Maria Baltogianni, Vasileios Giapros, Niki Dermitzaki
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引用次数: 0
摘要
侵袭性念珠菌感染是新生儿重症监护室(NICU)发病率和死亡率的一个重要原因,尤其是早产儿和低出生体重新生儿。侵袭性念珠菌病的临床表现无特异性,类似于多器官受累的细菌性败血症,因此诊断难度很大。鉴于其不典型的临床表现以及延迟治疗可能带来的不利影响,临床高度怀疑的病例通常会启动经验性治疗。这凸显出,除了已知灵敏度低、检测时间长的培养外,还需要开发其他实验室方法来优化治疗策略。血清生物标记物,包括甘露聚糖抗原/抗甘露聚糖抗体和 1,3-β-D-葡聚糖(BDG)(两者均为酵母细胞壁的成分)、利用 T2 磁共振的纳米诊断方法和基于 PCR 技术的念珠菌 DNA 检测,已作为体液培养的辅助方法进行了研究,并在提高诊断效率和缩短新生儿检测时间方面取得了可喜的成果。本综述旨在概述新生儿侵袭性念珠菌病的诊断工具和现行管理策略。及时准确的诊断和有针对性的抗真菌治疗可显著提高受念珠菌感染的新生儿的存活率和预后。
Recent Challenges in Diagnosis and Treatment of Invasive Candidiasis in Neonates.
Invasive Candida infections represent a significant cause of morbidity and mortality in the neonatal intensive care unit (NICU), particularly among preterm and low birth weight neonates. The nonspecific clinical presentation of invasive candidiasis, resembling that of bacterial sepsis with multiorgan involvement, makes the diagnosis challenging. Given the atypical clinical presentation and the potential detrimental effects of delayed treatment, empirical treatment is often initiated in cases with high clinical suspicion. This underscores the need to develop alternative laboratory methods other than cultures, which are known to have low sensitivity and a prolonged detection time, to optimize therapeutic strategies. Serum biomarkers, including mannan antigen/anti-mannan antibody and 1,3-β-D-glucan (BDG), both components of the yeast cell wall, a nano-diagnostic method utilizing T2 magnetic resonance, and Candida DNA detection by PCR-based techniques have been investigated as adjuncts to body fluid cultures and have shown promising results in improving diagnostic efficacy and shortening detection time in neonatal populations. This review aims to provide an overview of the diagnostic tools and the current management strategies for invasive candidiasis in neonates. Timely and accurate diagnosis followed by targeted antifungal treatment can significantly improve the survival and outcome of neonates affected by Candida species.
期刊介绍:
Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries.
The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.