Department of Pulmonary Diseases, Baskent University School of Medicine, Ankara, Turkey.
Curr Opin Pulm Med. 2012 May;18(3):202-12. doi: 10.1097/MCP.0b013e328352104f.
Hematopoietic stem cell as well as solid-organ transplantation is being carried out with increasing frequency throughout the world. Lower respiratory tract infections (LRTIs) remain a common life-threatening complication faced by the transplant recipients. The purpose of this review is to provide up-to-date information on pulmonary infections among the transplant recipients, especially emphasizing the endemicity of microorganisms, epidemiology, work-up of infections, and principles of their management.
A lower respiratory tract infection such as pneumonia is the most frequent of all the infections and is associated with high morbidity and mortality. Factors increasing the risk of pulmonary infections include surgical techniques, immune status, chemoradiotherapy, alloimmune mechanisms between the host and the graft, and the environment. A high degree of suspicion, computed tomography (CT) scan of the chest, and flexible bronchoscopy are required in most to establish the diagnosis.
Proper management of LRTI in transplant recipients requires a high degree of suspicion, thorough knowledge of the epidemiology and endemicity of the suspected organisms, CT scan of the chest, and expertise at bronchoscopy. Utmost teamwork among transplant physicians, infectious disease specialist, and bronchoscopist is essential.
造血干细胞和实体器官移植在全球范围内的应用频率越来越高。下呼吸道感染（LRTIs）仍然是移植受者面临的常见且危及生命的并发症。本综述的目的是提供有关移植受者肺部感染的最新信息，特别是强调微生物的地方性、流行病学、感染的检查以及其治疗原则。
下呼吸道感染（如肺炎）是所有感染中最常见的，与高发病率和死亡率相关。增加肺部感染风险的因素包括手术技术、免疫状态、放化疗、宿主和移植物之间的同种免疫机制以及环境。在大多数情况下，需要高度怀疑、胸部计算机断层扫描（CT）和纤维支气管镜检查来建立诊断。
适当管理移植受者的 LRTI 需要高度怀疑、充分了解可疑病原体的流行病学和地方性、胸部 CT 扫描以及支气管镜检查方面的专业知识。移植医生、传染病专家和支气管镜专家之间的最大团队合作至关重要。
