Department of Infectious Disease, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio 44195, USA.
Semin Respir Crit Care Med. 2011 Dec;32(6):717-26. doi: 10.1055/s-0031-1295719. Epub 2011 Dec 13.
Fungal infections are among the most serious complications of lung transplantation. The 1-year cumulative incidence of invasive fungal infections in lung transplant recipients is 6 to 10%, which is higher than most other solid organ transplant recipients. Aspergillus spp. are the most common etiologic agents, but Candida spp., non-Aspergillus mycelial fungi, Cryptococcus, Pneumocystis, and endemic mycoses can cause active infections in this population. Clinical manifestations of fungal infection in lung transplant recipients are protean, and include invasive pulmonary disease, airway and anastomotic infections, posttransplant empyemas, and disseminated infections. Most centers employ either universal or targeted antifungal prophylaxis in some form, but the agents, doses, durations, and monitoring strategies vary widely from one center to another. This review discusses the salient fungal organisms responsible for infection in lung transplant recipients and management strategies for prevention.
真菌感染是肺移植后最严重的并发症之一。肺移植受者侵袭性真菌感染的 1 年累积发生率为 6%至 10%，高于大多数其他实体器官移植受者。曲霉菌属是最常见的病原体，但念珠菌属、非曲霉菌丝状真菌、隐球菌、卡氏肺孢子虫和地方性真菌病也可引起该人群的活动性感染。肺移植受者真菌感染的临床表现多种多样，包括侵袭性肺部疾病、气道和吻合口感染、移植后脓胸和播散性感染。大多数中心以某种形式采用通用或靶向抗真菌预防，但药物、剂量、持续时间和监测策略在不同中心之间差异很大。本文讨论了导致肺移植受者感染的主要真菌，并探讨了预防感染的管理策略。
