新生儿非白念珠菌病的病理学：尸检研究与文献综述
Pathology of Neonatal Non- albicans Candidiasis: Autopsy Study and Literature Review.
作者信息
Hemedez Claire, Trail-Burns Elizabeth, Mao Quanfu, Chu Sharon, Shaw Sunil K, Bliss Joseph M, De Paepe Monique E
机构信息
1 Department of Pathology, Women and Infants Hospital, Providence, Rhode Island.
3 Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
出版信息
Pediatr Dev Pathol. 2019 Mar-Apr;22(2):98-105. doi: 10.1177/1093526618798773. Epub 2018 Sep 7.
INTRODUCTION/OBJECTIVES: Non- albicans Candida species such as Candida parapsilosis and Candida glabrata have emerged as prevalent pathogens in premature infants. The aim of this study was to systematically delineate the histopathologic findings in neonatal non- albicans candidiasis.
METHODS
We performed a retrospective clinicopathologic analysis of extremely premature (23-28 weeks' gestation) infants diagnosed with invasive candidiasis. Archival autopsy tissues were subjected to periodic acid-Schiff, methenamine-silver and anti- Candida (immuno)histochemical stains, as well as dual anti- Candida and anti-cytokeratin or anti-CD31 immunofluorescence assays. In addition, we studied the prevalence of intestinal Candida colonization in a consecutive autopsy series of extremely premature infants.
RESULTS
Based on positive postmortem blood and/or lung cultures, invasive candidiasis (3 non- albicans and 11 Candida albicans) was diagnosed in 14 of the 187 extremely premature infants examined between 1995 and 2017. In contrast to the well-known inflammatory and tissue-destructive phenotype of congenital C. albicans infection, invasive non- albicans candidiasis/candidemia caused by C. parapsilosis and C. glabrata was inconspicuous by routine hematoxylin-eosin-based histopathologic analysis despite a heavy fungal presence detected in intestines, lungs, and blood by targeted (immuno)histochemical assays. Intestinal colonization by Candida species was identified in 16 of the 26 (61%) extremely premature neonates who had lived for at least 1 week, as assessed by anti- Candida immunostaining.
CONCLUSION
Invasive neonatal non- albicans candidiasis/candidemia appears to have no distinct histopathologic signature. Based on the notoriously low sensitivity of fungal blood cultures and the observed high frequency of Candida intestinal colonization (>50%), it is likely that non- albicans candidiasis/candidemia may be underdiagnosed in (deceased) preterm infants. Routine inclusion of targeted (immuno)histochemical fungal detection strategies in the perinatal autopsy may lead to deeper insight into the prevalence and clinical relevance of neonatal non- albicans candidiasis.
引言/目的：近平滑念珠菌和光滑念珠菌等非白色念珠菌已成为早产儿中常见的病原体。本研究的目的是系统地描述新生儿非白色念珠菌病的组织病理学表现。
方法
我们对诊断为侵袭性念珠菌病的极早产儿（妊娠23 - 28周）进行了回顾性临床病理分析。对存档的尸检组织进行高碘酸-希夫染色、六胺银染色和抗念珠菌（免疫）组织化学染色，以及抗念珠菌和抗细胞角蛋白或抗CD31双重免疫荧光检测。此外，我们在一系列连续的极早产儿尸检中研究了肠道念珠菌定植的发生率。
结果
基于死后血液和/或肺部培养阳性，在1995年至2017年间检查的187例极早产儿中，有14例被诊断为侵袭性念珠菌病（3例非白色念珠菌和11例白色念珠菌）。与先天性白色念珠菌感染众所周知的炎症和组织破坏表型不同，尽管通过靶向（免疫）组织化学检测在肠道、肺部和血液中检测到大量真菌，但基于常规苏木精-伊红的组织病理学分析显示，由近平滑念珠菌和光滑念珠菌引起的侵袭性非白色念珠菌病/念珠菌血症并不明显。通过抗念珠菌免疫染色评估，在26例存活至少1周的极早产儿中有16例（61%）发现念珠菌肠道定植。
结论
侵袭性新生儿非白色念珠菌病/念珠菌血症似乎没有明显的组织病理学特征。鉴于真菌血培养的敏感性极低，且观察到念珠菌肠道定植的频率很高（>50%），非白色念珠菌病/念珠菌血症在（已故）早产儿中很可能被漏诊。在围产期尸检中常规纳入靶向（免疫）组织化学真菌检测策略可能有助于更深入地了解新生儿非白色念珠菌病的发生率和临床相关性。
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