Talluri G, Mangone C, Freyle J, Shirazian D, Lehman H, Wise G J
Division of Urology, Maimonides Medical Center, Brooklyn, New York 11219, USA.
Urology. 1998 Mar;51(3):501-5. doi: 10.1016/s0090-4295(97)00641-9.
Candiduria has been shown to be an early marker of disseminated fungal infection in critically ill patients who have undergone surgery. The management of candidemia and disseminated candidiasis depends on rapid and definitive identification of Candida. Routine or fungus-specific blood cultures are unreliable and require a large quantity of blood for incubation. We describe the importance of the polymerase chain reaction (PCR) procedure in the early detection of candidemia in critically ill patients who develop candiduria and the favorable outcome in treating these patients with systemic antifungal therapy.
We compared the results of cultures and PCR to detect the presence of C. albicans in the blood of two critically ill patients with clinical candidiasis and candiduria.
PCR detected the presence of C. albicans deoxyribonucleic acid (DNA) in urine and blood specimens of both patients in spite of negative blood cultures and did not detect fungal DNA after systemic antifungal therapy.
Candiduria manifests as an early sign of candidemia, and systemic antifungal therapy timed appropriately based on the clinical condition and onset of candiduria will improve outcome. Detection of fungal DNA in blood by PCR is of value in establishing the diagnosis. Additional studies with a larger sample size are required to evaluate the specificity and sensitivity of PCR as a routine diagnostic test for candidemia.
在接受手术的重症患者中，念珠菌尿已被证明是播散性真菌感染的早期标志物。念珠菌血症和播散性念珠菌病的治疗取决于对念珠菌的快速明确鉴定。常规血培养或真菌特异性血培养不可靠，且需要大量血液进行培养。我们描述了聚合酶链反应（PCR）程序在早期检测发生念珠菌尿的重症患者念珠菌血症中的重要性，以及全身抗真菌治疗这些患者的良好结果。
我们比较了培养和PCR检测两名患有临床念珠菌病和念珠菌尿的重症患者血液中白色念珠菌存在情况的结果。
尽管血培养阴性，但PCR在两名患者的尿液和血液标本中均检测到白色念珠菌脱氧核糖核酸（DNA），且在全身抗真菌治疗后未检测到真菌DNA。
念珠菌尿表现为念珠菌血症的早期迹象，根据临床情况和念珠菌尿的发生时间适时进行全身抗真菌治疗将改善预后。通过PCR检测血液中的真菌DNA对确诊有价值。需要进行更多样本量的研究来评估PCR作为念珠菌血症常规诊断试验的特异性和敏感性。
