Mandak J S, Pollack B, Fishman N O, Furth E E, Kochman M L, Acker M A, Lichtenstein G R
Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Am J Gastroenterol. 1995 Aug;90(8):1333-7.
Acalculous cholecystitis is a life-threatening complication in critically ill surgical patients. Whereas Candida albicans and Torulopsis glabrata have been reported as the primary pathogens in 14 previous cases of acalculous cholecystitis, we report the first case of Candida parapsilosis as a biliary pathogen in a patient after cardiac transplantation. Although cardiac transplant recipients often have many of the risk factors for acalculous candidal cholecystitis, including major surgery, immunosuppression, antibiotic therapy, parenteral nutrition, and prolonged intensive care unit stay, this entity has not been previously reported in the cardiac transplant population. Although rare, acalculous candidal cholecystitis is associated with very high morbidity and a mortality rate of 40%. Early diagnosis necessitates an aggressive approach to the critically ill patient with abdominal complaints. Prompt drainage or cholecystectomy, if possible, represent the mainstays of therapy and offer the greatest chance for survival.
无结石性胆囊炎是危重症外科患者中一种危及生命的并发症。尽管白色念珠菌和光滑念珠菌在之前14例无结石性胆囊炎病例中被报道为主要病原体，但我们报告了首例心脏移植术后患者发生近平滑念珠菌作为胆道病原体的病例。虽然心脏移植受者通常有许多无结石性念珠菌性胆囊炎的危险因素，包括大手术、免疫抑制、抗生素治疗、肠外营养和长时间入住重症监护病房，但此前在心脏移植人群中尚未有该病症的报道。无结石性念珠菌性胆囊炎虽然罕见，但发病率极高，死亡率达40%。早期诊断需要对有腹部症状的危重症患者采取积极的诊断方法。如有可能，及时引流或胆囊切除术是主要的治疗方法，也是提供最大生存机会的方法。
