Post-mortem analýza průlomové infekce Candida albicans při léčbě echinokandiny u pacienta po transplantaci kmenových buněk krvetvorby

English version

Authors: V. Chrenkova ¹; P. Hubacek ^1,2; P. Sedlacek ²; P. Riha ²; D. Kodetová ³; E. Bébrová ⁴
Authors‘ workplace: Department of Medical Microbiology nd Faculty of Medicine, Charles University in Prague and Motol University Hospital ¹; Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital ²; Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital ³; Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital ⁴
Published in: Epidemiol. Mikrobiol. Imunol. 63, 2014, č. 2, s. 121-124
Category: Review articles, original papers, case report

Overview

Představujeme případ úmrtí dívky na průlomovou infekci Candida albicans při léčbě echinokandiny po transplantaci kmenových buněk krvetvorby pro relaps akutní myeloidní leukémie. Hemokultivace prokázaly opožděně přítomnost rezistence na echinokandiny u kmene Candida albicans, která je obvykle považována za dobře citlivou k antimykotické terapii. Echinokandin podávaný v profylaxi nebyl z důvodu závažných orgánových komplikací (játra, ledviny) změněn na preparát z jiné skupiny ani v léčbě invazivní infekce. Později provedené molekulární analýzy prokázaly přítomnost mutace S645P, popsané jako příčiny rezistence k echinokandinům. Dále byla provedena post-mortem analýza nálože kvasinkové infekce ve tkáních, která prokázala velmi vysoké kvantity kvasinkové DNA v zažívacím traktu, játrech, slezině a ledvinách.

Klíčová slova:
invazivní kandidová onemocnění – transplantace kmenových buněk krvetvorby – rezistence na echinokandiny

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