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Key words: disseminated candidiasis, amphotericin B, fluconazole

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Fig. 1.

Clinical course CVC; central venous catheter (subclavian), ABPC; ampicillin, ABPC/MCIPC; ampicillin/ cloxacillin, AMPH-B; amphotericin B, CMZ; cefmetazole, FLCZ; fluconazole, IPM/CS; imipenem/ cilastatin.


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Table 1. WBC Neu Lym Mon Eos RBC Hb Ht Plt ESR Urine protein

Laboratory findings on August 28

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Vol. 17

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Drug 2000/07/28 a

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Fig. 2.

Chest X-ray (8/28) A posterior-anterior view of the chest obtained on internal medicine admission reveals many small nodules (black arrows) in many lobes.

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Houston, United States' ()& b-9-glucan * 639.5 pg/ml + ,-./ 012 3 X 456* (Fig. 2) 8/10 78 9:;< =>?@ABC)DEF& 01 CT (Fig. 3) G H)I.JE ῒ῎῍῔ῐῑ KLMNOJE Candida HP*& ID32C QR STUVWXYZ' [\ ]^_=`a *& bc6d FP efg hi8j' [\& kE D* Clinical Laboratory Standards Institue (CLSI) lmnopqr\9) ]^_=st Table 2  ῕ΐ῏ῌ u v O  J E  C. glabrata  w  x FLCZ  MIC * 2y4 mg/ml ^_=(/&  100 mg/day z{' |D 400 mg/day z{& 9/4 M N }7~'  \€‚\ ƒ„KL … & 6d*†JE |)& \ ‡& ˆ‰& Š|D* ID32C QRH‹ŒZ Fig. 3.

Chest computed tomography (8/28) CT scanning of the chest performed one week after FLCZ administration shows many small nodular shadows in both lungs (white arrow).

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Fig. 4.

Chest computed tomography (9/14) CT scanning of the chest performed three weeks after FLCZ administration shows some nodules slightly decreased in size, as compared with earlier chest CT scan, but a new lesion appeared (black arrow).

Fig. 5.

127

Chest computed tomography (10/12) CT scanning of the chest four weeks after AMPH-B administration shows little nodules (white circle).

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  28: 177ῌ182.       1984.  !"#$%&'()*$+ ,
-(./0 Disseminated Candidiasis ! 1 123 456789 58: 556ῌ561. Tanaka, H., K. Suzuki, T. Nakahata, et al. 2002. Disseminated candidiasis following prednisolone therapy in systemic lupus erythematosus. Pediatr. Int. 44: 702ῌ704. :; < =>?@A BCD E 2003. FG HIJKL B !MNOPQRS0TUVWXXY Z$[\-]./0^_`ab^c! 1 3 R0d/ebf 20: 669ῌ672. ghij >klm n; o E 2004. pq rsLtL-uv/0^_`ab^c! 3 3 Progress in Medicine 24: 2807ῌ2817. John, E. B. 2005. Candida species. p. 2938ῌ 2957, In: Principles and practice of infectious disease, 7th ed. (G. L. Mandell, J. E. Bennet, R. Dolin, eds.), Elsevier. Myerowitz, R. L., G. J. Pazin, C. M. Allen. 1977. Disseminated candidiasis. Changes in incidence, underlying diseases, and pathology. Am. J. Clin. Pathol. 00: 29ῌ38. BwxyA z {| }~€ E 1998. ‚ n7ƒ7„…†$‡ˆ‰ 17 ŠY!`a 6 ‹Œa!Ž 456789 72: 105ῌ113. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts; Approved Standard. 1997. NCCLS. Villanova. [‘ ’“”• – —˜ E 2002. qL ™š(.%›œž$Ÿ/J ¡¢¡$£‰ amphotericn-B !¤¥¦§¨N©P/0 ª«  (M2) ! 1 3 ¬ 38 ­®¯%)7° ±°

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Zaoutis, T. E., H. M. Greves, E. Lautenbach, et al. 2004. Risk factors for disseminated candidiasis in children with candidemia. Pediatr. Infect. Dis. J. 23: 635ῌ641. Brook, R. G. 1989. Prospective study of Candida endophthalmitis in hospitalized patients with candidemia. Arch. Intern. Med. 149: 2226ῌ2268. Ostrosky-Zeichner, L., B. D. Alexander, D. H. Kett, et al. 2005. Multicenter clinical evaluation of the (1²3)b-9-glucan assay as an aid to diagnosis of fungal infections in humans. Clin. Infect. Dis. 42: 654ῌ659. Peter, P. G., J. H. Rex, J. D. Sobel, et al. 2004. Guidelines for treatment of candidiasis. Clin. Infect. Dis. 38: 161ῌ189. Anaissie, E. J., S. E. Vartivarian, D. Abi-Said, et al. 1996. Fluconazole versus amphotericin B in the treatment of hematogenous candidiasis: A matched cohort study. Am. J. Med. 101: 170ῌ 176. John, E. B. 2004. Candidiasis. p. 1185ῌ1188, In: Harrison’s Principles of Internal Medicine, 16th ed. (L. K. Dennis, B. Eugene, S. F. Anthony, et al., eds.), McGraw-Hill Medical Publishing. Mora-Duarte J., R. Betts, C. Rotstein, et al. 2002. Comparison of caspofungin and amphotericin B for invasive candidiasis. New Engl. J. Med. 347: 2020ῌ2029. Cagnoni, P. J., T. J. Walsh, M. M. Prendergast, et al. 2000. Pharmacoeconomic analysis of liposomal amphotericin B versus conventional amphotericin B in the empirical treatment of persistently febrile neutropenic patients. J. Clin. Oncol. 18: 2476ῌ2483.

A Case of Disseminated Pulmonary Candidiasis Caused by Candida glabrata Toshimori Yamaoka,1) Sayoko Kawakami,2) Mariko Yamamura,1) Ryuichi Fujisaki,1) Yasuo Ono,3) Hajime Nishiya1) 1) 2) 3)

Department of Internal Medicine, Teikyo University School of Medicine Department of Central Laboratory, Teikyo University Hospital Department of Microbiology and Immunology, Teikyo University School of Medicine

Twenty-seven year old woman was admitted to our surgical department because of abdominal pain. Several days after an insertion of a central venous catheter she had a candidemia, followed by disseminated lesions in the both lungs of candidiasis 2 weeks-after. The high levels of serum (1²3)b-9-glucan, two times of episodes of Candida glabrata from blood and localized lesions in the lung with no other foci evaluated with radiological findings supported her disseminated candidiasis localized in both lungs, the candidiasis localized in the lungs by Candida glabrata being the first reported case in Japan. After a removal of the catheter, administration of fluconazol brought defervescence, but the serum levels of the b-9-glucan and the ®¯789

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disseminated lesions showed little improvement, which improved after administration of amphotericin B. Many cases with disseminated candidiasis were diagnosed after their death. The serum levels of the glucan and radiological evaluation present useful information in diagnosing and monitoring the disseminated candidiasis.

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