Johnson L S, Shields R K, Clancy C J
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Transpl Infect Dis. 2014 Aug;16(4):578-87. doi: 10.1111/tid.12244. Epub 2014 Jun 24.
Few studies of Scedosporium infections following solid organ transplantation have been performed in the era of induction immunosuppression and widespread antifungal prophylaxis.
We performed a single-center, retrospective study of transplant recipients from 2000 through 2010 who had a positive Scedosporium culture.
Among 27 patients, 67% (n = 18) and 33% (n = 9) were infected with Scedosporium apiospermum and Scedosporium prolificans, respectively. A total of 67% received induction immunosuppression and 74% received prior antifungal therapy. Isolates were broadly resistant to antifungals. Of these patients, 59% (n = 16) were colonized by Scedosporium, and 41% (n = 11) had disease (scedosporiosis). No significant clinical differences were seen between species. Colonization occurred exclusively in the lungs of lung transplant recipients (LTR). Scedosporiosis followed lung transplantation in 55%, and other organ transplants (multivisceral [18%]; and heart, liver, small intestine [9% each]) in 45%. Scedosporiosis was preceded by colonization in 36%. Diseases included pneumonia (64%), mediastinitis (18%), and fungemia/disseminated infections (18%). The 6-month outcomes were death in 55%, progression in 18%, stability in 9%, and resolution in 18%. Patients who died had earlier onset scedosporiosis post transplant (median: 80.5 vs. 1388 days; P = 0.04), and were more likely to have mediastinitis or disseminated infections than pneumonia (100% vs. 29%; P = 0.06). The 3 patients who developed scedosporiosis >1 year post transplant survived. All patients who survived were treated with a voriconazole-containing regimen.
LTR were most susceptible to Scedosporium colonization and scedosporiosis, particularly within the lungs. Death was common with scedosporiosis in the first year after all types of organ transplants, consistent with profound immunosuppression and antifungal resistance, but not encountered thereafter.
在诱导免疫抑制和广泛使用抗真菌预防药物的时代，针对实体器官移植后斯氏孢子菌感染的研究较少。
我们对2000年至2010年间斯氏孢子菌培养呈阳性的移植受者进行了一项单中心回顾性研究。
27例患者中，分别有67%（n = 18）和33%（n = 9）感染了尖端赛多孢子菌和多育赛多孢子菌。共有67%的患者接受了诱导免疫抑制，74%的患者接受了先前的抗真菌治疗。分离菌株对抗真菌药物普遍耐药。这些患者中，59%（n = 16）为斯氏孢子菌定植，41%（n = 11）患有疾病（斯氏孢子菌病）。不同菌种之间未见明显临床差异。定植仅发生在肺移植受者（LTR）的肺部。55%的斯氏孢子菌病发生在肺移植后，45%发生在其他器官移植后（多脏器移植[18%]；心脏、肝脏、小肠移植各占[9%]）。36%的斯氏孢子菌病之前有定植。疾病包括肺炎（64%）、纵隔炎（18%）和真菌血症/播散性感染（18%）。6个月的转归情况为：55%死亡，18%病情进展，9%病情稳定，18%病情缓解。死亡患者移植后斯氏孢子菌病发病较早（中位数：80.5天对1388天；P = 0.04），且与肺炎相比，更易发生纵隔炎或播散性感染（100%对29%；P = 0.06）。3例移植后>1年发生斯氏孢子菌病的患者存活。所有存活患者均接受了含伏立康唑的治疗方案。
肺移植受者最易发生斯氏孢子菌定植和斯氏孢子菌病，尤其是在肺部。在各类器官移植后的第一年，斯氏孢子菌病常导致死亡，这与深度免疫抑制和抗真菌耐药有关，但此后未再出现。
