Invasive Aspergillosis Causing Aortic Pseudoaneurysm and Endocarditis After Heart Transplantation.
Invasive Aspergillosis Causing Aortic Pseudoaneurysm and Endocarditis After Heart Transplantation.
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DOI：
10.1161/circimaging.120.012370
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发表时间：
2021-06
期刊：
影响因子：
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通讯作者：
Tiku Owens A
中科院分区：
文献类型：
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作者：
Reza N;Genuardi MV;Weikert BC;McLean R;Deshpande C;Jagasia D;Tiku Owens A
II和III在数据补充），高度关注持续侵袭性曲霉病（IA）。分别启动两性霉素B和抗凝治疗，以进一步覆盖真菌和经验性管理潜在的左心房血栓。考虑手术治疗，但是，他发生了急性颅内出血，导致手术风险过高。关于心脏移植后侵袭性真菌感染（IFI）的发病率和患病率的数据有限。美国一项关于实体器官移植患者IFI的前瞻性多中心研究发现，HT后第一年期间IFI的累积发生率为3.4%，曲霉属占IFI的23%。1在本系列的所有实体器官移植病例中，烟曲霉是最常见的菌种，78%的曲霉病病例仅导致肺部感染。在一项包含479例连续HT接受者的西班牙单中心研究中，31例发生IA的患者中仅2例发生肺外受累，其中仅1例累及纵隔。2在我们的病例中，胸部CT在最初诊断时并没有显示肺曲霉菌病的影像学证据。HT后IFI的危险因素还没有得到很好的研究。有限的多中心数据表明，再次手术、巨细胞病毒病、HT后血液透析和HT前或HT后3个月内在同一HT单位发生IA是IA的风险因素;我们的患者没有这些风险因素。其他单中心研究已经确定HT后ECMO的使用是真菌感染的风险因素，HT后急性细胞排斥反应是IA的风险因素，我们的患者都经历过这两种情况。个别中心已经制定了真菌预防方案的风险患者，但是，这种做法是不统一的HT中心。
II and III in the Data Supplement), highly concerning for ongoing invasive aspergillosis (IA). Amphotericin B and anticoagulation were initiated for additional fungal coverage and empirical management of potential left atrial thrombus, respectively. Surgical management was considered, however, he developed an acute intracranial hemorrhage resulting in prohibitive surgical risk. Data regarding the incidence and prevalence of invasive fungal infections (IFI) after heart transplantation are limited. A prospective multicenter United States study of IFI in solid organ transplant patients identified a 3.4% cumulative incidence of IFI during the first year after HT with Aspergillus species accounting for 23% of IFI. 1 Among all solid organ transplant cases in this series, Aspergillus fumigatus was the most common species isolated, and 78% of aspergillosis cases led to pulmonary infection only. In a single-center Spanish series of 479 consecutive HT recipients, only 2 of 31 patients who developed IA had extrapulmonary involvement and only one of these involved the mediastinum. 2 In our case, chest computed tomography at the time of initial diagnosis did not demonstrate radiographic evidence of pulmonary aspergillosis.Risk factors for IFI after HT have not been well studied. Limited multicenter data suggest that reoperation, cytomegalovirus disease, post-HT hemodialysis, and an episode of IA in the same HT unit in a 3-month pre-HT or post-HT period are risk factors for IA; our patient had none of these risk factors. Additional single-center studies have identified the use of post-HT ECMO as a risk factor for fungal infection and post-HT acute cellular rejection as a risk factor for IA, both of which our patient experienced. Individual centers have instituted fungal prophylaxis protocols for at-risk patients; however, this practice is not uniform across HT centers.