Fainstein V, Gilmore C, Hopfer R L, Maksymiuk A, Bodey G P
Rev Infect Dis. 1982 Jan-Feb;4(1):78-85. doi: 10.1093/clinids/4.1.78.
In disseminated candidiasis, various organs frequently become involved, usually as a consequence of hematogenous spread of the organism. However, involvement of the joints is rare even with dissemination. Nineteen cases of joint involvement have previously been reported in adults and 21 cases in children. The most commonly involved joint has been the knee; in such cases, amphotericin B has been effective in controlling the infection. Five patients with cancer developed septic arthritis due to Candida species at the M. C. Anderson Hospital and Tumor Institute in the past five years. Four of these patients were seen in 1980. Candida albicans was isolated from three patients and Candida tropicalis from two. All five patients had predisposing conditions - e.g., intravenous and/or urinary catheterization, neutropenia, and previous treatment with steroids and antibiotics. The knee was the affected joint in all five. Different modalities of treatment were used, including intravenous miconazole, oral ketoconazole, and systemic and local amphotericin B; adequate levels of these drugs were found in the joint fluid when measured. Infection was cured in two patients. The condition of the third patient improved. The fourth patient died of disseminated disease despite therapy, and the fifth died of malignancy without the benefit of antifungal therapy. For treatment of such infections, the use of an antifungal agent is recommended in addition to frequent evacuation of the joint fluid. Some new compounds may prove useful alternatives to amphotericin B. Arthritis can be resolved even in the presence of unresolved disseminated disease.
在播散性念珠菌病中，各种器官常受累，通常是该病原体血行播散的结果。然而，即使发生播散，关节受累也很罕见。此前已报道19例成人关节受累病例和21例儿童关节受累病例。最常受累的关节是膝关节；在这类病例中，两性霉素B已被证明可有效控制感染。在过去五年中，在MD安德森医院和肿瘤研究所，有5例癌症患者因念珠菌属感染发生了化脓性关节炎。其中4例患者于1980年就诊。从3例患者中分离出白色念珠菌，从2例患者中分离出热带念珠菌。所有5例患者都有易感因素，如静脉内和/或导尿、中性粒细胞减少，以及先前使用过类固醇和抗生素。所有5例患者的受累关节均为膝关节。采用了不同的治疗方式，包括静脉注射咪康唑、口服酮康唑，以及全身和局部使用两性霉素B；测量时在关节液中发现了这些药物的足够浓度。2例患者感染治愈。第3例患者病情好转。第4例患者尽管接受了治疗仍死于播散性疾病，第5例患者未接受抗真菌治疗死于恶性肿瘤。对于此类感染的治疗，除了频繁抽取关节液外，建议使用抗真菌药物。一些新化合物可能被证明是两性霉素B的有用替代物。即使存在未解决的播散性疾病，关节炎也可以得到缓解。
