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題名 | Leveamisole Aids in Treatment of Refractory Oral Candidiasis in Two Patients with Thymoma Associated with Myasthenia Gravis: Report of Two Cases=Levamisole 輔助治療胸腺瘤合併重症肌無力患者之復發性口腔念珠菌感染--二例報告 |
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作 者 | 賴維顥; 盧心玉; 邢福柳; | 書刊名 | 長庚醫學 |
卷期 | 25:9 2002.09[民91.09] |
頁次 | 頁606-611 |
分類號 | 416.94 |
關鍵詞 | 胸腺瘤; 重症肌無力; 口腔念珠菌感染; Thymoma; Myasthenia gravis; Oral candidiasis; Levamisole; |
語文 | 英文(English) |
中文摘要 | 口腔念珠菌病是一伺機性感染的疾病,可能因局部或全身性抵抗力降低而發病,尤其當人體的細胞免疫能力嚴重缺陷時會導致長期反覆感染。本文所提出的二位胸腺瘤合併重症肌無力患者,在胞腺切除後,都受到復發性口腔念珠菌病的困擾。在單獨使用抗黴菌藥物的前1到3年反應不錯,之後則療效不佳。經評估後發現患者的T細胞有嚴重缺陷,且CD4/CD8比例降低。在投與Levamisole後,患者的T細胞增加,CD4/CD8比例上升,再合併Nystatin的使用得以迅速改善口內症狀。這項發現顯示細胞性免疫力在口腔念珠菌病上扮演重要角色,感染最後的根除並非單靠抗生素,而是靠患者的免疫能力。本文提供Levamisle修復T細胞免疫力的部分證據,並對胸腺切除患者的口腔念珠菌病有疾控制。這種合併的治療方式未見於以往的文獻,特此提出報告。 |
英文摘要 | Oral candidiasis is associated with defects in cell-mediated immunity and is common among patients undergoing cytotoxic chemotherapy, or corticosteroid or antibiotic therapy, and those patients seropositive for AIDS and HIV (human immunodeficiency virus). This paper demonstrates the important role of cell-mediated immunity in oral candidiasis in 2 ases of thymoma associated with myasthenia gravis. Both suffered from recurrent oral candidiasis after a thymectomy, radiotherapy, and chemotherapy. There was an initial good response to conventional antifungal therapy, which later became refractory. Lymphocyte subset quaantitation showed a T cell deficiency and a decreased CD4/CD8 ratio. Levamisole, an immunomodulator, or an immnuoportentiating drug was added as adjunctive therapy in combination with oral nystatin treatment. Oral candidiasis responded favorably, and substantial relief was obtained with a concurrent increase in T cells and the CD4/CD8 ratio. There findings clearly demonstrate a significant role of cell-mediated immunity in oral candidiasis, and that eradication of infection is dependent on the host defense mechanism. |
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