Kujath P, Lerch K, Dämmrich J
Klinik für Chirurgie, Medizinische Universität zu Lübeck, Germany.
Mycoses. 1990 Sep-Oct;33(9-10):441-8. doi: 10.1111/myc.1990.33.9-10.441.
Between May 1, 1988 and January 1, 1990, 10 patients were treated for Candida peritonitis. Origins of the infections were lesions and perforations of the gastrointestinal tract. Risk factors promoting the disease were tumours, diabetes mellitus and extensive antibiotic therapy. The mean classification by the APACHE score 2 was 19.0. All patients underwent the programmed peritoneal lavage for diffuse peritonitis. Daily relaparotomy and lavage of all quadrants of the abdomen was performed. The diagnosis of Candida peritonitis had been established by microbiological investigation, increasing serologic titres, histologic demonstration of a deep mycosis and clinical picture. All patients were treated with 300 mg fluconazole daily. Five of the ten patients died from their severe primary diseases in spite of control of fungal peritonitis. Daily relaparotomies allowed to follow up the microbiologic and histologic course of the disease. Within 2 to 4 days after administration of fluconazole, hydrous swelling and reduction of fungal elements could be demonstrated histologically. On the 4th day after onset of antifungal therapy, fungal mycelia were markedly reduced and distendedly decayed. Fluconazole clearly leads to a destruction of deeply invading Candida elements within 4 days.
1988年5月1日至1990年1月1日期间，10例患者接受了念珠菌性腹膜炎治疗。感染源为胃肠道病变和穿孔。促发该疾病的危险因素包括肿瘤、糖尿病和广泛的抗生素治疗。急性生理与慢性健康状况评分系统（APACHE）2评分的平均值为19.0。所有患者均因弥漫性腹膜炎接受了计划性腹膜灌洗。每天进行再次剖腹手术并对腹部所有象限进行灌洗。念珠菌性腹膜炎的诊断通过微生物学检查、血清学滴度升高、深部真菌病的组织学证明和临床表现得以确立。所有患者每天接受300毫克氟康唑治疗。尽管真菌性腹膜炎得到了控制，但10例患者中有5例死于严重的原发性疾病。每天的再次剖腹手术有助于跟踪疾病的微生物学和组织学进程。在给予氟康唑后2至4天内，组织学检查可显示真菌成分出现水肿和减少。在抗真菌治疗开始后的第4天，真菌菌丝明显减少并呈肿胀性衰退。氟康唑显然在4天内导致深部侵袭性念珠菌成分遭到破坏。
