Candida尿路感染症の治療二血清中抗体価および血清中 D-arabinito1値の推移からみた検討

Abstract

Candida尿路感染症11例中10例で5-FC投与は有効であった.うちCandida腎盂腎炎が疑われた4例中3例に, Candida血症を伴った2例中1例に4倍以上の血清中Candida抗体価の上昇を認めたが, その上昇には14～31日間を要した.血清中D-arabinitolはCandida腎盂腎炎やCandida血症を伴った全例に検出可能で, 5-FC投与とともに速やかに下降し陰性化した

A clinical study was carried out on 11 patients with Candida urinary tract infection; 4 with chronic cystitis and 7 with acute pyelonephritis including 2 patients associated with candidemia. The patients received 1.5 to 6.0 g of 5-fluorocytosine (5-FC) orally daily for 6 to 22 days. The response was excellent in 6, moderate in 4 and poor in 1 case, overall efficacy rate being 90.9%. No patients showed any adverse reaction. The antibody against the Candida species was measured by an indirect hemagglutination test and the serum level of D-arabinitol, a major metabolite of Candida species, was determined by gas-liquid chromatography. A 4-fold or greater rise in anti-Candida antibody was detected in 4 of the 6 patients with pyelonephritis, including one patient associated with candidemia, 14 to 31 days following the treatment. Serum D-arabinitol levels in all of the 4 patients with pyelonephritis exceeded the detection limit of 0.2 microgram/ml before treatment. The levels decreased promptly during treatment and normalized 10 to 20 days after the start of treatment. These results suggest that 5-FC is an effective drug for Candida urinary tract infections. The determinations of anti-Candida antibody titer and serum D-arabinitol level may be clinically useful for the diagnosis of Candida pyelonephritis. In particular, the serum levels of D-arabinitol appear to be a useful parameter to follow-up the effect of anti-fungal treatment on Candida pyelonephritis.