Sun Hsin-Yun, Wagener Marilyn M, Singh Nina
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
Clin Infect Dis. 2009 Jun 1;48(11):1566-76. doi: 10.1086/598936.
The impact of current transplantation practices on the characteristics of cryptococcosis in solid-organ transplant recipients is not well defined. The incidence of cryptococcal disease among solid-organ transplant recipients has remained unchanged; however, patients are less likely to present with central nervous system or disseminated disease and are more likely to have cryptococcosis limited to the lungs. Additionally, lipid formulations of amphotericin B are now used more frequently, whereas their use in combination with flucytosine has decreased. The overall mortality of cryptococcosis has significantly improved in the current era. Renal failure remains associated with poor outcome, whereas use of lipid formulations of amphotericin B is associated with a higher survival rate. Despite rare infectious complication, certain peculiar attributes of cryptococcal disease in hematopoietic stem cell recipients and tissue transplant recipients warrant recognition.
目前移植治疗方法对实体器官移植受者隐球菌病特征的影响尚不明确。实体器官移植受者中隐球菌病的发病率保持不变；然而，患者出现中枢神经系统或播散性疾病的可能性降低，而患局限于肺部的隐球菌病的可能性增加。此外，两性霉素B脂质体制剂目前使用更为频繁，而其与氟胞嘧啶联合使用的情况减少。在当前时代，隐球菌病的总体死亡率已显著改善。肾衰竭仍然与不良预后相关，而使用两性霉素B脂质体制剂与较高的生存率相关。尽管存在罕见的感染并发症，但造血干细胞受者和组织移植受者隐球菌病的某些特殊特征值得关注。
