日本新生児成育医学会雑誌　35(2)：286-291；2023　

日本新生児成育医学会雑誌　第35巻　第2号　137 ～ 142頁（2023年）

受付日：2022．10．20

受理日：2023．02．27

急激な脳室拡大を契機に診断した侵襲性カンジダ症の超早産児例

An Extremely Preterm Infant with Invasive Candidiasis Diagnosed with acute Ventricular Dilatation

＊ 1 福岡市立こども病院　新生児科，＊ 2 福岡市立こども病院　脳神経外科， ＊ 3 松籟会病院　精神科，＊ 4 福岡市立こども病院　胎児循環器科

＊ 1 Department of Neonatology, Fukuoka Children’s Hospital， ＊ 2 Department of Neurosurgery, Fukuoka Children’s Hospital， ＊ 3 Department of Psychiatry, Shourai Hospital， ＊ 4 Department of Fetal Cardiology, Fukuoka Children’s Hospital

村川直道＊ 1・楠田　剛＊ 1・田中　航＊ 1・土持皓平＊ 1・芹田陽一郎＊ 1・野口雄史＊ 1・ 黒木　愛＊ 2・島　貴史＊ 1・鈴木　諭＊ 3・村上信哉＊ 2・漢　伸彦＊ 4・金城唯宗＊ 1

Naomichi MURAKAWA ＊ 1，Takeshi KUSUDA ＊ 1，Wataru TANAKA ＊ 1，Kohei TSUCHIMOCHI ＊ 1， Yoichiro SERITA ＊ 1，Yushi NOGUCHI ＊ 1，Ai KUROGI ＊ 2，Takashi SHIMA ＊ 1， Satoshi O. SUZUKI ＊ 3，Nobuya MURAKAMI ＊ 2，Nobuhiko KAN ＊ 4，Tadamune KINJO ＊ 1

Key Words：extremely preterm infant，Candida ablicans，ventriculitis，hydrocephalus，β-D glucan

カンジダによる髄膜炎や血流感染は侵襲性カンジダ症と呼ばれ，早産や抗菌薬，ステロイドの投与等がリスク因 子であり死亡や神経学的後遺症の原因となる。今回急激な脳室拡大を契機に診断に至った侵襲性カンジダ症の超早 産児例を報告する。 　母体はカンジダ腟症の治療中であった。妊娠23 週5 日に破水し，妊娠26 週1 日に経腟分娩となった。児の出生 体重1,018g。NICU 入室時の血液培養は陰性，特に感染所見もなかった。抗菌薬投与と日齢4 より酸素需要増加に 対しステロイドの投与を行った。全身状態安定後の日齢19 より急激に脳室拡大が進行し，日齢55 にcerebrospinal fluid reservoir を留置した。その際の髄液検査で細胞数増多があり，培養にてCandida albicans を検出しカンジダ 脳室炎と診断した。抗真菌薬の静注および髄腔内投与を行ったが脳室拡大は進行，嚢胞形成並びに白質軟化所見も 認め治療に難渋した。 　脳室内出血がないか軽微な児で脳室拡大が急激に進行した場合，髄膜炎や脳室炎の鑑別が必要である。

Invasive candidiasis（ IC） refers to infections caused by species of Candida, either in the bloodstream or deep tissue, such as meningitis. The risk factors frequently associated with IC are preterm delivery, antibiotics, and steroid administration after birth, leading to neurological sequelae or even mortality. Herein, we report a case of an extremely preterm male infant with IC, diagnosed with rapidly progressive ventricular enlargement after birth. The mother was being treated for Candida vaginitis, and following a premature rupture of the membrane at 23 weeks and 5 days, she vaginally delivered the baby at 26 weeks and 1 day. The baby’s weight at birth was 1,018 g. Postnatal blood cultures were negative, and there was no evidence of infection. Prophylactic antibiotics and steroids were administered at day 4, owing to increased oxygen demand. After his general condition was stabilized, we observed rapid ventricular enlargement progression at day 19, and the cerebrospinal fluid（ CSF） reservoir was implanted at day 55 after birth. CSF examination revealed increased cell counts, and Candida albicans was detected in the culture. Subsequently, we diagnosed the patient with Candida ventriculitis. Intravenous and intrathecal antifungal drugs were administered；however, the ventricular enlargement progressed significantly. The treatment was continued, but was difficult due to formation of multiple cysts and softening of the white matter. The prognosis for IC is often poor. Furthermore, if no obvious or even mild intracerebral hemorrhage followed by gradual expansion of the ventricles is observed during its course, infections, such as ventriculitis, should be considered.