RESUMEN
Objective To discuss the therapeutic significance of granulocyte colony stimulating factor (G-CSF) in the treatment of invasive Candida infections in congenital immunodeficiency,especially in cases with low level of interleukin 17(IL-17). Methods Therapeutic processes of 2 children suffering from invasive Candida infections secondary to congenital immunodeficiency were retrospectively studied,further-more,the related literatures were also reviewed. Results Whole-exome sequencing revealed CARD9 muta-tion in the first patient, who suffered from Candida albicans meningoencephalitis, while the other patient revealed STAT1 mutation suffering from recurrent lung abscess caused by Candida albicans,and both of them showed low level of blood IL-17. Routine antifungal drugs were insufficiency,even treatment period had pro-longed for several months. But after the G-CSF adjuvant therapy,their symptoms,signs and images recov-ered. With 5 to 10 months follow-up,no recurrent infections were found. Conclusion Antifungal drugs com-bined with G-CSF can effectively improve the treatment effect in invasive fungal infections secondary to immunodeficiency. Further more,genetic screening especially whole-exome sequencing can be suggested to find unusual immunodeficiency,which helps more individualized treatment.
RESUMEN
Objective To compare diagnostic value of four fungal scoring methods in invasive Candida infection,provide evidence for early diagnosis and treatment of invasive Candida infection.Methods High-risk patients with invasive Candida infection in the intensive care unit(ICU) in a hospital from 2011 to 2016 were analyzed retrospectively.According to diagnostic criteria,patients were divided into four groups:non-infection group,suspected infection group,clinically diagnosed group,and confirmed group,patients were conducted multi-diseases risk assessment (MDRA) score,invasive fungal infections risk scoring system (IFIRSS) score,Sevilla score,and Candida score,diagnostic value of four scoring methods for invasive Candida infection were evaluated.Results There were 275 high-risk patients,138 in non-infection group,63 in suspected infection group,and 74 in infection group(clinically diagnosed group:n =64;confirmed group:n =10).The age and length of hospital stay in the infection group were all higher than non-infection group (both P＜0.05).74 strains of Candida were isolated from 74 infected patients,mainly Candida albicans (n =60,81.1％).Positive rates for MDRA score,Candida score,Sevilla score,and IFIRSSscore were 41.5％(n =114),30.2％(n =83),15.3％(n =42),and 8.4％ (n =23) respectively.Of four MDRA scoring methods,MDRA had the higher sensitivity(Se,59％) but lowest specificity(Sp,66％);IFIRSS had higher Sp(91％) but very low Se (9％);Sevilla score had the highest Sp (96％)and higher Se(45％);Candida score had the highest Se(68％) and higher Sp (90％).Conclusion Sevilla score has higher Se and Sp,which can be used in early diagnosis of invasive Candida infection;Candida score has the highest coincidence with clinical diagnostic criteria for invasive Candida infection,both Se and Sp are high,which is of great value for early diagnosis of invasive Candida infection.