血清マンナン，D-アラビニトール濃度を経時的に測定しえた真菌性心内膜炎の1例

A case of candida endocarditis with consequtive measurement of serum Mannan and D-arabinitol concentrations

　心エコー図により全身性カンジタ症に伴う大動脈弁疣贅を記録し，さらに血清マンナン，D-アラビノシド，抗カンジダ抗体等の免疫血清学的検索を経時的に施行し得た1例を経験した。症例は83歳の男性で大動脈弁閉鎖不全症で加療されていたが膵頭部癌に伴う閉塞性黄疸の加療中全身性カンジダ症に罹患した。心エコー図では大動脈弁の右冠尖に1.5 cm×2.0cmの大きな疣贅が認められた。また血液，胆汁，尿中よりカンジダが検出され，血清抗カンジダ抗体の力価の上昇，マンナン抗原陽性，D-アラビノシド濃度の上昇を認めた。血清D-アラビノシド濃度は菌血症の病勢を反映して増減し治療効果の判定に有用であった。以上のようにカンジダ心内膜炎に伴う全身性カンジダ症において血液培養のみならず，免疫血清学的方法の併用により本症がより正確に診断することができ，その経時的観察は病勢の判定に有用であると考えられた。

We encountered a case of an 83-year-old patient with candida endocarditis. He had been diagnosed as having aortic regurgitation with moderately cal-cified aortic valve 5 years previously, and had received medication He was admitted to our hos-pital because of pancreatic cancer. He had high fever from the time of his admission and antibiotics produced no effect. Candida albicans was detected in arterial blood culture. We also detected antibody against Candida albicans, and investigated serum mannan and the D-arabinitol creatinine ratio several times. We performed echo-cardiographic examination and recorded a vegetation at the aortic valve. Rising antibody titers against Candida albicans, mannan antigenemia and an elevated creatinine ratio were also observed. So we concluded that these examinations were also effective in the diag-nosis of candida infection. Finally, this patient died of cerebral hemorrhage and was autopsied. Macroscopic findings showed mass-like vegetation involving the aortic valve, and microscopic findings showed candida organisms scattered within the vegetation.