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从临床样本中分离罕见机会性酵母——来自印度南部一家三级护理医院的经验及文献简要综述

Isolation of the Rare Opportunistic Yeast from Clinical Samples-Experience from a Tertiary Care Hospital in Southern India and a Brief Review of the Literature.

作者信息

Pamidimukkala Umabala, Kancharla Anuradha, Sudhaharan Sukanya, Gundeti Sadashivudu, Mandarapu Surendra, Nagalla Vamsi Krishna, Raju Sree Bhushan, Karanam Sandhya Devi

机构信息

Associate Professor, Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana, India.

Consultant, Department of Microbiology, Asian Institute of Gastroenterology, Hyderabad, Telengana, India.

出版信息

J Clin Diagn Res. 2017 Sep;11(9):DC36-DC42. doi: 10.7860/JCDR/2017/30339.10669. Epub 2017 Sep 1.

Abstract

INTRODUCTION

(Teleomorph: ) is a ubiquitous yeast found in environmental sources such as soil, water, air, plants and dairy products. It is also a part of the normal microbial flora in humans. The yeast is being increasingly reported as an opportunistic pathogen, especially in patients in the haemato-oncology setting, the infection being often mistakenly diagnosed as invasive candidiasis.

AIM

To review the epidemiological, clinical and microbiological features of six patients admitted in our hospital over a period of 10 years (from January 2007 to December 2016), from whom was isolated.

MATERIALS AND METHODS

A retrospective study was conducted and the epidemiological, clinical, imaging and microbiological data of the six patients were collected and analysed.

RESULTS

The age of the six patients ranged from 19 years to 65 years with a median age of 53 years. There were two males and four females. In three out of the six patients, the isolation of was considered clinically significant as the yeast was isolated repeatedly from blood and/or respiratory specimens and the clinical features could not be explained by any other alternative diagnosis. Haematological malignancy was the underlying disease in three out of the six patients while one patient was on triple immunosuppression following renal transplantation four years back. Three out of the six patients had severe neutropenia with Absolute Neutrophil Count (ANC) ≤ 500 at the time of isolation of Two patients with clinical features of fungal sepsis received antifungal therapy with Amphotericin B but succumbed within a short period of starting the therapy. The post renal transplant patient who presented with pneumonia recovered after treatment with a combination of Amphotericin B and Voriconazole.

CONCLUSION

Awareness regarding the epidemiological, clinical and microbiological aspects of invasive infections caused by is essential for early recognition and appropriate management.

摘要

引言

(有性型:)是一种广泛存在于土壤、水、空气、植物和乳制品等环境来源中的酵母。它也是人类正常微生物群的一部分。越来越多的报道称这种酵母是一种机会性致病菌,尤其是在血液肿瘤患者中,其感染常被误诊为侵袭性念珠菌病。

目的

回顾我院10年间(2007年1月至2016年12月)收治的6例分离出的患者的流行病学、临床和微生物学特征。

材料与方法

进行回顾性研究,收集并分析这6例患者的流行病学、临床、影像学和微生物学数据。

结果

6例患者年龄在19岁至65岁之间,中位年龄为53岁。其中男性2例,女性4例。6例患者中有3例,由于从血液和/或呼吸道标本中反复分离出该酵母,且临床特征无法用任何其他替代诊断来解释,因此该酵母的分离被认为具有临床意义。6例患者中有3例的基础疾病是血液系统恶性肿瘤,而1例患者在4年前肾移植后接受三联免疫抑制治疗。6例患者中有3例在分离出时伴有严重中性粒细胞减少,绝对中性粒细胞计数(ANC)≤500。2例有真菌败血症临床特征的患者接受了两性霉素B抗真菌治疗,但在开始治疗后不久死亡。肾移植后出现肺炎的患者经两性霉素B和伏立康唑联合治疗后康复。

结论

了解由引起的侵袭性感染的流行病学、临床和微生物学方面对于早期识别和适当管理至关重要。

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