Colomba Claudia, Antinori Spinello
Istituto di Patologia Infettiva e Virologia, Università, Palermo.
Recenti Prog Med. 2003 Nov;94(11):516-28.
Invasive fungal infections have became one of the principal obstacles to successful solid organ and bone marrow transplantation. The natural history and incidence of systemic fungal infection varies with the type of organ transplanted and the immunosuppressive therapy administered; the majority of infections occur within the first two months after transplantation. The most common fungi that cause disease in transplant recipients are Candida spp. and Aspergillus spp. The clinical presentations of fungal infections in solid-organ transplant recipients are non specific and often overlap with other infectious and non infectious processes; for this reason it's important maintain a high index of suspicion for this type of infection so to start an aggressive diagnostic and therapeutic approach. Difficulty in establishing an etiological diagnosis, lack of effective therapy in certain situations, difficult management of certain antifungal drugs due to toxicity and/or interaction with immunosuppressive drugs, and limited data on effective antifungal prophylactic regimens in solid-organ transplantation represent major problems in the treatment of fungal infection in this population.
侵袭性真菌感染已成为实体器官和骨髓移植成功的主要障碍之一。系统性真菌感染的自然病史和发病率因移植器官的类型和所给予的免疫抑制治疗而异;大多数感染发生在移植后的头两个月内。在移植受者中引起疾病的最常见真菌是念珠菌属和曲霉属。实体器官移植受者中真菌感染的临床表现不具特异性,且常与其他感染性和非感染性过程重叠;因此,对这类感染保持高度怀疑指数很重要,以便启动积极的诊断和治疗方法。在确定病因诊断方面存在困难,在某些情况下缺乏有效治疗,由于毒性和/或与免疫抑制药物相互作用导致某些抗真菌药物难以管理,以及实体器官移植中有效抗真菌预防方案的数据有限,这些都是该人群真菌感染治疗中的主要问题。