Worthington M
J Infect. 1983 Sep;7(2):159-61. doi: 10.1016/s0163-4453(83)90674-6.
An 83-year-old previously well non-immunosuppressed woman developed invasive fatal candida pneumonia, apparently caused by aspiration. Diagnosis was suggested by the presence of sheets of budding yeasts and pseudohyphae on Gram-stained expectorated sputum and confirmed by an open lung biopsy which demonstrated candida invading lung tissue. Culture of material obtained by open lung biopsy yielded Candida albicans. At autopsy the patient had extensively invasive bilateral candida pneumonia. No other pathogens were isolated from sputum, open lung biopsy or at the time of autopsy. Evidence of disseminated candidiasis was not seen at autopsy. To our knowledge, this is only the fourth documented case of aspiration candida pneumonia in a non-immunosuppressed adult. While candida pneumonia in an immunocompetent adult is very rare, it should be considered in an elderly patient who is not responding to antibiotic therapy. Diagnosis requires aspiration or biopsy of lung, with preferably both histological and cultural evidence of candida infection.
一名83岁、此前健康且无免疫抑制的女性患上了侵袭性致命念珠菌肺炎，显然是由误吸引起的。革兰氏染色咳出痰液中存在成片的芽生酵母和假菌丝提示了诊断，经开放性肺活检证实，活检显示念珠菌侵入肺组织。开放性肺活检获取的材料培养出白色念珠菌。尸检时患者患有广泛侵袭性双侧念珠菌肺炎。痰液、开放性肺活检或尸检时均未分离出其他病原体。尸检时未发现播散性念珠菌病的证据。据我们所知，这是有记录的第四例非免疫抑制成年人误吸念珠菌肺炎病例。虽然免疫功能正常的成年人患念珠菌肺炎非常罕见，但对于对抗生素治疗无反应的老年患者应考虑此病。诊断需要进行肺抽吸或活检，最好同时有念珠菌感染的组织学和培养证据。
