Johnson D E, Thompson T R, Green T P, Ferrieri P
Pediatrics. 1984 Feb;73(2):138-43.
Previous reports in the literature have documented that systemic infection with Candida albicans in very premature infants is frequently fatal (54%) or associated with significant morbidity in survivors (25%). Five patients with a mean birth weight of 829 g had a diagnosis of systemic candidiasis during their stay in a newborn intensive care unit. All infants survived with minimal sequelae following aggressive early treatment with amphotericin B and 5-flucytosine. A review of these five extremely premature infants and 26 previously reported patients suggests the following: (1) disseminated candidiasis is common in the absence of positive findings in blood, CSF, and/or urine cultures; (2) transient candidemia rarely resolves without therapy; (3) meningitis and osteoarthritis occur more frequently than in older patients with disseminated disease; and (4) premature infants tolerate amphotericin B and 5-flucytosine well. Infants who are found to have systemic cultures positive for candidiasis should be treated by (1) removing all factors that predispose to systemic candidiasis (eg, indwelling catheters, broad-spectrum antibiotics); (2) early initiation of systemic antifungal therapy with amphotericin B and 5-flucytosine; and (3) searching for additional foci of disease. After the disease is recognized and treatment is prompt and aggressive, outcome can be substantially improved.
文献中先前的报告记载，极低体重早产儿的白色念珠菌全身性感染往往是致命的（54%），或在幸存者中伴有严重的发病情况（25%）。5名平均出生体重为829克的患儿在新生儿重症监护病房住院期间被诊断为全身性念珠菌病。在用两性霉素B和5-氟胞嘧啶进行积极的早期治疗后，所有婴儿均存活，且后遗症极少。对这5名极早产儿和之前报告的26例患者进行回顾后发现如下情况：（1）在血培养、脑脊液培养和/或尿培养无阳性结果的情况下，播散性念珠菌病很常见；（2）未经治疗的短暂性念珠菌血症很少自行缓解；（3）脑膜炎和骨关节炎在播散性疾病患儿中比在年龄较大的患者中更常见；（4）早产儿对两性霉素B和5-氟胞嘧啶耐受性良好。对于血培养念珠菌呈阳性的婴儿，应通过以下方式进行治疗：（1）去除所有易引发全身性念珠菌病的因素（如留置导管、广谱抗生素）；（2）早期开始用两性霉素B和5-氟胞嘧啶进行全身性抗真菌治疗；（3）寻找其他疾病病灶。在疾病得到确认且治疗迅速且积极的情况下，预后可得到显著改善。
