PDF(Pubmed)
Abstract：
Invasive fungal infections (IFIs) are associated with high mortality rates and mostly affect patients with compromised immunity. The incidence of IFIs is increasing worldwide with the expanding population of susceptible patients. Candida and other yeast infections represent a major component of IFIs. Rare Candida/yeast infections have also increased in recent years and pose considerable diagnostic and management challenges as they are not easily recognized by routine phenotypic characteristic-based diagnostic methods and/or by the automated yeast identification systems. Rare Candida/yeasts also exhibit reduced susceptibility to antifungal drugs making proper management of invasive infections challenging. Here, we review the diagnosis and management of 60 cases of rare Candida/yeast IFIs described so far in Kuwait, an Arabian Gulf country in the Middle East. Interestingly, majority (34 of 60, 56.7%) of these rare Candida/yeast invasive infections occurred among neonates or premature, very-low-birth-weight neonates, usually following prior bacteremia episodes. The clinical details, treatment given, and outcome were available for 28 of 34 neonates. The crude mortality rate among these neonates was 32.2% as 19 of 28 (67.8%) survived the infection and were discharged in healthy condition, likely due to accurate diagnosis and frequent use of combination therapy. Physicians treating patients with extended stay under intensive care, on mechanical ventilation, receiving broad spectrum antibiotics and with gastrointestinal surgery/complications should proactively investigate IFIs. Timely diagnosis and early antifungal treatment are essential to decrease mortality. Understanding the epidemiology and spectrum of rare Candida/yeast invasive infections in different geographical regions, their susceptibility profiles and management will help to devise novel diagnostic and treatment approaches and formulate guidelines for improved patient outcome.
摘要：
侵袭性真菌感染（IFIs）与高死亡率相关，主要影响免疫力受损的患者。随着易感患者人群的扩大，IFIs的发病率在世界范围内不断增加。念珠菌和其他酵母菌感染是IFIs的主要组成部分。近年来,罕见的念珠菌/酵母菌感染也有所增加,并且带来了相当大的诊断和管理挑战,因为它们不容易被常规的基于表型特征的诊断方法和/或自动化酵母识别系统识别。罕见的念珠菌/酵母也表现出对抗真菌药物的敏感性降低,使得侵入性感染的适当管理具有挑战性。这里,我们回顾了迄今为止在科威特描述的60例罕见的念珠菌/酵母IFIs的诊断和处理，中东的阿拉伯海湾国家。有趣的是,这些罕见的念珠菌/酵母菌侵入性感染中的大多数（60个中的34个，56.7％）发生在新生儿或早产儿中，极低出生体重的新生儿，通常在先前的菌血症发作之后。临床细节，给予治疗，34例新生儿中有28例获得了结果。这些新生儿的粗死亡率为32.2％，因为28人中有19人（67.8％）在感染中幸存下来并在健康状态下出院，可能是由于准确的诊断和频繁使用联合治疗。医生在重症监护下治疗长期住院的患者，关于机械通风，接受广谱抗生素和胃肠手术/并发症应积极调查IFIs.及时诊断和早期抗真菌治疗对降低死亡率至关重要。了解不同地理区域的罕见念珠菌/酵母菌侵入性感染的流行病学和频谱，他们的易感性和管理将有助于设计新的诊断和治疗方法，并制定改善患者预后的指南。
