Grim S A, Proia L, Miller R, Alhyraba M, Costas-Chavarri A, Oberholzer J, Clark N M
Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
Transpl Infect Dis. 2012 Feb;14(1):17-23. doi: 10.1111/j.1399-3062.2011.00658.x. Epub 2011 Jul 12.
A review of the clinical presentation, diagnosis, treatment and outcomes of 30 solid organ transplant recipients (SOTRs) with histoplasmosis or blastomycosis from 3 Midwestern academic medical centers.
The endemic fungal pathogens, Histoplasma capsulatum and Blastomyces dermatitidis, may cause severe infection in SOTRs. In this report, we describe the clinical presentation, diagnosis, treatment, and outcomes of these endemic fungal infections (EFIs) among SOTRs at 3 academic transplant centers.
A retrospective review was conducted of SOTRs with histoplasmosis or blastomycosis from 3 Midwestern medical centers in the United States. Data collected included demographics, immunosuppression, clinical presentation, method of diagnosis, antifungal treatment, response to therapy, and patient and graft survival.
Between 1996 and 2008, 30 transplant recipients with histoplasmosis or blastomycosis were identified, giving a cumulative incidence of infection of 0.50% (30/5989); 73% of the study patients were renal transplant recipients, and the median time to disease onset after transplantation was 10.5 months. The lungs were the most common site of infection (83%), and 60% had disseminated disease. Urine antigen testing was positive in all patients in whom it was performed (23/23). Initial antifungal therapy consisted of amphotericin B in 70%, and 87% received azoles, typically itraconazole (83%). Two patients developed relapsed infection and 7 patients had graft failure after EFI. Overall mortality was 30%, with an attributable mortality of 13%.
As in several previous single-center studies, the incidence of post-transplant histoplasmosis and blastomycosis was <1%, but often resulted in disseminated infection. In this cohort, EFI was associated with a high rate of allograft loss and overall mortality.
回顾来自3个中西部学术医疗中心的30例实体器官移植受者（SOTR）感染组织胞浆菌病或芽生菌病的临床表现、诊断、治疗及预后。
地方性真菌病原体荚膜组织胞浆菌和皮炎芽生菌可在实体器官移植受者中引起严重感染。在本报告中，我们描述了这3个学术移植中心实体器官移植受者中这些地方性真菌感染（EFI）的临床表现、诊断、治疗及预后。
对来自美国3个中西部医疗中心的感染组织胞浆菌病或芽生菌病的实体器官移植受者进行回顾性研究。收集的数据包括人口统计学资料、免疫抑制情况、临床表现、诊断方法、抗真菌治疗、治疗反应以及患者和移植物存活率。
1996年至2008年期间，共识别出30例感染组织胞浆菌病或芽生菌病的移植受者，感染累积发生率为0.50%（30/5989）；73%的研究患者为肾移植受者，移植后疾病发病的中位时间为10.5个月。肺部是最常见的感染部位（83%），60%的患者有播散性疾病。所有进行尿抗原检测的患者（23/23）结果均为阳性。初始抗真菌治疗70%采用两性霉素B，87%接受唑类药物治疗，通常为伊曲康唑（83%）。2例患者发生复发性感染，7例患者在感染EFI后出现移植物失功。总体死亡率为30%，归因死亡率为13%。
与之前的几项单中心研究一样，移植后组织胞浆菌病和芽生菌病的发生率<1%，但常导致播散性感染。在这一队列中，EFI与较高的同种异体移植物丢失率和总体死亡率相关。
