Sandhu Kamaldeep, Gupta Somesh, Kumar Bhushan, Dhandha Raman, Udigiri Naval Kishore, Minz Mukut
Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Dermatol. 2003 Aug;30(8):590-5. doi: 10.1111/j.1346-8138.2003.tb00440.x.
Immunosuppression-related mucocutaneous lesions are a significant problem in renal transplant recipients. Infections account for the majority of these manifestations. The aim of this study was to determine the spectrum of mucocutaneous infections and infestations in renal transplant recipients. Over a period of three years, all the renal transplant recipients presenting with mucocutaneous lesions (only with infectious etiology) were included in the study. Diagnosis was based on the clinical appearance and appropriate investigations like scraping for KOH, Tzanck smear, cultures, and skin biopsies whenever necessary. In order to study the temporal effect of immunosuppression on these mucocutaneous infections, the patients were divided into six groups -with durations of graft survival ranging from 0-2, 2-6, 6-12, 12-24, 24-60, and more than 60 months in Groups A-F, respectively. A total of 104 renal transplant recipients presented with 117 infections and infestations. The mean age at presentation was 35.9 +/- 1.2 years (15-65 yrs), and the mean duration after the transplant was 23.3 +/- 3.5 months (1-175). The mean serum creatinine level at the time of clinical presentation was 1.4 +/- 0.07 mg/dl (0.7-6). Twenty-seven patients were on a two-drug regimen, prednisolone and azathioprine, and the rest were on a three-drug regimen with cyclosporine in addition. Out of the total of 117 infections in 104 patients, 57 were viral, 49 were fungal, and 8 were bacterial. Two patients had scabies and one had cysticercosis. The mean time interval for the occurrence of infections after the transplant was earlier in patients on three-drug immunosuppression (12.4 +/- 2.3 months) than in those on the two-drug regimen (51.3 +/- 1.8 months), (p<0.01). The viral infections had the shortest mean time interval for presentation following transplant, 15.8 +/- 1.2 months (p<0.05). We did not find any statistically significant difference with regard to age or sex of the patients, duration after the transplant, or the pattern of infection. Careful examination of transplant patients is essential for early detection and proper treatment, because the mucocutaneous infections can have atypical morphologies and are likely to become extensive if not treated early.
免疫抑制相关的皮肤黏膜病变是肾移植受者面临的一个重大问题。感染是这些表现的主要原因。本研究的目的是确定肾移植受者皮肤黏膜感染和寄生虫感染的范围。在三年的时间里，所有出现皮肤黏膜病变（仅由感染病因引起）的肾移植受者都被纳入研究。诊断基于临床表现以及必要时进行的适当检查，如氢氧化钾涂片、Tzanck涂片、培养和皮肤活检。为了研究免疫抑制对这些皮肤黏膜感染的时间影响，患者被分为六组——A - F组的移植存活时间分别为0 - 2个月、2 - 6个月、6 - 12个月、12 - 24个月、24 - 60个月和超过60个月。共有104例肾移植受者出现了117例感染和寄生虫感染。出现症状时的平均年龄为35.9±1.2岁（15 - 65岁），移植后的平均时间为23.3±3.5个月（1 - 175个月）。临床表现时的平均血清肌酐水平为1.4±0.07mg/dl（0.7 - 6mg/dl）。27例患者采用泼尼松龙和硫唑嘌呤的两药方案，其余患者采用三药方案，外加环孢素。在104例患者的117例感染中，57例为病毒感染，49例为真菌感染，8例为细菌感染。2例患者患有疥疮，1例患有囊尾蚴病。三药免疫抑制患者移植后感染发生的平均时间间隔（12.4±2.3个月）比两药方案患者（51.3±1.8个月）更早（p<0.01）。病毒感染在移植后出现的平均时间间隔最短，为15.8±1.2个月（p<0.05）。我们没有发现患者的年龄、性别、移植后的时间或感染模式有任何统计学上的显著差异。对移植患者进行仔细检查对于早期发现和正确治疗至关重要，因为皮肤黏膜感染可能具有非典型形态，如果不及早治疗可能会扩散。
