临床儿科杂志 ›› 2015, Vol. 33 ›› Issue (3): 218-.doi: 10.3969j.issn.1000-3606.2015.03.005

• 围产新生儿疾病专栏 • 上一篇    下一篇

新生儿白色念珠菌性关节炎1例报告

尹莉萍,李函,朱欢,钱丽娟   

  1. 东南大学附属中大医院儿科(江苏南京 210009)
  • 收稿日期:2015-03-15 出版日期:2015-03-15 发布日期:2015-03-15
  • 通讯作者: 钱丽娟 E-mail:qianlijuan@seu.edu.cn

One case report of neonatal Candida arthritis

 YIN Liping, LI Han, ZHU Huan, QIAN Lijuan   

  1. Department of Pediatrics, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, Jiangsu, China
  • Received:2015-03-15 Online:2015-03-15 Published:2015-03-15

摘要: 目的 探讨新生儿白色念珠菌性关节炎的临床特点、诊断与治疗。方法 回顾性分析1例以多关节肿痛为首发症状的新生儿白色念珠菌性关节炎患儿的临床资料。结果 男性患儿,出生胎龄31周,出生体质量2 100 g。生后即入新生儿重症监护病房,因有感染长期应用抗生素。出生24 d血培养示白假丝酵母菌生长。出生29 d发现患儿双侧膝关节明显肿胀,经X线摄片及关节穿刺液培养诊断为白色念珠菌性关节炎。氟康唑抗真菌治疗共13周。出院时(出生59 d)患儿各关节无肿胀,双上肢肌张力明显低下;肩部可轻微自主活动,双指、双腕、肘部自主活动少;双下肢肌张力稍低,自主活动较上肢多,但活动范围较正常小;握持反射微弱。随访30个月,患儿四肢等长,无任何畸形,各关节活动正常,语言、智力均正常。结论 新生儿念珠菌关节炎多同时伴发或继发于全身性播散性念珠菌病,治疗以抗真菌药物为主,必要时可辅以外科手术治疗,预后大多良好。

Abstract: Objective To explore the clinical characteristics, diagnosis and treatment of neonatal Candida arthritis.
Methods  The clinical data from one case of neonatal Candida arthritis with swelling and pain in multiple joints as the first symptoms were reviewed. Results  Boy born at 31 weeks' gestational age had the birth weight of 2100 g. The patients was admitted to neonatal intensive care unit after birth and treated with antibiotics for a long time due to infection. At 24 days after birth, blood culture showed the growth of Candida albicans. At 29 days after birth, the bilateral knee joints showed swelling. The Candida arthritis was diagnosed through X ray and joint-cavity fluid culture. The patient was treated with Fluconazole for 13 weeks. When discharged, the joints swelling had been disappeared, while the muscle tension of the double upper limbs was significantly weak. The shoulders had visible slight activities independently. The fingers, wrists and elbows had less independent activities. The muscle tension of the double lower limbs was slight and the independent activity was more than upper limbs, but the extend was smaller than normal. The palmar grasp reflex was weak. The 30 months follow-up showed that each joint had even length, no abnormality and normal activities. The language and intelligence were normal. Conclusions  Neonatal Candida arthritis is mostly combined with or secondary to systemic disseminated candidiasis, and the priority therapy is antifungal drugs. Surgical operation can be considered if necessary, which can improve the prognosis.