Autopsy-identified infections among bone marrow transplant recipients: a clinico-pathologic study of 56 patients. Bone Marrow Transplantation Team.
Autopsy-identified infections among bone marrow transplant recipients: a clinico-pathologic study of 56 patients. Bone Marrow Transplantation Team.
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骨髓移植受者尸检发现的感染：56 名患者的临床病理学研究。
DOI：
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发表时间：
1995
影响因子：
4.8
通讯作者：
C. Shearer
中科院分区：
文献类型：
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作者：
Chandrasekar Ph;A. Weinmann;C. Shearer
我们回顾了1988-1992年间在底特律医疗中心接受BMT的56例患者的尸检记录。大多数患者（56例中的43例）在BMT术后2个月内死亡。尸检时发现，40例异体移植患者中有25例（63%）感染，16例自体BMT患者中有4例（25%）感染。尸检分离的微生物有巨细胞病毒（CMV） 14例、酵母菌13例、霉菌（曲霉6例、毛霉1例）和细菌7例。14例巨细胞病毒患者中有9例（65%）、13例酵母菌患者中有6例（46%）和6例曲霉患者中有4例（67%）在死亡前未发现或证实存在感染。大多数细菌感染（7例患者中有5例）是在死前发现的。肺和胃肠道是主要累及的器官系统，无论有无尸检确认的感染。肺部病理表现为弥漫性肺泡损伤、间质性肺炎和支气管肺炎，胃肠道病理表现为食管、胃、小肠和大肠溃疡出血。5例患者的心脏检查显示非细菌性血栓性心内膜炎（NBTE），其中4例仅累及右侧。在目前的研究中，未能在死前识别非细菌性病原体及其与骨髓移植患者死亡率的频繁关联是重点。
We reviewed the autopsy records of 56 patients who had undergone BMT at the Detroit Medical Center during 1988-1992. Most patients (43 of 56) had died within 2 months of BMT. One or more infections were identified at autopsy in 25 of 40 (63%) allogeneic and four of 16 (25%) autologous BMT recipients. Microorganisms isolated at autopsy were cytomegalovirus (CMV) (14 patients), yeasts (13 patients), molds (aspergillus six patients, mucor one patient) and bacteria (seven patients). Presence of infection was not identified or proven prior to death in nine of 14 patients (65%) with CMV, six of 13 patients (46%) with yeasts and four of six patients (67%) with aspergillus. Most bacterial infections (five of seven patients) were identified ante-mortem. Lungs and the gastrointestinal tract were the organ systems mostly involved in patients with or without autopsy-identified infections. Pathologic findings in the lungs were diffuse alveolar damage, interstitial pneumonia and bronchopneumonia and, in the gastrointestinal tract, were ulcerations and hemorrhages of esophagus, stomach, small and large intestines. Examination of the heart showed non-bacterial thrombotic endocarditis (NBTE) in five patients, four with right-sided involvement only. Failure to identify non-bacterial pathogens ante-mortem and their frequent association with mortality in bone marrow transplant patients are high-lighted in the present study.