Department of Pediatrics, Wakayama Medical University, Wakayama City, Wakayama, Japan; Department of Medical Safety Promotion, Wakayama Medical University, Wakayama City, Wakayama, Japan.
Department of Pediatrics, Wakayama Medical University, Wakayama City, Wakayama, Japan.
J Infect Chemother. 2021 Apr;27(4):642-646. doi: 10.1016/j.jiac.2020.11.005. Epub 2020 Nov 17.
Candidemia is a life-threatening fungal infection among patients undergoing long-term intravenous catheterization, hematopoietic stem cell transplantation, or immunosuppressive therapy, as well as patients with severe immunodeficiency or cancer. Endophthalmitis is a rare but severe form of ocular inflammation caused by infection of the intraocular cavity, which can lead to irreversible visual loss if not treated properly and promptly. The initial manifestation typically involves chorioretinitis, which requires early diagnosis and appropriate treatment. Candida guilliermondii is a non-Candida albicans yeast species; its frequency of detection in Japan has increased in recent years, and many drug-resistant and less-chorioretinitis-related strains are known. Here, we describe a 17-year-old girl with an eating disorder who exhibited chorioretinitis because of catheter-related bloodstream infection (CRBSI) caused by C. guilliermondii. The patient was hospitalized with severe weight loss, and she was presumed to develop candidemia because of immunosuppression during central parenteral nutrition therapy with a peripherally inserted central catheter. After onset of CRBSI, the catheter was immediately removed. Antifungal therapy was modified following fundus examination, fungal species confirmation, and drug sensitivity confirmation; thus, the patient recovered without long-term complications. To the best of our knowledge, this is the first report of C. guilliermondii-induced chorioretinitis in a patient with an eating disorder. Prolonged malnutrition and immunosuppression during nutritional therapy create a risk of candidemia in patients with eating disorders. After the onset of CRBSI, early administration and appropriate use of antifungal agents, with respect to specific ocular complications, are important for reduction of both mortality and ocular complications.
念珠菌血症是长期静脉置管、造血干细胞移植或免疫抑制治疗的患者，以及严重免疫缺陷或癌症患者的生命威胁性真菌感染。眼内炎是一种罕见但严重的眼部炎症形式，由眼内腔感染引起，如果不及时、适当治疗，可能导致不可逆转的视力丧失。其初始表现通常涉及脉络膜视网膜炎，需要早期诊断和适当治疗。近平滑念珠菌是一种非白念珠菌酵母种；近年来，在日本的检出频率有所增加，已知存在许多耐药和较少与脉络膜视网膜炎相关的菌株。在这里，我们描述了一名 17 岁的饮食失调症女孩，她因导管相关血流感染（CRBSI）而出现脉络膜视网膜炎，感染源是近平滑念珠菌。该患者因严重体重减轻住院，并且由于使用外周插入的中心导管进行中心肠外营养治疗而出现免疫抑制，被认为患有念珠菌血症。CRBSI 发病后，立即移除了导管。根据眼底检查、真菌种类确认和药物敏感性确认，修改了抗真菌治疗方案；因此，患者在没有长期并发症的情况下康复。据我们所知，这是首例饮食失调症患者由近平滑念珠菌引起的脉络膜视网膜炎报告。营养治疗期间的长期营养不良和免疫抑制使饮食失调症患者发生念珠菌血症的风险增加。CRBSI 发病后，早期给药和适当使用抗真菌药物，同时针对具体的眼部并发症，对于降低死亡率和眼部并发症都很重要。
