Table 1 Profiles of and number of clinical specimens obtain in febrile episodes *

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1 Key words: deep-seated mycosis, critical care center,(1 3)-ƒÀ-D-glucan, candida antigen

2 Table 1 Profiles of and number of clinical specimens obtain in febrile episodes *

3 Table 2 Underlying diseases of 92 admitted to critical care center a) adult respiratory distress syndrome b) chronic obstructive pulmonary disease c) acquired immunodeficiency symdrome d) acute promyelocytic leukemia Table 3 Correlation between blood culture, serum (1 3)-ƒÀ-D glucan and serum candida antigen

4 746 Fig. 川山 1 Plasma control and (1 3)-ƒÀ-D-glucan subjects, concentrations invasive open curcles ( ): from fungal in 智隆 他 Fig. colonization deep-mycosis. three Plasam nia spesimens Pneumocystis 2 were carinii and (1 3)-ƒÀ-D-glucan fungal concentrations sepsis, panperitonitis, empyema. obtained pneumonia. あ っ た12). 一 方,深 部 真 菌 感 染 症 群 で52検 (13.5%)が(1 3)-β-D-glucan陰 (47.6%)が 培 養,血 ン トロ ー ル)群 清(1 3)-β-D-glucan値 で の血液 お よ び カ ン ジ ダ抗 原 価 の 陽 性 率 は,そ れ ぞ れ81検 体 中0検 %),81検 体(6.2%)お よ び54検 体 中5検 検 体(13.0%)で 体(0.0 体 中7 D-glucan値 の 感 度 は86.5%で,特 優 れ て い た.ま も,深 た,血 異 清(1 3)-β- 部 真 菌 感 染 症 群 が,コ ロニゼー 清(1 3)-β-D- glucan値 が 高値 を示 す の は,敗 血 症 で あ っ た.敗 血 症 群 は汎 発 性 腹 膜 炎 や 肺 炎 群 と比 較 して 有 意 に 高 い 値 を示 した(Fig.2). 考 以 上 の 結 果 か ら深 部 真 菌 感 染 症 の 診 断 に対 す る 性 は93.8%と 体 性 で あ っ た(Fig. 深 部 真 菌 感 染 症 の う ち で,血 あ っ た. 血 清(1 3)-β-D-glucan値 体 中7検 1). 陽 性 で あ っ た. ま た 非 真 菌 感 染 症(コ in pneumo- 察 当 院 救 命 救 急 セ ン タ ー に お い て,対 18.5%が 象患者の 真 菌 学 的 お よ び組 織 学 的 に深 部 真 菌 感 染 症 の確 定 診 断 が 得 られ た.こ の結 果 は担 癌 患 者 に お け る 真 菌 感 染 率 と比 較 して や や 低 率 で あ っ た シ ョ ン群 や コ ン トロー ル 群 に比 較 して 高 値 を示 す が,患 こ と も 証 明 さ れ た(Fig.1). し て 再 認 識 す る 必 要 が あ る と 考 え ら れ た1) 3).深 し か し,コ %),コ ン ト ロ ー ル 群 で81検 ロ ニ ゼ ー シ ョ ン 群 で27検 %)が(1 3)-β-D-glucan陽 性 で あ っ た.但 ロ ニ ゼ ー シ ョ ン 群 で の 陽 性5検 Pneumocystis 体 中5検 体 中5検 体 中3検 体(6.2 体(18.5 し,コ 体 は carinii肺 炎 患 者 か ら 得 ら れ た も の で 者 の 予 後 を左 右 す る極 め て 重 要 な 感 染 症 と 部 真 菌 感 染 症 の 頻 度 と して は汎 種 性 腹 膜 炎 が 最 も 多 く,消 化 管 穿 孔 に伴 う もの が5例,消 化管手術 後 に伴 う術 後 感 染 症 が5例 村 ら13}は で あ っ た.谷 消 化 管 穿 孔 お よび 消 化 管 手 術 の場 合 は,術 前 術 後 を通 してMRSAな どの 難 治 性 細 菌 感 染 症 と 同 様 感 染症 学 雑 誌 第73巻 第8号

