基础医学与临床 ›› 2021, Vol. 41 ›› Issue (11): 1658-1661.

• 疑难病例 • 上一篇    下一篇

罕见酵母菌-胶红酵母菌血流感染1例

冯晓凯1,2, 何怀武1*, 张佳慧1, 程卫1, 隆云1, 郭伏平3   

  1. 中国医学科学院 北京协和医学院 北京协和医院 1.重症医学科;3.感染内科,北京 100730;
    2.鹤壁市人民医院 急诊科, 河南 鹤壁 458030
  • 收稿日期:2021-01-18 修回日期:2021-07-23 出版日期:2021-11-05 发布日期:2021-10-27
  • 通讯作者: *tjmuhhw@126.com

A rare case of blood stream infection caused by yeast-Rhodotorula glutinis

FENG Xiao-kai1,2, HE Huai-wu1*, ZHANG Jia-hui1, CHENG Wei1, LONG Yun1, GUO Fu-ping3   

  1. 1. Department of Intensive Care Unit; 3. Department of Infections Disease, Peking Union Medical College Hospital, CAMS & PUMC,Beijing 100730;
    2. Department of Emergency, the People's Hospital of Hebi, Hebi 458030,China
  • Received:2021-01-18 Revised:2021-07-23 Online:2021-11-05 Published:2021-10-27
  • Contact: *tjmuhhw@126.com

摘要: 目的 提高关于重症患者关联胶红酵母(R.glutinis)菌血流感染的诊治水平。方法 结合1例心外科术后重症患者继发导管相关性胶红酵母菌血流感染的临床资料,对胶红酵母菌感染导致真菌血症的临床表现、诊断和治疗进行总结。结果 国内外关于胶红酵母菌血流感染,早期诊断困难,容易误诊和漏诊。多发生在免疫抑制人群,表现为反复高热,广谱抗生素治疗无效,G试验(真菌D-葡聚糖)监测无异常升高。诊断需要依赖病原菌培养结果。胶红酵母菌对卡泊芬净和氟康唑耐药,而对其他抗真菌药物两性霉素B、伊曲康唑和伏立康唑敏感。本例患者在培养结果明确后,给予静脉应用两性霉素B及续贯口服泊沙康唑抗真菌治疗取得较好效果。结论 针对应用广谱抗生素和经验性抗真菌(卡泊芬净和氟康唑)治疗无效的重症患者,需要警惕罕见酵母菌-胶红酵母菌血流感染的可能,及时给予敏感抗真菌药物治疗,避免误诊和漏诊。

关键词: 胶红酵母, 血流感染, 念珠菌血症

Abstract: Objective To report a rare severe case of blood stream infection by Rhodotorula glutinis(R.glutinis)and to share our experience in the diagnosis and treatment with colleagues. Methods The report described a case of catheter-associated R.glutinis bloodstream infection was analyzed after cardiac surgery and reviewed relevant literature. Results R.glutinis bloodstream infection is uncommon in the world. It is difficult to make early diagnosis or tend to leading mis-diagnosis. This kind infection is inclined to occur in immuno-compromised individuals, and its clinical features are repeated high fever, failure of treatment with broad-spectrum antibiotics, normal G test (fungal D-glucose Sugar) results. The diagnosis depends on pathogen culture. R. glutinis is resistant to caspofungin and fluconazole but is sensitive to other antifungal drugs, such as amphotericin B, itraconazole and voriconazole. Patient responded well to intravenous amphotericin B and continued oral posaconazole antifungal therapy. Conclusions For critically ill patients who are not respond to broad-spectrum antibiotics and empirical antifungal (caspofungin and fluconazole) treatment, doctors should be aware of the possibility of bloodstream infection caused by yeast-R.glutinis, and treat patient with sensitive antifungal drugs and timely and avoid potential misdiagnosis.

Key words: Rhodotorula glutinis, bloodstream infection, candidemia

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