Patel Madhukar S, Wright Alissa J, Kohn Rachel, Markmann James F, Kotton Camille N, Vagefi Parsia A
Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Mycoses. 2015 Mar;58(3):181-6. doi: 10.1111/myc.12289. Epub 2015 Jan 15.
Central nervous system (CNS) infections after liver transplantation may be fungal in aetiology, with involvement from either common organisms such as Cryptococcus neoformans and Aspergillus spp. as well as less common organisms, such as the Mucorales and Scedosporium spp. Although the mortality of CNS fungal infections was nearly 100% in early series, more recent data has suggested that good outcomes can be achieved. This may be due to both improved diagnostic capabilities, such as the ability to obtain fungal susceptibilities and therapeutic drug levels, and improved therapeutic options, such as the newer triazoles- voriconazole and posaconazole. Due to improved outcomes, issues have now arisen around the long-term tolerability of these agents. The following two cases of invasive cerebral fungal infections following liver transplantation, one with Aspergillus flavus, and the other with Scedosporium boydii/apiospermum highlight the success that can be seen with the modern management of a previously fatal diagnosis. In particular, we highlight the issues around therapeutic monitoring and discontinuation of therapy.
肝移植后中枢神经系统（CNS）感染的病因可能为真菌，常见病原体如新型隐球菌和曲霉菌属可引发感染，少见病原体如毛霉目和赛多孢属也可致病。尽管早期研究中CNS真菌感染的死亡率接近100%，但最新数据表明可以取得较好的治疗效果。这可能得益于诊断能力的提高，如获取真菌药敏和治疗药物水平的能力，以及治疗选择的改善，如新的三唑类药物——伏立康唑和泊沙康唑。由于治疗效果的改善，现在这些药物的长期耐受性出现了问题。以下两例肝移植后侵袭性脑真菌感染病例，一例为黄曲霉感染，另一例为博伊德赛多孢菌/尖端赛多孢菌感染，凸显了对先前致命诊断进行现代管理所能取得的成功。特别是，我们强调了治疗监测和停药方面的问题。
