Güleç A Tülin, Demirbilek Müge, Seçkin Deniz, Can Füsun, Saray Yasemin, Sarifakioglu Evren, Haberal Mehmet
Departments of Dermatology, Microbiology and General Surgery, Başkent university Faculty of Medicine, Ankara, Turkey.
J Am Acad Dermatol. 2003 Aug;49(2):187-92. doi: 10.1067/s0190-9622(03)00861-2.
Renal transplant recipients are predisposed to superficial fungal infections caused by graft-preserving immunosuppressive therapy. Reports have documented a wide range of prevalence rates for superficial fungal infections in this patient group.
The aim of this study was to determine the prevalence and clinical and mycological features of superficial fungal infections in renal transplant recipients at our center.
One hundred two consecutively registered renal transplant recipients (34 women, 68 men) and 88 healthy age- and sex-matched persons acting as controls (30 women, 58 men) underwent screening for the presence of superficial fungal infection. Skin scrapings and swabs were obtained from the dorsum of the tongue, upper part of the back, toe webs, and any suspicious lesions. Nail clippings were also collected. All samples were examined by direct microscopy and were stained with calcofluor white. The samples were cultured in Sabouraud dextrose agar, mycobiotic agar, and dermatophyte test medium. Candida species were identified on the basis of germ-tube production, spore formation in cornmeal agar, and results of biochemical testing. Dermatophytes were identified on the basis of colonial and microscopic morphologic features in conjunction with results of physiologic evaluation (in vitro hair perforation test, urease activity, temperature tolerance test, and nutritional test).
Sixty-five (63.7%) of the 102 renal transplant recipients had cutaneous-oral candidiasis, dermatophytosis, or pityriasis versicolor, whereas only 27 (30.7%) of controls had fungal infection. Pityriasis versicolor was the most common fungal infection in the patient group (36.3%), followed by cutaneous-oral candidiasis (25.5%), onychomycosis (12.7%), and fungal toe-web infection (11.8%). Pityriasis versicolor and oral candidiasis were significantly more common among the renal transplant recipients, whereas the frequency of dermatophytosis in patients and controls was similar. Candida albicans was the main agent responsible for oral candidiasis, and Trichophyton rubrum was the most common dermatophyte isolated. Analysis showed that age, sex, and duration of immunosuppression did not significantly affect the prevalence of superficial fungal infection. Cyclosporine treatment and azathioprine therapy were identified as independent risk factors for superficial fungal disease.
The prevalence of opportunistic infections with Pityrosporum ovale and C albicans is increased among renal transplant recipients, probably owing to the immunosuppressed state of this patient population. However, renal transplant recipients are not at increased risk of dermatophytosis.
肾移植受者因维持移植肾的免疫抑制治疗而易患浅表真菌感染。报告记录了该患者群体中浅表真菌感染的广泛患病率。
本研究的目的是确定我们中心肾移植受者浅表真菌感染的患病率以及临床和真菌学特征。
102例连续登记的肾移植受者（34名女性，68名男性）和88名年龄及性别匹配的健康人作为对照（30名女性，58名男性）接受浅表真菌感染筛查。从舌背、背部上方、趾间以及任何可疑病变处获取皮肤刮屑和拭子。还收集了指甲剪。所有样本均进行直接显微镜检查并用荧光增白剂染色。样本在沙氏葡萄糖琼脂、霉菌琼脂和皮肤癣菌测试培养基中培养。白色念珠菌根据芽管形成、玉米粉琼脂中的孢子形成以及生化测试结果进行鉴定。皮肤癣菌根据菌落和显微镜形态特征结合生理评估结果（体外毛发穿孔试验、脲酶活性、温度耐受性试验和营养试验）进行鉴定。
102例肾移植受者中有65例（63.7%）患有皮肤口腔念珠菌病、皮肤癣菌病或花斑癣，而对照组中只有27例（30.7%）有真菌感染。花斑癣是患者组中最常见的真菌感染（36.3%），其次是皮肤口腔念珠菌病（25.5%）、甲癣（12.7%）和真菌性趾间感染（11.8%）。花斑癣和口腔念珠菌病在肾移植受者中明显更为常见，而患者和对照组中皮肤癣菌病的发生率相似。白色念珠菌是口腔念珠菌病的主要病原体，红色毛癣菌是分离出的最常见皮肤癣菌。分析表明，年龄、性别和免疫抑制持续时间对浅表真菌感染的患病率没有显著影响。环孢素治疗和硫唑嘌呤治疗被确定为浅表真菌病的独立危险因素。
肾移植受者中卵圆形糠秕孢子菌和白色念珠菌机会性感染的患病率增加，可能是由于该患者群体的免疫抑制状态。然而，肾移植受者患皮肤癣菌病的风险并未增加。
