RESUMO
Transient candidemia is common with prolonged intravenous therapy. Sustained candidemia, however, usually indicates a persistent focus of infection. A complication of intravenous therapy not previously emphasized is persistent candidemia caused by candidal suppurative peripheral thrombophlebitis. We report six cases that appeared during intravenous therapy: the infection was characterized by a thrombosed peripheral vein at an intravenous site with manifestations for candida septicemia with or without disseminated candidiasis. In two patients, the source of the process was occult; the examination showed only a thrombosed noninflamed vein. In all cases, surgical exploration showed the thrombosed veins to be suppurative with positive cultures for Candida. Special stains, moreover, showed Candida in the luminal clot and the vascular wall. In the five surviving patients, cure was achieved by excision of the affected vein. Four received a short course of amphotericin B and 5-fluorocytosine, and one patient received amphotericin B only.
Assuntos
Candidíase/etiologia , Cateterismo/efeitos adversos , Infusões Parenterais/efeitos adversos , Tromboflebite/etiologia , Adulto , Cateteres de Demora , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sepse/etiologia , Supuração/etiologiaRESUMO
The cytotoxicity of peripheral blood leukocytes from normal human donors and from patients with EBV-associated infectious nomonucleosis (IM) has been determined for human lymphoid cell lines (LCL) containing Epstein-Barr virus (EBV) DNA. In a 51Cr release assay, mononuclear leukocytes from all donors are spontaneously cytotoxic. Leukocytes taken from patients within the first 2 weeks of overt IM are significantly more cytotoxic. This increased cytotoxicity declines to the spontaneous level as the disease progesses. The increase shows no correlation with the degree of lymphocytosis but a positive correlation with numbers of circulating atypical cells. The reaction is apparently not directed against histocompatability antigens, known EBV membrane antigens, or other characteristics of fresh human lymphoid cells. Susceptibility to damage is shared by bone marrow-derived (B) cell lines but not thymus derived (T) cell lines. EBV-gene products cannot be soley responsible for expression of the unknown characteristic. Transformation of B cells with EBV in vivo or in vitro, however, may trigger its expression
