侵袭性念珠菌病

IF 76.9 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Cornelia Lass-Flörl, Souha S Kanj, Nelesh P Govender, George R Thompson, Luis Ostrosky-Zeichner, Miriam Alisa Govrins
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引用次数: 0

摘要

侵袭性念珠菌病是由白色念珠菌以及越来越多的非白色念珠菌病原体引起的一种重要真菌疾病。侵袭性念珠菌感染最常见于人类内源性储库,由宿主防御功能受损引发。侵袭性念珠菌病的体征和症状无特异性;念珠菌血症是最常见的诊断表现,播散性念珠菌病会影响单个或多个器官。诊断面临许多挑战,传统的培养技术经常辅以非培养检测。念珠菌血症和播散性感染造成的死亡率约为 30%。氟康唑耐药性是光滑中色酵母菌、副荚膜念珠菌和无荚膜念珠菌感染的一个问题,热带念珠菌感染的耐药性则较少;获得性棘白菌素耐药性仍不常见。侵袭性念珠菌病的流行病学在不同的地理区域和不同的患者人群中各不相同。风险因素包括入住重症监护室、使用中心静脉导管、使用广谱抗生素、腹部手术和免疫抑制。早期抗真菌治疗和移除中心静脉导管是降低死亡率的基础。新型疗法的应用范围正在不断扩大;然而,由于新药的作用范围仅限于少数真菌种类,因此需要对符合条件的患者进行仔细筛选。悬而未决的问题和知识空白决定了未来研究的重点,而对侵袭性念珠菌病进行个性化诊断和治疗至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Invasive candidiasis.

Invasive candidiasis.

Invasive candidiasis is an important fungal disease caused by Candida albicans and, increasingly, non-albicans Candida pathogens. Invasive Candida infections originate most frequently from endogenous human reservoirs and are triggered by impaired host defences. Signs and symptoms of invasive candidiasis are non-specific; candidaemia is the most diagnosed manifestation, with disseminated candidiasis affecting single or multiple organs. Diagnosis poses many challenges, and conventional culture techniques are frequently supplemented by non-culture-based assays. The attributable mortality from candidaemia and disseminated infections is ~30%. Fluconazole resistance is a concern for Nakaseomyces glabratus, Candida parapsilosis, and Candida auris and less so in Candida tropicalis infection; acquired echinocandin resistance remains uncommon. The epidemiology of invasive candidiasis varies in different geographical areas and within various patient populations. Risk factors include intensive care unit stay, central venous catheter use, broad-spectrum antibiotics use, abdominal surgery and immune suppression. Early antifungal treatment and central venous catheter removal form the cornerstones to decrease mortality. The landscape of novel therapeutics is growing; however, the application of new drugs requires careful selection of eligible patients as the spectrum of activity is limited to a few fungal species. Unanswered questions and knowledge gaps define future research priorities and a personalized approach to diagnosis and treatment of invasive candidiasis is of paramount importance.

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来源期刊
Nature Reviews Disease Primers
Nature Reviews Disease Primers Medicine-General Medicine
CiteScore
76.70
自引率
0.20%
发文量
75
期刊介绍: Nature Reviews Disease Primers, a part of the Nature Reviews journal portfolio, features sections on epidemiology, mechanisms, diagnosis, management, and patient quality of life. The editorial team commissions top researchers — comprising basic scientists and clinical researchers — to write the Primers, which are designed for use by early career researchers, medical students and principal investigators. Each Primer concludes with an Outlook section, highlighting future research directions. Covered medical specialties include Cardiology, Dermatology, Ear, Nose and Throat, Emergency Medicine, Endocrinology, Gastroenterology, Genetic Conditions, Gynaecology and Obstetrics, Hepatology, Haematology, Infectious Diseases, Maxillofacial and Oral Medicine, Nephrology, Neurology, Nutrition, Oncology, Ophthalmology, Orthopaedics, Psychiatry, Respiratory Medicine, Rheumatology, Sleep Medicine, and Urology.
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