancer, but to our knowledge has never been described as the infecting organism with oropharyngeal candidiasis (OPC). This study presents the first three patients described with C. glabrata OPC in this patient population. Patient 1 developed C. glabrata OPC and required fluconazole, 800 mg/day, for clinical resolution. Antifungal susceptibility testing revealed a MIC of fluconazole of >64 microg/ml. Elapsed time from initial culturing to treatment decision was 7 days. Patients 2 and 3 developed C. glabrata OPC. They were patients in a study evaluating OPC infections, and cultures were taken immediately. CHROMagar Candida plates with 0, 8, and 16 microg of fluconazole/ml were employed for these cultures. Lavender colonies, consistent with C. glabrata, grew on the 0- and 8-microg plates but not on the 16-microg plate from patient 2 and grew on all three plates from patient 3. Based on these data, a fluconazole dose of 200 mg/day was chosen for patient 2 and a dose of 400 mg/day was chosen for patient 3, with clinical resolution in both. Elapsed time from initial culturing to treatment decision was 2 days. C. glabrata does cause OPC in head and neck radiation treatment patients, and the use of fluconazole-impregnated chromogenic agar may significantly reduce treatment decision time compared to that with conventional culturing and antifungal susceptibility testing.
光滑念珠菌定植在接受头颈部癌症放射治疗的患者中很常见，但据我们所知，从未被描述为口咽念珠菌病（OPC）的感染病原体。本研究报告了该患者群体中首例3例光滑念珠菌所致OPC患者。患者1发生光滑念珠菌所致OPC，临床缓解需要每日服用800mg氟康唑。抗真菌药敏试验显示氟康唑的最低抑菌浓度>64μg/ml。从初次培养到决定治疗的时间为7天。患者2和患者3发生光滑念珠菌所致OPC。他们是参与评估OPC感染研究的患者，培养标本立即送检。这些培养采用含0、8和16μg/ml氟康唑的CHROMagar念珠菌平板。与光滑念珠菌一致的淡紫色菌落，在患者2的含0μg/ml和8μg/ml氟康唑的平板上生长，但在含16μg/ml氟康唑的平板上未生长；在患者3的所有3个平板上均生长。基于这些数据，患者2选择每日200mg氟康唑的剂量，患者3选择每日400mg氟康唑的剂量，二者均临床缓解。从初次培养到决定治疗的时间为2天。光滑念珠菌确实可引起头颈部放射治疗患者发生OPC，与传统培养和抗真菌药敏试验相比，使用含氟康唑的显色琼脂可能显著缩短治疗决策时间。
