Forrest G N, Bhalla P, DeBess E E, Winthrop K L, Lockhart S R, Mohammadi J, Cieslak P R
Division of Infectious Diseases, Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon, USA.
Transpl Infect Dis. 2015 Jun;17(3):467-76. doi: 10.1111/tid.12370. Epub 2015 May 19.
Cryptococcus gattii was recognized as an emerging infection in the Pacific Northwest in 2004. Out of 62 total infections in Oregon since the outbreak, 11 were in solid organ transplant (SOT) recipients. SOT recipients were more likely to have disseminated disease and higher mortality than normal hosts, who mostly had isolated mass lesions. The median time from transplantation to C. gattii diagnosis was 17.8 months. The primary sites of infection were lung (n = 4), central nervous system (n = 3), or both (n = 4). The Oregon-endemic strain, VGII (subtypes IIa and IIc) was present in 10 of 11 patients; the median fluconazole minimum inhibitory concentration (MIC) was 12 μg/mL (range 2-32 μg/mL) for this strain. We found C. gattii infection among organ transplant recipients was disseminated at diagnosis, had low cerebrospinal fluid cryptococcal antigen titers, and was associated with an elevated fluconazole MIC and high attributable mortality.
2004年，加氏隐球菌被认定为太平洋西北地区的一种新发感染源。自疫情爆发以来，俄勒冈州总计62例感染病例中，有11例为实体器官移植（SOT）受者。与大多仅有孤立肿块病变的正常宿主相比，SOT受者更易发生播散性疾病且死亡率更高。从移植到加氏隐球菌诊断的中位时间为17.8个月。感染的主要部位为肺部（n = 4）、中枢神经系统（n = 3）或两者皆有（n = 4）。11例患者中有10例感染的是俄勒冈地方流行菌株VGII（IIa和IIc亚型）；该菌株的氟康唑最低抑菌浓度（MIC）中位数为12μg/mL（范围为2 - 32μg/mL）。我们发现，器官移植受者中的加氏隐球菌感染在诊断时已发生播散，脑脊液隐球菌抗原滴度较低，且与氟康唑MIC升高及高归因死亡率相关。
