A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation
A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation
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DOI：
10.1111/j.1399-3062.2011.00658.x
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发表时间：
2012-02-01
影响因子：
2.6
通讯作者：
Clark, N. M.
中科院分区：
文献类型：
--
作者：
Grim, S. A.;Proia, L.;Clark, N. M.
目的 对来自 3 个中西部学术医疗中心的 30 名患有组织胞浆菌病或芽生菌病的实体器官移植受者 (SOTR) 的临床表现、诊断、治疗和结果进行回顾。背景。地方性真菌病原体，荚膜组织胞浆菌和皮炎芽生菌，可能会引起 SOTR 的严重感染。在本报告中，我们描述了 3 个学术移植中心 SOTR 中这些地方性真菌感染 (EFI) 的临床表现、诊断、治疗和结果。方法。对来自美国中西部 3 个医疗中心的患有组织胞浆菌病或芽生菌病的 SOTR 进行了回顾性审查。收集的数据包括人口统计、免疫抑制、临床表现、诊断方法、抗真菌治疗、治疗反应以及患者和移植物存活率。结果。 1996年至2008年间，共鉴定出30名移植受者患有组织胞浆菌病或芽生菌病，累计感染发生率为0.50%(30/ 5989)； 73%的研究患者是肾移植受者，移植后发病的中位时间为10.5个月。肺部是最常见的感染部位（83%），60% 患有播散性疾病。所有接受此项检查的患者尿抗原检测均呈阳性 (23/ 23)。 70% 的患者初始抗真菌治疗使用两性霉素 B，87% 的患者接受唑类药物，通常为伊曲康唑 (83%)。 EFI 后，2 名患者出现复发感染，7 名患者出现移植失败。总死亡率为 30%，归因死亡率为 13%。结论。与之前的几项单中心研究一样，移植后组织胞浆菌病和芽生菌病的发生率为o1%，但常常导致播散性感染。在该队列中，EFI 与高同种异体移植物丢失率和总体死亡率相关。
Aim A review of the clinical presentation, diagnosis, treatment and outcomes of 30 solid organ transplant recipients (SOTRs) with histoplasmosis or blastomycosis from 3 Midwestern academic medical centers. Background. The endemic fungal pathogens, Histoplasma capsulatum and Blastomyces dermatitidis, may cause severe infection in SOTRs. In this report, we describe the clinical presentation, diagnosis, treatment, and outcomes of these endemic fungal infections (EFIs) among SOTRs at 3 academic transplant centers. Methods. A retrospective review was conducted of SOTRs with histoplasmosis or blastomycosis from 3 Midwestern medical centers in the United States. Data collected included demographics, immunosuppression, clinical presentation, method of diagnosis, antifungal treatment, response to therapy, and patient and graft survival. Results. Between 1996 and 2008, 30 transplant recipients with histoplasmosis or blastomycosis were identified, giving a cumulative incidence of infection of 0.50%(30/ 5989); 73% of the study patients were renal transplant recipients, and the median time to disease onset after transplantation was 10.5 months. The lungs were the most common site of infection (83%), and 60% had disseminated disease. Urine antigen testing was positive in all patients in whom it was performed (23/ 23). Initial antifungal therapy consisted of amphotericin B in 70%, and 87% received azoles, typically itraconazole (83%). Two patients developed relapsed infection and 7 patients had graft failure after EFI. Overall mortality was 30%, with an attributable mortality of 13%. Conclusions. As in several previous single-center studies, the incidence of post-transplant histoplasmosis and blastomycosis was o1%, but often resulted in disseminated infection. In this cohort, EFI was associated with a high rate of allograft loss and overall mortality.