Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA.
Am J Transplant. 2011 Jan;11(1):111-9. doi: 10.1111/j.1600-6143.2010.03328.x. Epub 2010 Nov 18.
Coccidioidomycosis is an infection caused by Coccidioides species, which are endemic for the Southwestern United States and parts of Central America and South America. Most infected individuals are asymptomatic or have mild-to-moderate respiratory illness. Coccidioidomycosis is more severe in patients with depressed cellular immunity, such as organ transplant recipients. We retrospectively reviewed charts of 391 liver transplant recipients (mean follow-up, 38.7 months; range, 2-105 months). Before transplantation, 12 patients had a history of coccidioidomycosis and 13 patients had asymptomatic seropositivity. Of these 25 patients, 23 had no active coccidioidomycosis posttransplantation and 2 had reactivated infection. One of 5 patients with indeterminate serology before transplantation died of disseminated coccidioidomycosis shortly after transplantation. De novo coccidioidomycosis developed in 12 patients (3%) who had no evidence of coccidioidomycosis pretransplantation. Of 15 total episodes of posttransplantation coccidioidomycosis, 10 (66%) occurred during the first year. Dissemination was noted in 33% of active coccidioidomycosis after transplantation; two patients (13%) died of coccidioidomycosis. Because most coccidioidal infections occurred in the first posttransplantation year despite targeted antifungal prophylaxis, we recommend a new strategy of universal antifungal prophylaxis for 6-12 months for liver transplant recipients who reside in the endemic area.
球孢子菌病是由球孢子菌属引起的感染，该属在美西南部和中美洲及南美洲部分地区流行。大多数感染个体无症状或有轻度至中度呼吸道疾病。球孢子菌病在细胞免疫功能低下的患者中更为严重，如器官移植受者。我们回顾性分析了 391 例肝移植受者的病历（平均随访时间 38.7 个月；范围 2-105 个月）。移植前，12 例患者有球孢子菌病病史，13 例患者有无症状血清阳性。在这 25 例患者中，23 例移植后无活动性球孢子菌病，2 例感染复发。1 例移植前血清学结果不确定的患者在移植后不久死于播散性球孢子菌病。12 例（3%）无移植前球孢子菌病证据的患者新发球孢子菌病（de novo coccidioidomycosis）。在 15 例移植后球孢子菌病总发病例中，有 10 例（66%）发生在移植后第一年。在移植后活动性球孢子菌病中，有 33%的患者出现播散；2 例（13%）患者死于球孢子菌病。由于尽管进行了靶向抗真菌预防，但大多数球孢子菌感染发生在移植后第一年，我们建议对居住在流行地区的肝移植受者进行 6-12 个月的通用抗真菌预防的新策略。
