Forrest G N, Mankes K
Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Transpl Infect Dis. 2007 Jun;9(2):161-4. doi: 10.1111/j.1399-3062.2006.00197.x.
Zygomycosis is an infrequent and difficult-to-treat fungal infection that is found in patients with underlying immunocompromised states. The advent of the lipid amphotericin B products has allowed for treatment with higher doses of therapy and less systemic toxicity. We reviewed the outcomes of 6 renal transplant recipients diagnosed with biopsy-proven invasive zygomycosis who received amphotericin B lipid complex (ABLC) in doses greater than 5 mg/kg between 2000 and 2004. All 6 patients had baseline diabetes mellitus, were receiving immunosuppressive agents, and subsequently underwent concomitant surgery. Three of the 6 patients that survived had undergone significant surgical debridement, reduction of their immunosuppression to minimal prednisone, and received prolonged course of ABLC at 10 mg/kg/day. All survivors lost graft function during the course of their therapy. The 3 patients who died all had delays in diagnosis of their disease and subsequent surgical and appropriate medical therapy. Therefore, in renal transplant recipients the early diagnosis of invasive zygomycosis is imperative along with early therapy with surgical debridement, reduced immunosuppression, and the use of high doses of ABLC.
接合菌病是一种罕见且难以治疗的真菌感染，见于有潜在免疫功能低下状态的患者。脂质型两性霉素B产品的出现使得能够使用更高剂量的治疗且全身毒性更小。我们回顾了2000年至2004年间6例经活检证实为侵袭性接合菌病的肾移植受者的治疗结果，这些患者接受了剂量大于5mg/kg的两性霉素B脂质复合物（ABLC）治疗。所有6例患者基线时均患有糖尿病，正在接受免疫抑制剂治疗，随后均接受了同期手术。6例存活患者中有3例接受了广泛的手术清创，将免疫抑制减至最低剂量的泼尼松，并接受了为期较长的10mg/kg/天的ABLC治疗。所有存活者在治疗过程中均丧失了移植肾功能。死亡的3例患者均在疾病诊断、后续手术及适当的药物治疗方面出现延误。因此，对于肾移植受者，侵袭性接合菌病的早期诊断以及早期进行手术清创、降低免疫抑制和使用高剂量ABLC治疗至关重要。
