臨牀透析 Vol.24 No.8(7)


特集名 透析患者の呼吸器合併症
題名 肺真菌症
発刊年月 2008年 07月
著者 樽本 憲人 埼玉医科大学感染症科・感染制御科
著者 前崎 繁文 埼玉医科大学感染症科・感染制御科
【 要旨 】 腎不全の合併症として感染症は重要であり,抗菌薬不応性の発熱を認めたときには肺真菌症も考慮する必要がある.血液内科疾患・臓器移植領域以外の肺真菌症にはアスペルギルス症が多いが,その他カンジダ肺炎,トリコスポロン症,接合菌症などもみられる.血清診断検査のなかには透析中で疑陽性を示すものもある.肺アスペルギローマ以外では抗真菌薬による内科的治療が中心であるが,腎機能障害患者へ投与するとき,投与量の減少や投与間隔の延長を行う薬剤もある.近年,アムホテリシンBリポソーム製剤やボリコナゾールなどの新薬が上市されたが,これらに対するブレイクスルー感染症の報告もあるため注意が必要である.
Theme Complications of Respiratory Organs in Dialysis Patients
Title Pulmonary mycosis
Author Norihito Tarumoto Department of Infectious Disease and Infection Control, Saitama Medical University
Author Shigefumi Maesaki Department of Infectious Disease and Infection Control, Saitama Medical University
[ Summary ] Pulmonary mycosis is a severe opportunistic infection occuring in patients who are immunocompromised. Aspergillus species have emerged as an important cause of life-threatening infections in immunocompromised patients. Micafungin is a novel class of antifungal agents. Micafungins are effective in treating Aspergillus species but have not been approved for treating pulmonary aspergillosis. Voriconazole is approved for treatment of pulmonary aspergillosis. Voriconazole is recommended for primary treatment of pulmonary aspergillosis. Itraconazole is a triazole antifungal agent which has proven effective in treatingAspergillus species. Itraconazole is formulated in capsules, oral solutions, and parenteral solutions. AmBisome is a liposomal amphotericin B displaying efficacy similar to voriconazole as a primary therapy for pulmonary aspergillosis. AmBisome may reduce adverse effects in patients being treated for amphotericin B. There are many unanswered and unresolved clinical questions concerning treatment for pulmonary aspergillosis. The availability of more-active and better-tolerated antifungal agents has improved therapy for patients with pulmonary aspergillosis.
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