Rezai M S, Vaezi A, Fakhim H, Soleimani A, Mohammad Jafari H, Mohseni S, Badali H
Infectious Diseases Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, Iran.
Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
J Mycol Med. 2017 Jun;27(2):261-265. doi: 10.1016/j.mycmed.2017.01.006. Epub 2017 Feb 8.
Symptomatic candiduria often occurs in patients with indwelling bladder catheters or immunocompromised host. Isolation of Candida in urine in high-risk patients should primarily be considered as a marker for candidemia. Hematological and genitourinary malignancies are one of the main risk factors associated with Candida urinary tract infections (CUTI). Fluconazole is a choice for initial treatment of CUTI, but it is fluctuate depending on the patient's condition including renal failure, site of urinary infection and Candida species. Poor glomerular filtration is the main disadvantage echinocandins resulting in very low urinary concentrations. Therefore, echinocandins have prohibited their use in CUTI. Up to now, there are only 10 cases reported in the literatures with highly effective echinocandins in CUTI because of high concentrations in the tissue are needed to control invasive fungal disease. Herein, we report a candiduria followed by renal candidiasis caused by Candida albicans in a 6-year-old Iranian male with a history of Wilms tumor in left kidney. Direct examination of urine specimen revealed an infection due to budding yeast cells with numerous pseudohyphae and growths of C. albicans was reconfirmed by sequencing of ITS rDNA region. MICs in increasing order were as follows: caspofungin (0.016μg/ml), voriconazole (0.125μg/ml), amphotericin B (0.25μg/ml), itraconazole (0.5μg/ml) and fluconazole (2μg/ml). It seems that successful treatment with caspofungin owes achieved high renal tissue concentrations that are unrelated to glomerular filtration. In conclusion, predisposing factors for better outcome are more important than treatment of CUTI, therefore, management of UTI is essential for critically patients.
有症状的念珠菌尿症常发生于留置膀胱导管的患者或免疫功能低下的宿主。高危患者尿液中分离出念珠菌，应首先考虑为念珠菌血症的标志物。血液系统和泌尿生殖系统恶性肿瘤是与念珠菌尿路感染（CUTI）相关的主要危险因素之一。氟康唑是CUTI初始治疗的一种选择，但会根据患者情况而有所不同，包括肾衰竭、泌尿道感染部位和念珠菌种类。肾小球滤过功能差是棘白菌素的主要缺点，会导致尿液中药物浓度极低。因此，棘白菌素已被禁止用于CUTI。到目前为止，文献中仅报道了10例使用棘白菌素治疗CUTI有效的病例，因为控制侵袭性真菌病需要组织中达到高浓度。在此，我们报告了一名6岁伊朗男性，有左肾Wilms瘤病史，发生了由白色念珠菌引起的念珠菌尿症，随后发展为肾念珠菌病。对尿液标本的直接检查显示为芽生酵母细胞感染，伴有大量假菌丝，通过ITS rDNA区域测序再次确认了白色念珠菌的生长。MICs由低到高依次为：卡泊芬净（0.016μg/ml）、伏立康唑（0.125μg/ml）、两性霉素B（0.25μg/ml）、伊曲康唑（0.5μg/ml）和氟康唑（2μg/ml）。似乎卡泊芬净治疗成功是因为在肾组织中达到了高浓度，这与肾小球滤过无关。总之，有利于取得更好疗效的易感因素比CUTI的治疗更重要，因此，对重症患者而言，尿路感染的管理至关重要。
