Marjani M, Tabarsi P, Najafizadeh K, Rashid Farokhi F, Sharifkashani B, Motahari S, Abbasi A, Masjedi M R, Mansouri D
Transplant Research Center, Massih Daneshvari Hospital, Darabad-Niavaran, Tehran, Iran.
Transplant Proc. 2008 Dec;40(10):3663-7. doi: 10.1016/j.transproceed.2008.06.070.
Aspergillosis is one of the most important opportunistic infections after organ transplantation. Early diagnosis and initiation of appropriate antifungal therapy are key factors for better prognosis.
We reviewed the medical records of patients with solid organ transplantation with evidence of Aspergillus infections from December 2001 to January 2008, evaluating patient demographics, time of onset after transplantation, risk factors, radiologic appearance, diagnostic criteria, antifungal therapy, and outcome.
We observed aspergillosis in 8 lung, 3 kidney, and 1 heart recipient, with overall mean age of 40.6 years. Seven cases of Aspergillus tracheobronchitis were diagnosed in lung transplant recipients, all of them in the first 6 months after transplantation. All patients responded to antifungal therapy and bronchoscopic debridement. We observed 5 cases of invasive pulmonary aspergillosis. Three patients survived in response to antifungal treatment. The two patients who died were treated with a combination of itraconazole and amphotericin B, whereas all cured patients had been treated with voriconazole alone or in combination with caspofungin.
It seems that the prognosis of aspergillosis in solid organ recipients is improving with new treatment regimens, particularly if they are used in early stages of infection.
曲霉病是器官移植后最重要的机会性感染之一。早期诊断并开始适当的抗真菌治疗是改善预后的关键因素。
我们回顾了2001年12月至2008年1月期间有曲霉感染证据的实体器官移植患者的病历，评估患者的人口统计学特征、移植后发病时间、危险因素、影像学表现、诊断标准、抗真菌治疗及预后。
我们在8例肺移植受者、3例肾移植受者和1例心脏移植受者中观察到曲霉病，总体平均年龄为40.6岁。在肺移植受者中诊断出7例曲霉性气管支气管炎，均发生在移植后的前6个月内。所有患者对抗真菌治疗和支气管镜清创均有反应。我们观察到5例侵袭性肺曲霉病。3例患者经抗真菌治疗后存活。死亡的2例患者接受了伊曲康唑和两性霉素B联合治疗，而所有治愈的患者均单独使用伏立康唑或与卡泊芬净联合使用进行治疗。
新的治疗方案似乎正在改善实体器官移植受者曲霉病的预后，尤其是在感染早期使用时。
