Candida albicans’a bağlı Fournier gangreni
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2008
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info:eu-repo/semantics/openAccess
Özet
Fournier gangreni perineal, genital veya perianal bölgenin fulminan nekrotizan fasiiti ile karakterize olup genellikle aerop ve anaerop bakterilere bağlı olarak gelişir. Idiyopatik olduğu düşünülse de, diyabetli, uzun süre alkol kullanan ve immün yetmezliği olan hastalar daha fazla etkilenmektedir. Etken genellikle üriner sistem, alt gastrointestinal sistem veya ciltte yerleşmektedir. Gangrenin ortaya çıkışı ve ilerlemesi çok hızlı olup, çoklu organ yetmezliği ve ölümle sonlanabilir, Bu raporda Candida albicans'in sebep olduğu bir Fournier gangreni olgusu sunulmaktadır. Elli dokuz yaşında bir kadın hasta, üç hafta önce oluşan travma sonrası sağ kalçada gelişen şişlik ile hastanemize başvurmuştur. Hastanın öyküsünden, diabetes mellitus, esansiyel trombositopeni, kronik hastalık anemisi ve hipertansiyon nedeniyle daha önceden dört kez hastaneye yatırıldığı öğrenilmiştir. Sağ trokanterik kırık saptanan hasta, kırığa ikincil anaerobik yumuşak doku enfeksiyonu ön tanısı ile operasyona alınmış ve yaygın nekroz nedeniyle geniş debridman uygulanmıştır. Ampirik olarak sefalosporin ve metronidazol tedavisi verilen hastanın yara yeri ve kan kültürü örneklerinde primer etken olarak C.albicans üremesi saptanmış, bunun üzerine tedaviye flukonazol eklenmiştir. Ancak hasta, fungal sepsisten kaynaklanan çoklu organ yetmezliğine bağlı olarak postopera-tif 25. gün eksitus olmuştur. Bu olgu, diabetik hastalarda gangrenli dokularda mayaların da patojen etkenler arasında düşünülmesi gerektiğinin vurgulanması amacıyla sunulmuştur.
Fournier's gangrene characterized by fulminant necrotizing fasciitis of the perineal, genital or perianal regions, is generally caused by aerobic and anareobic bacteria. Although it is thought to be an idiopathic process, Fournier's gangrene has been shown to have a predilection for patients with diabetes, long term alcohol misuse and immunocompromised patients. The focus of infection is usually located in the urinary tract, lower gastrointestinal tract or skin. The development and progression of the gangrene is often fulminating and can rapidly lead to multiple organ failures and death. Here, we present a Fournier's gangrene case caused by Candida albicans. A 59-year-old woman was admitted to hospital with the complaint of swelling on the right thigh following a trauma occurred three weeks ago. Her history revealed that she had been hospitalized previously for four times due to diabetes mellitus, essential thrombocytopenia, chronic disease anemia and hypertension. Right trochanteric fracture was detected and the patient was taken under surgical debridement with the pre-diagnosis of secondary anaerobic soft tissue infection. Empirical treatment was started with cephalosporin and metronidazole. Since wo- und and blood cultures revealed C. albicans as the primary microorganism, fluconazole was added to the therapy. However, the patient died on the post-operative 25th day because of multi-organ disfunction secondary to fungal sepsis. This case has been reported to emphasize that yeasts should be considered as pathogenic agents in diabetic patients with gangrene.
Fournier's gangrene characterized by fulminant necrotizing fasciitis of the perineal, genital or perianal regions, is generally caused by aerobic and anareobic bacteria. Although it is thought to be an idiopathic process, Fournier's gangrene has been shown to have a predilection for patients with diabetes, long term alcohol misuse and immunocompromised patients. The focus of infection is usually located in the urinary tract, lower gastrointestinal tract or skin. The development and progression of the gangrene is often fulminating and can rapidly lead to multiple organ failures and death. Here, we present a Fournier's gangrene case caused by Candida albicans. A 59-year-old woman was admitted to hospital with the complaint of swelling on the right thigh following a trauma occurred three weeks ago. Her history revealed that she had been hospitalized previously for four times due to diabetes mellitus, essential thrombocytopenia, chronic disease anemia and hypertension. Right trochanteric fracture was detected and the patient was taken under surgical debridement with the pre-diagnosis of secondary anaerobic soft tissue infection. Empirical treatment was started with cephalosporin and metronidazole. Since wo- und and blood cultures revealed C. albicans as the primary microorganism, fluconazole was added to the therapy. However, the patient died on the post-operative 25th day because of multi-organ disfunction secondary to fungal sepsis. This case has been reported to emphasize that yeasts should be considered as pathogenic agents in diabetic patients with gangrene.
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4