5 1) Yoshida M: Infectiouns in hematological diseases: Recent adbances in serological diagnosis and empiric therapy. Int J Hematol 1997; 66: ) Obayashi T, Yoshida M, Mori T et al.: Plasma (1 -ƒà-d-glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episodes. Lancet 1995; 345: ) Miyazaki T, Kohno S, Mitsutaka K et al.: Plasma (1 3)-ƒÀ-D-glucan and fungal antigenemia in Candidemia, aspergillosis, and cryptococcosis. J Clin Microbiol 1995; 33: ; 30: ) Obayashi T, Yoshida M, Tamura H et al.: Determination of Plasma (1.3)-ƒÀ-D-glucan: A new diagnostic aid to deep mycosis. J Med Vet Mycol

6 9) Piens MA, Guyotat S, Archimbaund E et al.: Evaluation of Candida antigen detections (CandtecTM) in the diagnosis of deep candidasis in neutropenic. Eur J Cancer Clin Oncol 1988; 24: ) Iwasaki H, Ueda T, Nakayama T et al.: A new diagnostic aid for deep mycosis associated hematologic disease using (1.3)-ƒÀ-D-glucan assey (G-test). Recent Adovances in Chemothrapy, (ed. Einhorn J, Nord CE, Norrby SR), Am Soc Microb, Washington DC, 1993, p ) Yoshida M, Obayashi T, Iwama A et al.: Detection of plasma (1.3)-ƒÀ-D-glucan in Fusarium, Trichosporon, Saccharomyces and Acremonium fungaemias. J Med Vet Mycol 1985; 98: 17) Ikemura K, Ikegami K, Shimazu T et al.: Falsepositive result in Limulus test caused by Limulus amebocyte lysate-reactive material in immunoglobulin products. J Clin Microbil 1989; 27: ) Yasuoka A, Tachikawa N, Shimoda L et al.: 3)-ƒÀ-D-glucan as a quantitative serological 19) Edman JC, Kovacs JA, Hasur H et al.: Ribosomal marker for Pneumocystis carinii pneumonia. Clin RNA sequence shows Pneumocystis carinii to be a Diagn Lab Immuno11996; 3: member of the fungi. Nature 1988; 334: ) Matumoto Y, Matsuda S, Tegoshi T: Yeast glucan in the cyst wall of Pneumocystis carinii. J Pro- tozool 1989; 36: 21S-22S. Clinical Features of Deep Mycosis in Critical Care Center Tomotaka KAWAYAMA1) & Kotaro OIZUMI2) The First Department of Internal Medicine, Kurume University School of Medicine The clincal features of invasive deep mycosis in the critical care center was studied and the usefulness for determinations of plasma (1 3)-ƒÀ-D-glucan, one of the major structural components of fungi, in making the diagnosis of deep mycosis was evaluated in comparison that of blood culture and candida antigen titer using CAND-tec kit. A total of 92 febrile (mean age=54.5yr., M/F=70/22) in our critical care center were enrolled in this study. Seventeen out of the 92 febrile (18.5%) were those deep mycosis. In the deep mycosis group, there were 10 fungal panperitonitis, 5 fungaemia, one candidal pneumonia and one candidal empyema. A total of 52 blood samples were obtained from 17 deep mycosis. Forty five out of the 52 blood samples (86.5%) were positive for serum (1.3)-ƒÀ-D-glucan while only 10 were culturepositive. In contrast, six (15.0%) out of the 40 blood samples were obtaind from 17 deep mycosis were positive for candida antigen by CAND-tec kit. In the critical care center, deep mycosis is a common infection and determination of serum concentration of (1.3)-ƒÀ-D-glucan is found to be a very useful examination in screening of deep mycosis high sensitivity and specificity.

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