Sobel J D, Vazquez J
Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan.
Semin Respir Infect. 1990 Jun;5(2):123-37.
The growing problem of candidemia and systemic candidiasis reflects the enormous increase in the pool of patients at risk as well as the increased opportunity that exists for Candida sp to invade tissues normally resistant to invasion. Candida sp, as truly opportunistic pathogens, exploit recent technological advances to gain access to the circulation and deep tissues. The increased prevalence of local and systemic disease caused by Candida organisms has resulted in new clinical syndromes, the expression of which depends upon the immune status of the host. These new syndromes include the focal hepatosplenic candidiasis, Candida peritonitis and systemic candidiasis. Management of serious and life-threatening invasive candidiasis remains severely hampered by the lack of reliable diagnostic methods that would allow early detection of both fungemia and tissue invasion by Candida organisms. Amphotericin B remains the cornerstone of effective antifungal therapy in systemic candidiasis. Over the last decade, new principles have emerged, including shorter and lower dosage regimens for catheter-related candidemia. The newer oral azoles may play a useful role in the management of invasive candidiasis.
念珠菌血症和系统性念珠菌病问题日益严重，这反映出高危患者群体大幅增加，以及念珠菌属侵入通常对感染具有抵抗力的组织的机会增多。念珠菌属作为真正的机会致病菌，利用近期的技术进步进入血液循环和深部组织。由念珠菌引起的局部和全身性疾病患病率上升，导致了新的临床综合征，其表现取决于宿主的免疫状态。这些新综合征包括局灶性肝脾念珠菌病、念珠菌性腹膜炎和系统性念珠菌病。由于缺乏可靠的诊断方法，无法早期检测到念珠菌属引起的真菌血症和组织侵袭，严重和危及生命的侵袭性念珠菌病的治疗仍然受到严重阻碍。两性霉素B仍然是系统性念珠菌病有效抗真菌治疗的基石。在过去十年中，出现了新的原则，包括针对导管相关念珠菌血症的更短疗程和更低剂量方案。新型口服唑类药物可能在侵袭性念珠菌病的治疗中发挥有益作用。
