Vilchez Regis A, Fung John, Kusne Shimon
Department of Medicine, University of Pittsburgh Medical Center, and Thomas E. Starzl Transplantation Institute, PA 15213, USA.
Am J Transplant. 2002 Aug;2(7):575-80. doi: 10.1034/j.1600-6143.2002.20701.x.
Cryptococcosis is the third most common invasive fungal infection in organ transplant recipients after candidiasis and aspergillosis. Reports indicate that cryptococcosis usually presents as symptomatic disease, and despite therapy the mortality remains high. In addition, some data suggest that there might be differences in the incidence and clinical manifestations of cryptococcosis, depending on the specific transplant organ. The incidence of cryptococcosis in our transplant center is significantly higher in heart transplant recipients than in other transplant groups (p=0.0001). Although the primary risk factor contributing to cryptococcosis in organ transplant recipients is probably the immunosuppressive therapy used to prevent allograft rejection, environmental factors may also play a role. This is indicated by studies that demonstrate differences in the rate of cryptococcosis according to geographic region. Moreover, data point out differences in the isolation of the fungus from soil samples with higher concentrations of Cryptococcus in areas frequented by birds or contaminated by bird droppings. Therefore, it is prudent to recommend that organ transplant recipients avoid birds or areas contaminated with bird droppings. The current review provides an overview of the changes in the incidence, clinical manifestations, and management of cryptococcosis in organ transplant recipients.
隐球菌病是器官移植受者中仅次于念珠菌病和曲霉病的第三常见侵袭性真菌感染。报告显示，隐球菌病通常表现为有症状的疾病，尽管进行了治疗，死亡率仍然很高。此外，一些数据表明，隐球菌病的发病率和临床表现可能因具体的移植器官而异。我们移植中心心脏移植受者的隐球菌病发病率明显高于其他移植组（p = 0.0001）。虽然导致器官移植受者发生隐球菌病的主要危险因素可能是用于预防同种异体移植排斥的免疫抑制治疗，但环境因素也可能起作用。这一点在根据地理区域显示隐球菌病发病率差异的研究中得到了体现。此外，数据指出在鸟类频繁出没或被鸟粪污染的地区，从土壤样本中分离出隐球菌的浓度较高。因此，建议器官移植受者避免接触鸟类或被鸟粪污染的区域是谨慎的做法。本综述概述了器官移植受者隐球菌病在发病率、临床表现和管理方面的变化。
