首页|新型隐球菌尿路感染合并血流感染1例并文献复习

新型隐球菌尿路感染合并血流感染1例并文献复习

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目的 分析总结新型隐球菌尿路感染合并血流感染的途径和临床特征,为临床对新型隐球菌感染病例的诊疗提供借鉴.方法 回顾性分析1例新型隐球菌尿路感染合并血流感染病例,并分别以"Cryptococcus neoformans""Cryptococcal neoformans infection""新型隐球菌""新型隐球菌感染"为关键词,检索1965-2023年外文PubMed数据库、中文万方数据知识服务平台以及中国知网数据库中相关文献.结合文献报道,总结新型隐球菌感染的诊疗线索及方法.结果 中文数据库未见新型隐球菌尿路感染病例报道,有外文文献回顾调查了 1992-2003年新型隐球菌中段尿培养阳性的16名患者情况.其中,15例患有HIV感染、糖尿病、高血压或系统性红斑狼疮等基础疾病;9例患者接受了抗真菌治疗,其余7例患者在治疗前被误诊或死亡,病死率为64%;13例有新型隐球菌播散性感染的表现,其余3例表现为单一性尿路感染;16例患者尿培养均检出新型隐球菌,其中2例(占13%)尿常规提示酵母菌阳性、12例尿蛋白阳性(75%)、5例为脓尿(31%).本例患者在入院当日尿常规检测中提示酵母菌阳性,并先后在中段尿培养和血培养中检出新型隐球菌,给予氟康唑等抗感染治疗,最终患者出现感染性休克和多器官衰竭而死亡.结论 新型隐球菌引起尿路感染的病例极罕见,尿路创伤受损可能是主要危险因素.尿中检出新型隐球菌可能是播散性隐球菌病的一个潜在的早期指标,临床应提高对该菌致尿路感染的认识,及早进行相关监测及治疗,以改善预后,提高生存率.
Urinary tract and bloodstream infections caused by novel Cryptococcus neoformans:One case report and literature review
Objective This study analyzed and summarized the ways and clinical characteristics of urinary tract infection with blood stream infection caused by Cryptococcus neoformans and provided reference for clinical diagnosis and treatment of Cryptococciasis neoformans.Methods A case of Cryptococcus neoformans urinary tract infection combined with a bloodstream infection was retrospectively analyzed.Using"Cryptococcus neoformans"and"Cryptococcus neoformans infection"as keywords,respectively,the foreign PubMed database,Chinese Wanfang Data Knowledge Service Platform and China National Knowledge Infrastructure were searched from 1965 to 2023.By consulting the relevant literature above,the clues and methods of diagnosis and treatment of Cryptococcus neoformans infection diseases were summarized.Results There were no reported cases of Cryptococcus neoformans urinary tract infection in Chinese databases.A review of foreign literature investigated the situation of 16 patients with positive midstream urine cultures for Cryptococcus neoformans from 1992 to 2003.Among them,15 patients had underlying diseases such as HIV infection,diabetes,hypertension,or systemic lupus erythematosus;9 patients received antifungal treatment;and the remaining 7 patients were misdiagnosed or died before treatment,with a case fatality rate of 64%.13 cases had symptoms of disseminated infection with Cryptococcus neoformans,and the remaining 3 cases presented with a single urinary tract infection.Cryptococcus neoformans was detected in the urine culturesof 16 patients,and 2 of them(13%)had positive urine tests for yeast.12 cases were positive for proteinuria(75%),and 5 cases were positive for pyuria(31%).Among the cases reported,the patient showed that yeast was positive in the urine routine test on the day of admission,and Cryptococcus neoformans was detected in midstream urine culture and blood culture.The patient was given anti-infection treatment with fluconazole,et al,and finally died of septic shock and multiple organ failure.Conclusion Urinary tract infections caused by Cryptococcus neoformans are extremely rare,and urinary tract trauma might be the main risk factor.The detection of Cryptococcus neoformans in urine was considered to be one of the early indicators of disseminated cryptococcosis.Clinically,we should improve our understanding of urinary tract infections caused by this strain,monitor them as early as possible,and carry out targeted treatment in time to improve the prognosis and survival rate.

Cryptococcus neoformansUrinary tract infectionBloodstream infectionUrine mycologyInfectious diseases

周国栋、曹贤、张娜

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内蒙古鄂尔多斯市中心医院检验科,鄂尔多斯 017010

新型隐球菌 尿路感染 血流感染 尿液真菌学 感染性疾病

内蒙古自治区科技计划 "十四五"社会公益领域重点研发和成果转化项目

2022YFSH0123

2024

中国抗生素杂志
中国医药集团总公司四川抗菌素工业研究所,中国医学科学院医药生物技术研究所

中国抗生素杂志

CSTPCD北大核心
影响因子:1.08
ISSN:1001-8689
年,卷(期):2024.49(6)
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