Ferra C, Doebbeling B N, Hollis R J, Pfaller M A, Lee C K, Gingrich R D
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City.
Clin Infect Dis. 1994 Oct;19(4):697-703. doi: 10.1093/clinids/19.4.697.
Two adult patients who had undergone bone marrow transplantation had transient fungemia due to Candida tropicalis during the posttransplantation neutropenic period and later (at 5 and 14 months post-transplantation) developed vertebral osteomyelitis due to the same organism. The courses of all adult patients who underwent bone marrow transplantation at our center during this time were reviewed for determining the frequency of this problem. Molecular typing techniques were used to establish the relationship between the organisms isolated during the initial fungemia and those causing the subsequent osteomyelitis. Only two of 532 adults who received transplants at our center from 1980 to 1993 developed candidal osteomyelitis. Moreover, they are part of a subset of 13 patients (2.4% of the total) whose cultures were positive for C. tropicalis; five of the 13 had fungemia. The study of fungal isolates from prior sites of colonization and from blood sampled during the original fungemia and of subsequently recovered vertebral bone isolates by means of DNA restriction fragment analysis (with use of standard agarose gel electrophoresis or pulsed-field gel electrophoresis) showed that the colonizing, bloodstream, and bone isolates were identical in each case. Transient C. tropicalis fungemia in severely immunocompromised patients may cause important late infectious complications, including osteomyelitis. Although these initial septic events may appear to resolve easily, the outcome in the two cases in this report suggests that special treatment considerations, such as immediate removal of the central venous catheter and intensive treatment with amphotericin B, may be required in selected cases for prevention of late sequelae.
两名接受过骨髓移植的成年患者在移植后中性粒细胞减少期出现热带假丝酵母菌引起的短暂真菌血症，随后（移植后5个月和14个月）因同一病原体发生椎体骨髓炎。回顾了在此期间在我们中心接受骨髓移植的所有成年患者的病程，以确定该问题的发生率。采用分子分型技术确定初始真菌血症期间分离出的病原体与引起随后骨髓炎的病原体之间的关系。1980年至1993年在我们中心接受移植的532名成年人中，只有2人发生念珠菌性骨髓炎。此外，他们是13名患者亚组的一部分（占总数的2.4%），其培养物热带假丝酵母菌呈阳性；13人中有5人发生真菌血症。通过DNA限制性片段分析（使用标准琼脂糖凝胶电泳或脉冲场凝胶电泳）对先前定植部位、原始真菌血症期间采集的血液以及随后从椎体骨中分离出的真菌进行研究，结果表明，每种情况下定植、血流和骨分离株均相同。严重免疫功能低下患者的短暂热带假丝酵母菌真菌血症可能导致重要的晚期感染并发症，包括骨髓炎。尽管这些初始败血症事件似乎很容易解决，但本报告中的两例病例结果表明，在某些情况下可能需要特殊的治疗考虑，如立即拔除中心静脉导管并用两性霉素B进行强化治疗，以预防晚期后遗症。
