Braddy C M, Heilman R L, Blair J E
Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA.
Am J Transplant. 2006 Feb;6(2):340-5. doi: 10.1111/j.1600-6143.2005.01169.x.
Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States of particular concern for immunosuppressed renal transplant recipients. The clinical course of coccidioidomycosis can be severe in immunosuppressed patients, with high rates of dissemination and mortality, and antifungal prophylaxis is routinely administered to high-risk patients. We sought to determine the impact of coccidioidomycosis on patients who received their renal transplant at our hospital in Phoenix, Arizona. A retrospective records review of the first 205 patients who received a renal transplant between June 1999 and December 2003 identified 6 patients (3%) who had contracted coccidioidomycosis after transplantation. All six cases occurred more than 6 months after transplantation. Two of these six patients had disseminated coccidioidomycosis. Two patients, one with pulmonary infection and one with disseminated infection, died. None of the six patients with coccidioidomycosis after transplantation had identified risk factors before transplantation. No high-risk patient who received targeted antifungal prophylaxis had a reactivation of coccidioidomycosis after transplantation. Treatment for acute rejection and induction with antithymocyte globulin did not appear to increase the risk of subsequent coccidioidomycosis.
球孢子菌病是美国西南部沙漠地区的一种地方性真菌感染，对于免疫抑制的肾移植受者来说尤其值得关注。在免疫抑制患者中，球孢子菌病的临床病程可能很严重，播散率和死亡率都很高，高危患者通常会接受抗真菌预防治疗。我们试图确定球孢子菌病对在亚利桑那州凤凰城我们医院接受肾移植的患者的影响。对1999年6月至2003年12月期间接受肾移植的前205例患者进行回顾性病历审查，发现有6例患者（3%）在移植后感染了球孢子菌病。这6例病例均发生在移植后6个月以上。这6例患者中有2例发生了播散性球孢子菌病。2例患者死亡，其中1例患有肺部感染，1例患有播散性感染。6例移植后发生球孢子菌病的患者在移植前均未发现危险因素。接受针对性抗真菌预防治疗的高危患者在移植后均未出现球孢子菌病复发。急性排斥反应的治疗和抗胸腺细胞球蛋白诱导治疗似乎并未增加随后发生球孢子菌病的风险。
