Candida尿路感染症, ことに腎孟腎炎について

Abstract

1)日本および米国の各1施設における各種臨床材料由来Candida spp.中でもC. albicansが最も多く分離された.また, C. albicans serotype A株はB株に比し, 5-FCに対する感受性は有意に低かった.2) Candida尿症患者20例(19例はC. albicans, 1例はC. tropicalis)のC. albicansに対する血清中抗体価の分布パターンは, 細菌性複雑性UTI患者23例のそれと類似していた.なお, Candida尿症患者は全例, 神経因性膀胱, 膀胱癌, 前立腺肥大症などの尿路の基礎疾患を有し, 15例は尿路にカテーテルが留置され, また全例が検索前に抗菌化学療法を受けていた.3)雌性ラットを用いた上行性Candida腎盂腎炎は, C. albicans ATCC 10259株を経尿道的に膀胱内へ接種することにより作成された.Candida腎盂腎炎の発症率はcyclophosphamideが投与されたラットで約80%, また一側の不完全尿管閉塞を有するラットでも70%以上であった.なお, 腎内と尿中Candida生菌数の間に有意の相関々係が認められ, さらに腎内Candida生菌数と腎盂腎炎の程度も有意に相関した

The pathogenesis of Candida urinary tract infection (UTI) has been investigated clinically and experimentally with special reference to ascending pyelonephritis in rats. Among the Candida species, Candida albicans was most frequently isolated from clinical specimens including urine in two medical centers, one in Japan and the other in the United States. The isolates of C. albicans serotype B showed a significantly lower susceptibility to 5-fluorocytosine compared to those of serotype A (p less than 0.01). The distribution pattern of the serum antibody titers against C. albicans in 20 candiduria patients (C. albicans 19 and Candida tropicalis 1) was similar to that in 23 bacterial complicated UTI patients. All patients with candiduria had underlying diseases of the urinary tract, such as neurogenic bladder, bladder cancer or benign prostatic hyperplasia: indwelling urinary catheters were present in 15 patients and all had received antimicrobial agents before the study. Ascending Candida pyelonephritis has been investigated in female rats which were transurethrally inoculated into the bladder with C. albicans ATCC 10259 strain. The incidence of Candida pyelonephritis was approximately 80% in rats treated with cyclophosphamide and more than 70% in rats with partial ureteral obstruction. There was a significant relationship between renal and urinary Candida cell populations (p less than 0.01). Furthermore, a significant relationship was revealed between renal Candida cell populations and histological grades of pyelonephritis (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)