J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 739KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 95(4): 217-223, 1994

Original article

A MULTI-INSTITUTIONAL STUDY FOR PREVALENCE, DIAGNOSIS AND TREATMENT OF DEEP FUNGAL INFECTION IN GASTROINTESTINAL SURGERY

1) Department of Surgery II, Osaka University Medical School, Osaka, Japan
2) The First Department of Surgery, The Center for Adult Diseases, Osaka, Japan

Toshimasa Tsujinaka1), Jun-ichi Kambayashi1), Masayoshi Imaoka2), Takeshi lwanaga2), Takesada Mori1)

A multi-institutional study was conducted for prevalence, diagnosis and treatment of deep fungal infection in gastrointestinal surgery. Forty five cases including thirty six complete cases were entered basing on the diagnotic criteria and the mortality of complete cases was 17%. By the administration of miconazole (MCZ), clinical response rate was obtained in 87%, mycological eradiation rate in 82% and valuable rate in 71%, with occurrence of side effects in 20%. Fungal endophthalmitis was found in 41% (12/29 cases). β-glucan [the toxinometer method (T), the Seikagaku-Kogyo method (S)] and candida antigen [the Cand-Tec method (C)] were monitored as sero-diagnotic methods, the positive rates for all cases, fungemia, and myocosis of which were 63, 83, 62% (T), 88, 100, 92% (S) and 52, 83, 50% (C), respectively. After mycological re-classification, the positive rates of the T method and endophthalmitis, and the mortality rates were 86, 60, 38% in fungemia, 63, 43, 23% in urinary tract infection, 64, 80, 7% in TPN infection, and 33, 17, 33% in drain infection, respectively. High association of endophthalmitis was found in TPN infection. The β-glucan assay and a prospective ophthalmoscopic examination are useful for the early diagnosis of deep fungal infection and it is reasonable to treat patients in gastrointestinal surgery by MCZ when mycosis is confirmed or suspected.

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