de Pablo A, Ussetti P, Cruz Carreño M, Lázaro T, Ferreiro M J, López A, Mendaza P, Estada J
Servicio de Neumología, Clínica Puerta de Hierro, Madrid.
Enferm Infecc Microbiol Clin. 2000 May;18(5):209-14.
Fungal infections are a frequent cause of morbidity an mortality in transplant recipients. Aspergillus spp. is an ubiquitous fungus capable of producing diverse clinical entities with varying severity.
To study the incidence and severity of Aspergillus spp. infections in lung transplantation, analysing the different clinical presentations and response to antifungal drugs.
A review was made of the clinical histories of all patients undergoing lung transplantation who developed positive Aspergillus spp. cultures in our centre between June 1991 and December 1996.
Eleven of 49 transplanted patients (22%) developed Aspergillus spp. infections. Four patients presented invasive aspergillosis forms and 7 tracheobronchitis. In spite of antifungal treatment 3 patients (30%) died of invasive aspergillosis as a direct consequence of the infection. Of the 7 patients with tracheobronchitis, 2 were ulcerative and 1 pseudomembranous, all responded to antifungal treatment. Three patients (10.3%) developed Aspergillus spp. infections despite prophylaxis with itraconazole.
Invasive aspergillosis in the immediate posttransplant period was mortal despite treatment. As opposed, aspergillar tracheobronchitis have been overcome using combined treatments of liposomal or lipidic amphotericin, itraconazole and nebulised amphotericin.
真菌感染是移植受者发病和死亡的常见原因。曲霉菌属是一种普遍存在的真菌，能够导致严重程度各异的多种临床病症。
研究肺移植中曲霉菌属感染的发生率和严重程度，分析不同的临床表现及对抗真菌药物的反应。
回顾了1991年6月至1996年12月在本中心接受肺移植且曲霉菌属培养呈阳性的所有患者的临床病史。
49例移植患者中有11例（22%）发生曲霉菌属感染。4例表现为侵袭性曲霉菌病，7例为气管支气管炎。尽管进行了抗真菌治疗，仍有3例患者（30%）因感染导致的侵袭性曲霉菌病死亡。7例气管支气管炎患者中，2例为溃疡性，1例为假膜性，所有患者对抗真菌治疗均有反应。3例患者（10.3%）尽管接受了伊曲康唑预防治疗仍发生了曲霉菌属感染。
移植后即刻发生的侵袭性曲霉菌病尽管进行了治疗仍可致命。相反，脂质体或脂质性两性霉素、伊曲康唑和雾化两性霉素联合治疗已成功治愈曲霉菌性气管支气管炎。
