アンフォテリシンB耐性Cネオフォームス髄膜炎の治療:症例報告と文献レビュー
Liang Long1, Qingzi Yan1, Can Xiao1
1Clinical Pharmacy, Xiangtan Central Hospital, Xiangtan, Hunan Province, China.
Medicine
|September 3, 2025
まとめ
免疫能力のある患者のアンフォテリシンB耐性Cryptococcus neoformans髄膜炎は,アンフォテリシンBのコロイド分散 (ABCD) とフルシトシンを用いた救済療法で治療された. ABCDは成功を示したが,患者はデキサメタゾンの免疫抑制による二次感染で死亡した.
科学分野:
- 感染症
- 菌類学
- 薬理学について
背景:
- Cryptococcus neoformansとCryptococcus gattiiによって引き起こされるクリプトコックスの髄膜炎は,主に免疫力が低下した個人に影響します.
- アンフォテリシンBに対する耐性は,特に免疫能力のある宿主において,重要な治療上の課題を提示する.
研究 の 目的:
- アンフォテリシンB耐性Cryptococcus neoformans Meningitisの 免疫能力のある患者の症例を報告する
- この困難な臨床シナリオにおいて,アンフォテリシンBコロイド分散 (ABCD) による救済療法の有効性と安全性を評価する.
主な方法:
- アンフォテリシンB耐性C.ネオフォームス髄膜炎と診断された高齢の免疫能力のある男性に関するケース研究.
- 標準的な誘導療法 (アンフォテリシンBデオキシコラート/フルコナゾールおよびフルコナゾール/フルコチトシン) の初期治療が失敗した.
- アムフォテリシンBコロイド分散 (ABCD) とフルスチシンを併用して救出療法を開始した.
主要な成果:
- ABCDとフリューサイトシンによる救助療法に対する最初の成功反応が観察されました.
- 患者は最終的に 薬剤耐性のKlebsiella肺炎に罹患して亡くなりました
- 二次感染は,ABCD輸液反応の予防のために長期間使用されたデキサメタゾンによる有意な免疫抑制に起因した.
結論:
- アンフォテリシンBコロイド分散 (ABCD) は,アンフォテリシンB耐性Cryptococcus neoformans髄膜炎の治療に適した代替治療法である.
- 長期にわたるABCD治療では,薬剤の安全性,副作用の管理,治療失敗を防ぐために緊密な薬剤学的ケアが不可欠です.
- このケースは 免疫機能が低下した患者や 最初から耐性菌性髄膜炎を患っている患者でも 二次感染のモニタリングと予防が 極めて重要であることを強調しています
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