Candidal thrombophlebitis of central veins: case report and review
Candidal thrombophlebitis of central veins: case report and review
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DOI：
10.3109/13693786.2011.604046
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发表时间：
2012-04-01
期刊：
影响因子：
2.9
通讯作者：
Venditti, Mario
中科院分区：
文献类型：
--
作者：
Caccese, Roberta;Carfagna, Paolo;Venditti, Mario
虽然念珠菌血症和中心静脉导管败血症血栓形成相当常见，但由念珠菌引起的中心静脉血栓性静脉炎。在危重病人中是一种罕见的并发症。我们在此报告一例因白色念珠菌所致的右颈内静脉及锁骨下静脉血栓性静脉炎，此病例发生于因严重创伤而住进重症监护室的病人。在长时间的抗真菌治疗后，该患者最终痊愈。我们还回顾了自1978年以来报道的另外24例念珠菌引起的中心静脉血栓性静脉炎。所有25例患者均放置了中心静脉导管，其中21例(84%)住进重症监护室，22例(88%)接受完全肠外营养，23例(92%)接受了一个疗程的抗生素治疗。总死亡率为16%，其中包括两名未接受治疗并死亡的患者。在单纯接受药物治疗的患者组中，死亡率为13%，而在接受内科和外科综合治疗的患者中，没有观察到死亡。文献资料表明，念珠菌引起的中心静脉血栓性静脉炎是一种罕见的危重患者可能被低估的感染性并发症。尽管有持续性念珠菌血症的戏剧性表现，但即使采用保守的医学方法，通过使用两性霉素B或棘球菌素进行长期的杀菌治疗，死亡率也很低。因此，联合手术清创的决定应该针对每个患者进行评估。
Although candidemia and central catheter septic thrombosis is quite common, central veins thrombophlebitis caused by Candida spp. is a rarely reported complication in critically ill patients. Here we report a case of thrombophlebitis of the right internal jugular and subclavian veins due to Candida albicans which occurred in a patient admitted in the intensive care unit for major trauma. The individual was eventually cured after prolonged course of antifungal therapy. We also review 24 additional cases of Candida induced central veins thrombophlebitis reported since 1978. A central vein catheter was in place in all 25 patients with 21 (84%) being admitted in an intensive care unit, 22 (88%) were receiving total parenteral nutrition and 23 (92%) undergoing a course of antibiotic therapy. Overall mortality was 16%, including two patients who received no therapy and died. In the group of patients receiving only medical therapy, the mortality rate was 13%, while no deaths were observed among those treated with combined medical and surgical therapy. Literature data suggest that Candida caused central veins thrombophlebitis is a rare and probably under diagnosed infectious complication of the critically ill patient. Despite the dramatic presentation with persistent candidemia, mortality is low even with a conservative medical approach with prolonged fungicidal therapy through the use of amphotericin B or echinocandins. Thus, the decision for a combined surgical debridement should be assessed for each patient.