肺移植受者支气管肺泡灌洗中的内格西西曼卡菌：与急性排斥反应的可能关联。

Simkania negevensis in bronchoalveolar lavage of lung transplant recipients: a possible association with acute rejection.

作者信息

Husain Shahid, Kahane Simona, Friedman Maureen G, Paterson David L, Studer Sean, McCurry Kenneth R, Wolf Dana G, Zeevi Adriana, Pilewski Joseph, Greenberg David

机构信息

Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.

出版信息

Transplantation. 2007 Jan 27;83(2):138-43. doi: 10.1097/01.tp.0000250477.65139.02.

DOI:10.1097/01.tp.0000250477.65139.02

PMID:17264809

Abstract

BACKGROUND

Simkania negevensis is a novel organism closely related to chlamydiae. The organism has been associated with community acquired pneumonia and acute exacerbation of chronic obstructive pulmonary disease. The prevalence and pathogenic potential of S. negevensis is not known in lung transplant recipients.

METHODS

In this multicenter study comparative analysis of bronchoalveolar lavage (BAL) in lung transplants (Tx) and kidney Tx, immunocompromised and nasopharyngeal (NP) washes of immunocompetent patients was done. The BAL specimens were tested by nested polymerase chain reaction (PCR) for C. pneumoniae and S. negevensis. Selected S. negevensis positive PCR cases were confirmed by culture.

RESULTS

In the initial 41 BAL samples S. negevensis was detected in 97.5% (40/41) of lung transplant recipients as compared to 14.1% (1/7) in other organ transplant recipients (P<0.0001). In the sequential samples of 19 lung transplant recipients, 59% (24/41) had concomitant positive PCR and rejection as compared to 30% (3/10) who had negative PCR but had rejection (P=0.16). S. negevensis infection had hazard ratio of 3.29 (95% CI: 0.73-14.76; P=0.11) for developing acute rejection.

CONCLUSION

S. negevensis is highly prevalent in liver Tx recipients and may be associated with acute rejection.

摘要

背景

内格希氏西曼卡菌是一种与衣原体密切相关的新型微生物。该微生物与社区获得性肺炎和慢性阻塞性肺疾病急性加重有关。内格希氏西曼卡菌在肺移植受者中的患病率和致病潜力尚不清楚。

方法

在这项多中心研究中，对肺移植（Tx）和肾移植患者的支气管肺泡灌洗（BAL）、免疫功能低下患者以及免疫功能正常患者的鼻咽（NP）冲洗液进行了比较分析。通过巢式聚合酶链反应（PCR）检测BAL标本中的肺炎衣原体和内格希氏西曼卡菌。选定的内格希氏西曼卡菌PCR阳性病例通过培养进行确诊。

结果

在最初的41份BAL样本中，97.5%（40/41）的肺移植受者检测到内格希氏西曼卡菌，而其他器官移植受者中这一比例为14.1%（1/7）（P<0.0001）。在19例肺移植受者的后续样本中，59%（24/41）的患者PCR检测呈阳性且伴有排斥反应，而PCR检测呈阴性但发生排斥反应的患者比例为30%（3/10）（P=0.16）。内格希氏西曼卡菌感染导致急性排斥反应的风险比为3.29（95%CI：0.73-14.76；P=0.11）。