Arslan H, Inci E K, Azap O K, Karakayali H, Torgay A, Haberal M
Department of Clinical Microbiology and Infectious Disease, Baskent University Facult of Medicine, Ankara, Turkey.
Transpl Infect Dis. 2007 Dec;9(4):270-5. doi: 10.1111/j.1399-3062.2007.00237.x. Epub 2007 May 19.
After transplantation, diarrhea may be caused by infectious agents, drug-specific effects, metabolic conditions, or mechanical complications of surgery. Determining the cause helps to determine whether to initiate antimicrobial therapy and the duration of treatment. In this study we aimed to determine the causes of diarrhea in kidney or liver recipients. Fifty-two diarrhea episodes among 43 solid organ recipients were evaluated. The cause of diarrhea was detected in 43 patients (82.6%). Infectious etiologies accounted for 33 out of the 43 episodes (76.7%) in which a specific cause was determined: Giardia lamblia in 9, Cryptosporidium parvum in 7, cytomegalovirus (CMV) in 6, Clostridium difficile in 3, Campylobacter jejuni in 2, Shigella sonnei in 2, Salmonella enteritidis in 1, rotavirus in 1, Entamoeba histolytica in 1, and Blastocystis hominis in 1. Non-infectious etiologies were found for 10 episodes (23.3%): mycophenolate mofetil-associated diarrhea in 5, antibiotic-associated diarrhea in 2, colchicine-associated diarrhea in 2, and laxative drug-associated in 1. Non-infectious etiologies seem to be relatively common causes of diarrhea among transplant recipients. Therapy was adjusted in 5 patients because of mycophenolate mofetil-associated diarrhea. CMV and C. parvum, which are seldom seen in the normal population, were frequent causes of diarrhea in this group. Evaluating the transplant recipients for non-infectious causes of diarrhea is important in prompt diagnosis and treatment.
移植后，腹泻可能由感染因素、药物特异性作用、代谢状况或手术的机械性并发症引起。确定病因有助于决定是否开始抗菌治疗以及治疗时长。在本研究中，我们旨在确定肾或肝移植受者腹泻的病因。对43例实体器官移植受者中的52次腹泻发作进行了评估。43例患者（82.6%）检测到了腹泻病因。在确定了具体病因的43次发作中，感染性病因占33次（76.7%）：9例为蓝氏贾第鞭毛虫，7例为微小隐孢子虫，6例为巨细胞病毒（CMV），3例为艰难梭菌，2例为空肠弯曲菌，2例为宋内志贺菌，1例为肠炎沙门菌，1例为轮状病毒，1例为溶组织内阿米巴，1例为结肠小袋纤毛虫。发现10次发作（23.3%）为非感染性病因：5例为霉酚酸酯相关腹泻，2例为抗生素相关腹泻，2例为秋水仙碱相关腹泻，1例为泻药相关腹泻。非感染性病因似乎是移植受者腹泻相对常见的原因。5例患者因霉酚酸酯相关腹泻调整了治疗。CMV和微小隐孢子虫在正常人群中很少见，但却是该组腹泻的常见病因。评估移植受者腹泻的非感染性病因对于及时诊断和治疗很重要。
