Montoya J G, Chaparro S V, Celis D, Cortés J A, Leung A N, Robbins R C, Stevens D A
Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California 94305-5107, USA.
Clin Infect Dis. 2003 Oct 1;37 Suppl 3:S281-92. doi: 10.1086/376527.
Among patients undergoing heart transplantation, Aspergillus is the opportunistic pathogen with the highest attributable mortality. The median time of onset from transplantation for invasive pulmonary aspergillosis (IPA) was 46 days, but the median time to first positive culture result was 104 days among patients with Aspergillus colonization but no invasive disease. Most patients with IPA presented with fever and cough within the first 90 days of transplantation and with single or multiple pulmonary nodules. None of the heart transplant recipients with either IPA or invasive extrapulmonary aspergillosis (IEPA) had associated neutropenia. Human leukocyte antigen A1 locus was found significantly more frequently among patients colonized with Aspergillus than among patients with IPA (P<.006) or IEPA (P<.001). Even in the absence of neutropenia, IPA should be suspected for heart transplant recipients who have fever and respiratory symptoms within the first 3 months of transplantation, have a positive result of culture of respiratory secretions, and have abnormal radiological findings (particularly nodules).
在接受心脏移植的患者中，曲霉菌是导致死亡归因最高的机会致病菌。侵袭性肺曲霉病（IPA）自移植开始的发病中位时间为46天，但在有曲霉菌定植但无侵袭性疾病的患者中，首次培养结果呈阳性的中位时间为104天。大多数IPA患者在移植后的前90天内出现发热和咳嗽，并伴有单个或多个肺结节。患有IPA或肺外侵袭性曲霉病（IEPA）的心脏移植受者均无相关中性粒细胞减少症。与患有IPA（P<0.006）或IEPA（P<0.001）的患者相比，在曲霉菌定植的患者中，人类白细胞抗原A1位点的发现频率显著更高。即使没有中性粒细胞减少症，对于在移植后前3个月内出现发热和呼吸道症状、呼吸道分泌物培养结果呈阳性且有异常影像学表现（特别是结节）的心脏移植受者，也应怀疑患有IPA。
