摘要
目的报道2例由糠秕马拉色菌引起的导管相关感染病例。方法2例接受全肠外营养住院患者出现发热后,分别留取中心静脉导管(PICC)进行培养,使用BACT/ALERT 3D系统进行外周血培养,检测(1,3)-β-D葡聚糖。采用VITEK II Compact和基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)进行菌种鉴定,并进行26S rDNA D1/D2和rDNA ITS双向测序。采用E-test法进行抗真菌药敏试验,测试药物包括氟康唑、伏立康唑、伊曲康唑、两性霉素B和卡泊芬净。结果2名患者PICC培养7 d后血琼脂上有小菌落生长,用VITEK II和MALDI-TOF MS鉴定均为糠秕马拉色菌,经ITS和26S D1/D2测序分析证实。两名患者的外周血瓶培养30 d均为阴性,(1,3)-β-D葡聚糖小于150 pg/mL。两株糠秕马拉色菌的体外药敏试验结果相同,氟康唑、伏立康唑、伊曲康唑、两性霉素B和卡泊芬净的最低抑菌浓度(MIC)分别为>256μg/mL、>32μg/mL、0.38μg/mL、>32μg/mL和>32μg/mL。结论由马拉色菌引起的导管相关感染不易检出,当临床怀疑使用PICC患者感染马拉色菌时,建议延长培养时间或使用专用培养基。(1,3)-β-D葡聚糖对马拉色菌属所致导管相关感染的诊断帮助不大。伊曲康唑可能是治疗糠秕马拉色菌所致感染的合适选择。
Objective To report two cases of catheter-related infection caused by Malassezia furfu.Methods Two hospitalized patients who received total parenteral nutrition developed fever.Their peripherally inserted central catheters(PICC)were collected and cultured separately.Their peripheral blood cultures were performed by BACT/ALERT 3D system and 1,3-β-D-glucan was examined.VITEK II compact and VITEK matrix-assisted laser desorption ionization-time of flight mass spectrometry(MALDI-TOF MS)were applied to identify the colonies,26S rDNA D1/D2 and rDNA ITS were sequenced bidirectionally.Antifungal agents including fluconazole,voriconazole,itraconazole,amphotericin B and caspofungin were tested by using E-test method.Results Colonies from the PICCs of the two patients were observed on the blood agars after 7 days,and both were identified as M.furfur by VITEK II and MALDI-TOF MS.Sequence analysis of ITS and 26S D1/D2 confirmed the results.Both of the two patients’blood cultures were negative although they had been cultured for over 30 days.Levels of 1,3-β-D-glucan for the two patients always didn’t exceed 150 pg/ml.Profiles of in vitro susceptibility test for the two M.furfur isolates were identical.The minimum inhibitory concentrations(MICs)of fluconazole,voriconazole,itraconazole,amphotericin B and caspofungin were>256μg/mL,>32μg/mL,0.38μg/mL,>32μg/mL,and>32μg/mL respectively.Conclusions Catheter related infections caused by Malassezia are difficult to detect.Clinical suspicion of infection with Malassezia in PICC patients suggests prolonging the culture time or using specialized culture media.
作者
王梦珍
于淑颖
闫文娟
窦红涛
徐英春
WANG Mengzhen;YU Shuying;YAN Wenjuan;DOU Hongtao;XU Yingchun(Department of Laboratory Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China)
出处
《中国真菌学杂志》
CSCD
2024年第2期126-130,共5页
Chinese Journal of Mycology
基金
北京协和医院沉淀整合基金(ZC201905334)。
