Coccidioidomycosis in Renal Transplant Recipients
Coccidioidomycosis in Renal Transplant Recipients
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DOI：
10.1097/01.idc.0000179883.64882.41
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发表时间：
2005-09-01
影响因子：
0.5
通讯作者：
Salas, Irma
中科院分区：
文献类型：
--
作者：
Antony, Suresh Jude;Dummer, Stephen J.;Salas, Irma
球孢子菌病是美国西南部的地方病，细胞免疫功能受损会大大增加对危及生命的球孢子菌感染的易感性。本研究结合了1987年至2002年埃尔帕索5例肾移植受者球虫菌病的临床表现，以及1966年至2002年文献中发表的28例其他病例的详细资料。埃尔帕索的5例病例发生在297名移植受者中。总体而言，33例球虫真菌病肾移植受者包括24例男性和9例女性，中位年龄38岁。58%的患者为白人，33%为西班牙裔，3%为非裔美国人，3%为美洲原住民，3%为亚洲人。23例（70%）患者有尸体供体，其余患者有活体供体。潜在的肾脏疾病包括慢性肾小球肾炎（48%）、糖尿病（30%）、自身免疫性疾病（3%）、Alport综合征（3%）和其他未记录的疾病（16%）。75%的患者从肺部分离出C. imimtis；在剩下的25%中，它累及脾脏、尿液、皮肤、胰腺、骨髓、甲状腺、脉络膜和淋巴结。在大多数患者中，最初的临床表现包括发烧和肺炎的临床和影像学证据。从移植到诊断感染的中位时间为6个月（15天至50个月）。播散性球孢子菌病18例。治疗方式包括两性霉素B 29例（88%）和氟康唑6例（18%）。55%（18例）的患者死亡，其中9例死于球孢子菌病，9例死于其他原因。有潜在糖尿病的患者的死亡率似乎没有显著增加。
Coccidioidomycosis is endemic in the southwest United States, and impaired cellular immunity profoundly increases the susceptibility to life-threatening Coccidioides immitis infections. This study combines the clinical presentation of coccidioidomycosis in 5 renal transplant recipients in El Paso from 1987 to 2002 with details from 28 other cases published in the literature from 1966 to 2002. The 5 cases in El Paso occurred in a population of 297 transplant recipients. Overall, the 33 renal transplant recipients with coccidioidomycosis included 24 men and 9 women with a median age of 38 years. Fifty-eight percent of the patients were white, 33% Hispanic, 3% African American, 3% Native American, and 3% Asian. Twenty-three (70%) of the patients had cadaveric donors, and the remainder had living donors. Underlying renal diseases included chronic glomerulonephritis (48%), diabetes mellitus (30%), autoimmune diseases (3%), Alport syndrome (3%), and others not documented (16%). C. immitis was isolated from the lung in 75% of the patients; in the remaining 25%, it involved the spleen, urine, skin, pancreas, bone marrow, thyroid, choroid, and lymph nodes. In the majority of the patients, the initial clinical presentation included fever with clinical and radiographic evidence of pneumonia. The median time between transplantation and the diagnosis of infection was 6 months (15 days to 50 months). Disseminated coccidioidomycosis occurred in 18 patients. Treatment modalities included amphotericin B in 29 patients (88%) and fluconazole in 6 patients (18%). Death occurred in 55% (18) of the patients with 9 of them dying from coccidioidomycosis and the other 9 dying of other causes. There did not appear to be a significant increase in the mortality in patients who had underlying diabetes mellitus.