Tsuboi Motoyuki, Uno Shunsuke, Hase Ryota, Yano Yudai, Sando Eiichiro, Otsuka Yoshihito, Hosokawa Naoto
Kansenshogaku Zasshi. 2016 Mar;90(2):134-7. doi: 10.11150/kansenshogakuzasshi.90.134.
Although candiduria is becoming increasingly common among hospitalized patients, Candida lusitaniae is a rare pathogen that account for less than 1% of Candida species isolated from urine. Ascending pyelonephritis and candidemia due to Candida species are uncommon complications. We report herein on a case of acute pyelonephritis and candidemia due to C. lusitaniae. A 66-year-old man presented with a high fever during hospitalization at our hospital following septic shock due to ischial osteomyelitis treated with tazobactam/piperacillin for 29 days. We suspected acute pyelonephritis, and urinary Gram staining showed only yeasts and leucocytes. The next day, blood culture and urine culture tested positive and showed yeast-like fungi. We diagnosed acute pyelonephritis and candidemia due to Candida species and started treatment with fluconazole. C. lusitaniae was identified on the hospital day 34 and treated with fluconazole for 14 days. Candida albicans was the most prevalent species isolated from the urinary tract, however non-albicans Candida species have emerged and are now dominant because of the advent and increasing use of fluconazole. C. lusitaniae is a rare but important pathogen, that is generally susceptible to fluconazole and resistant to amphotericin B. It is necessary to choose an appropriately effective antifungal drug based on identification of the fungal species.
尽管念珠菌尿症在住院患者中越来越常见，但葡萄牙念珠菌是一种罕见的病原体，在从尿液中分离出的念珠菌属中占比不到1%。念珠菌属引起的上行性肾盂肾炎和念珠菌血症是不常见的并发症。我们在此报告一例由葡萄牙念珠菌引起的急性肾盂肾炎和念珠菌血症病例。一名66岁男性在我院住院期间因坐骨骨髓炎接受他唑巴坦/哌拉西林治疗29天后出现感染性休克并伴有高热。我们怀疑是急性肾盂肾炎，尿液革兰氏染色仅显示酵母和白细胞。第二天，血培养和尿培养呈阳性，显示出酵母样真菌。我们诊断为由念珠菌属引起的急性肾盂肾炎和念珠菌血症，并开始用氟康唑治疗。在住院第34天鉴定出葡萄牙念珠菌，并用氟康唑治疗14天。白色念珠菌是从尿路分离出的最常见菌种，然而由于氟康唑的出现和使用增加，非白色念珠菌菌种已经出现并占主导地位。葡萄牙念珠菌是一种罕见但重要的病原体，通常对氟康唑敏感，对两性霉素B耐药。有必要根据真菌菌种的鉴定选择适当有效的抗真菌药物。
