Fitzpatrick M A, Caicedo J C, Stosor V, Ison M G
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Transpl Infect Dis. 2010 Aug 1;12(4):336-41. doi: 10.1111/j.1399-3062.2010.00517.x. Epub 2010 May 30.
Most guidelines for pre-transplant screening recommend enhanced screening among patients with potential exposure to such pathogens as Strongyloides stercoralis and Trypanosoma cruzi, the cause of Chagas disease. The incidence of these diseases in the Hispanic immigrant population has not been extensively studied. Transplant candidates who were evaluated by our program's Hispanic Transplant Program were referred for expanded infectious disease screening including Mycobacterium tuberculosis, S. stercoralis, Leishmania, and T. cruzi. Between December 2006 and December 2008, 83 patients were screened. Most were from Mexico but we also screened patients from Ecuador, Puerto Rico, and Peru. Most patients lived in urban locations before moving to the United States. Latent tuberculosis infection (LTBI) was found in 20%, and 6.7% had serologic evidence of S. stercoralis infection. These patients underwent treatment of latent infection without difficulty. To date, 14 patients have undergone living-donor kidney transplantation. Two of these patients had positive Leishmania titers and are being followed clinically, 1 was treated for S. stercoralis, and 2 were treated for LTBI pre-transplant. All have done well without evidence of screened pathogens an average of 348 days (range 65-766 days) post transplant. Expanded screening identifies endemic infections in the Hispanic immigrant population that can be treated before transplant, thereby minimizing post-transplant infectious complications.
大多数移植前筛查指南建议，对于可能接触诸如粪类圆线虫和克氏锥虫（恰加斯病的病原体）等病原体的患者，应加强筛查。这些疾病在西班牙裔移民人群中的发病率尚未得到广泛研究。由我们项目的西班牙裔移植项目评估的移植候选人被转介进行扩大的传染病筛查，包括结核分枝杆菌、粪类圆线虫、利什曼原虫和克氏锥虫。在2006年12月至2008年12月期间，对83名患者进行了筛查。大多数患者来自墨西哥，但我们也筛查了来自厄瓜多尔、波多黎各和秘鲁的患者。大多数患者在移居美国之前居住在城市地区。发现20%的患者有潜伏性结核感染（LTBI），6.7%的患者有粪类圆线虫感染的血清学证据。这些患者顺利接受了潜伏感染的治疗。迄今为止，已有14名患者接受了活体供肾移植。其中两名患者利什曼原虫滴度呈阳性，正在接受临床随访，1名患者接受了粪类圆线虫治疗，2名患者在移植前接受了LTBI治疗。所有患者情况良好，移植后平均348天（范围65 - 766天）无筛查出病原体的证据。扩大筛查可识别西班牙裔移民人群中的地方性感染，这些感染可在移植前进行治疗，从而将移植后感染并发症降至最低。
