日本新生児成育医学会雑誌　第32巻　第2号　216 ～ 220頁（2020年）

日本新生児成育医学会雑誌　32(2)：454-458；2020　

受付日：2020．01．17

受理日：2020．06．30

十二指腸穿孔にCandida albicans が関与した超早産児の2 例

Duodenal Perforation Associated with Candida albicans Infection in Infants with Extremely Low Gestational Ages： A Report of Two Cases

熊本大学医学部附属病院　総合周産期母子医療センター新生児部門

Division of Neonatology, Perinatal Center, Kumamoto University Hospital

大塚里奈・森　博子・今村紘子・楢村哲生・井上　武・田仲健一・岩井正憲・三渕　浩

Rina OTSUKA，Hiroko MORI，Hiroko IMAMURA，Tetsuo NARAMURA， Takeshi INOUE，Kenichi TANAKA，Masanori IWAI，Hiroshi MITSUBUCHI

Key Words：duodenal perforation，extremely low gestational age neonate，Candida，steroids，elemental diet tube

　十二指腸穿孔は新生児消化管穿孔でも稀である。十二指腸穿孔の発症にCandida Albicans が関与した超低出生体重児2 例を経験した。症例1 はCandida の先天感染児で日齢5 に穿孔を来した。症例2 はCandida の消化管内常在を認めた児で日齢41 に穿孔を来した。これまでの文献報告では超早産児の十二指腸穿孔9 例中7 例がステロイドと関連しており，今回の2 症例でも使用していた。一方で，Candida が発症に関与した超早産児の十二指腸穿孔の報告は調べた限り認めない。早産児に対する予防的抗真菌薬投与は真菌保菌や深在性真菌症を有意に減らすが，真菌保菌児の深在性真菌症の発症を減らすことはできない。真菌保菌児に関しては十二指腸穿孔を含めた消化管穿孔のリスクを考慮した管理が重要である。

Duodenal perforation is a unique type of neonatal gastrointestinal perforation. We experienced two cases of duodenal perforation associated with Candida albicans infection in two neonates with extremely low gestational age. In the first case, the patient was a 5-day-old female infant with congenital candida infection. In the second case, the patient was a 41-dayold female infant with intestinal candidiasis. Steroids were administrated in these two cases and also in seven previously reported cases of duodenal perforation in neonates with extremely low gestational age. However, as far as we investigated, no report has indicated a relationship between candidiasis and duodenal perforation in neonates with extremely low gestational age. Prophylactic antifungal drug administration reduces the incidence of colonization and invasive candida infection in preterm neonates. However, the drug cannot modify the relationship between colonization and the subsequent development of invasive fungal infection. Therefore, consideration of the risk of gastrointestinal perforation, including duodenal perforation, is essential for the management of candidiasis cases in preterm neonates.