Muñoz Patricia, Cerón Ines, Valerio Maricela, Palomo Jesús, Villa Adolfo, Eworo Alia, Fernández-Yáñez Juan, Guinea Jesús, Bouza Emilio
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid; CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca; Red Española para la Investigación en Patología Infecciosa (RD06/0008/1025), Madrid.
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid.
J Heart Lung Transplant. 2014 Mar;33(3):278-88. doi: 10.1016/j.healun.2013.11.003. Epub 2013 Nov 28.
Invasive aspergillosis is a well-known complication in severely immunosuppressed patients, including heart transplant recipients, and associated mortality is high. Despite the severity of the disease in this population, few recent series with secular trends have addressed the problem.
We performed a descriptive study of 479 consecutive heart transplant recipients from 1988 to 2011 in a single institution.
Overall invasive aspergillosis incidence in heart transplant recipients was 6.5% (31 of 479). Incidence decreased from 8.7% (24 of 277) in the period 1988 to 2000 (historical cohort) to 3.5% (7 of 202) afterward (p = 0.02); 4 of the 7 cases were in the context of an outbreak. The most common presentation was lung infection, but episodes occurring >3 months after transplantation (late aspergillosis) showed a higher frequency of disseminated disease and involvement of the central nervous system and of atypical sites compared with early (first 3 months) episodes. Related mortality was 36%, with a significant decrease between the historical cohort and the present cohort: 46% vs 0% (p = 0.04) and a trend toward lower related death in early vs late cases (26% vs 63%, p = 0.09).
In our series, both incidence and mortality associated with invasive aspergillosis in heart transplant recipients showed a decrease in recent years. Careful environmental management and targeted anti-fungal prophylaxis may minimize the incidence of invasive aspergillosis in this setting.
侵袭性曲霉病是包括心脏移植受者在内的严重免疫抑制患者中一种众所周知的并发症，相关死亡率很高。尽管该疾病在这一人群中很严重，但近期很少有涉及长期趋势的系列研究探讨这个问题。
我们对1988年至2011年在单一机构连续接受心脏移植的479名受者进行了描述性研究。
心脏移植受者中侵袭性曲霉病的总体发病率为6.5%（479例中的31例）。发病率从1988年至2000年期间（历史队列）的8.7%（277例中的24例）降至之后的3.5%（202例中的7例）（p = 0.02）；7例中有4例发生在一次暴发的背景下。最常见的表现是肺部感染，但与移植后早期（前3个月）发作相比，移植后>3个月发生的发作（晚期曲霉病）显示播散性疾病、中枢神经系统受累及非典型部位受累的频率更高。相关死亡率为36%，历史队列与当前队列之间有显著下降：46% 对0%（p = 0.04），并且早期与晚期病例的相关死亡有降低趋势（26% 对63%，p = 0.09）。
在我们的系列研究中，心脏移植受者中与侵袭性曲霉病相关的发病率和死亡率近年来均有所下降。仔细的环境管理和针对性的抗真菌预防措施可能会使这种情况下侵袭性曲霉病 的发病率降至最低。
