Touraine R L, Bertrand Y, Nakache C, Barbé G, de Montclos H, Philippe N
Service d'hématologie pédiatrique et de transplantation de moelle osseuse, hôpital Debrousse, Lyon, France.
Pediatrie. 1991;46(12):791-5.
Candida arthritis is a rare event which is a result of direct intraarticular inoculation, or--in compromised host--of hematogenous spread. We report on the case of an 18-month-old boy who experienced such an infection during induction treatment for acute lymphoblastic leukemia with aplastic onset. He was healed by daily systemic amphotericin B administered over a period of 3 wks associated with intravenous flucytosine during the first 2 wks; the treatment was continued with oral administration of ketoconazole for 5 wks. Treatment control was performed by drug monitoring in plasma and synovial fluid, as well as by determination of Candida antigenemia and antibody levels. We consider that the required doses of amphotericin B should be based upon plasma concentrations greater than 0.5 or 1 mg/l to be maintained during 2-3 wks. Providing that there is no resistance, the association with flucytosine may be useful.
念珠菌性关节炎是一种罕见病症，它是由关节内直接接种所致，或者在宿主免疫功能低下时由血行播散引起。我们报告一例18个月大的男孩，他在急性淋巴细胞白血病伴再生障碍性发作的诱导治疗期间发生了这种感染。通过为期3周每日全身应用两性霉素B进行治疗，并在前2周联合静脉应用氟胞嘧啶，患儿得以痊愈；之后继续口服酮康唑5周。通过监测血浆和滑液中的药物浓度以及测定念珠菌血症抗原和抗体水平来进行治疗控制。我们认为，两性霉素B的所需剂量应基于2至3周内维持血浆浓度大于0.5或1mg/L来确定。在没有耐药性的情况下，联合应用氟胞嘧啶可能会有帮助。
