Hirai Yuji, Asahata Sayaka, Ainoda Yusuke, Fujita Takahiro, Miura Hitomi, Hizuka Naomi, Kikuchi Ken
Department of Infectious Diseases, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjuku, Tokyo, 162-8666, Japan,
Mycopathologia. 2015 Aug;180(1-2):111-6. doi: 10.1007/s11046-015-9884-3. Epub 2015 Apr 8.
Yeast with pseudohyphae or those that have been phagocytized by white blood cells are coincidentally found in peripheral blood smears. The clinical diagnostic value and outcome of candidaemia diagnosed from peripheral blood smears (CPBSs) are unclear.
A 45-year-old man with diabetes and panhypopituitarism for 20 years received 10 mg of hydrocortisone and 100 μg of levothyroxine sodium hydrate daily. He has been admitted seven times because of adrenal failure triggered by infections and was admitted for pneumonia. On day 56, some budding yeast was found microscopically in a peripheral blood smear with May-Giemsa staining. Some of them were phagocytized by white blood cells. The two blood cultures yielded Candida parapsilosis. Despite antifungal treatment and removal of an intravenous catheter, on day 98 (42 days after the candidaemia diagnosis), the patient died.
We analysed 36 cases including the present case. Almost all CPBS patients (96.5 %, n = 29) were using an intravenous catheter. The most frequently isolated species was C. parapsilosis (35.1 %), followed by C. albicans (29.7 %). The overall mortality rate was 53.6 % (n = 28). The time from the discovery of yeast-like pathogens using peripheral blood smears to death ranged from a few hours to 93 days (median 19 days). The present results suggest that intravenous catheter use and the underlying conditions of patients are responsible for CPBSs. The detection of yeast in peripheral blood smears suggests advanced infections with uncontrollable complications, which means a poor prognosis. Rapid detection methods besides blood culture are needed.
在外周血涂片偶然发现有假菌丝的酵母或被白细胞吞噬的酵母。外周血涂片诊断念珠菌血症（CPBS）的临床诊断价值及预后尚不清楚。
一名45岁男性，患糖尿病和全垂体功能减退20年，每日接受10mg氢化可的松和100μg左甲状腺素钠水合物治疗。他因感染引发的肾上腺功能衰竭已住院7次，此次因肺炎入院。在第56天，May-Giemsa染色的外周血涂片显微镜检查发现一些芽殖酵母，其中一些被白细胞吞噬。两次血培养均分离出近平滑念珠菌。尽管进行了抗真菌治疗并拔除了静脉导管，但在第98天（念珠菌血症诊断后42天），患者死亡。
我们分析了包括本病例在内的36例病例。几乎所有CPBS患者（96.5%，n = 29）都在使用静脉导管。最常分离出的菌种是近平滑念珠菌（35.1%），其次是白色念珠菌（29.7%）。总死亡率为53.6%（n = 28）。从外周血涂片发现酵母样病原体到死亡的时间从几小时到93天不等（中位数19天）。目前的结果表明，静脉导管的使用和患者的基础疾病是CPBS的原因。外周血涂片检测到酵母提示感染进展且并发症难以控制，这意味着预后不良。除血培养外，还需要快速检测方法。
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