Kennedy E, Vanichanan J, Rajapreyar I, Gonzalez B, Nathan S, Gregoric I, Kar B, Loyalka P, Weeks P, Chavez V, Wanger A, Ostrosky Zeichner L
Infection Prevention Department, Memorial Hermann Texas Medical Center, Houston, TX, USA.
Division of Infectious Diseases, UT Health Medical School at Houston, Houston, TX, USA.
Mycoses. 2016 Feb;59(2):75-9. doi: 10.1111/myc.12433. Epub 2015 Dec 2.
Cryptococcal infection is the third most common invasive fungal infection (IFI) among solid-organ transplant (SOT) recipients and is considered an important opportunistic infection due to its significant morbidity and mortality. To determine whether a cluster of cryptococcosis in heart transplant patients was of nosocomial nature, three cases of orthotopic heart transplant recipients with postoperative disseminated cryptococcal infection were investigated and paired with an environmental survey in a tertiary care hospital. The infection prevention department conducted a multidisciplinary investigation, which did not demonstrate any evidence of health care-associated environmental exposure. Moreover, multilocus sequence typing showed that one isolate was unique and the two others, although identical, were not temporally related and belong to the most common type seen in the Southern US. Additionally, all three patients had preexisting abnormalities of the CT chest scan and various degrees of acute and chronic rejection. Reactivation was suggested in all three patients. Screening methods may be useful to identify at risk patients and trigger a prophylactic or preemptive approach. However, more data is needed.
隐球菌感染是实体器官移植（SOT）受者中第三常见的侵袭性真菌感染（IFI），因其显著的发病率和死亡率，被视为一种重要的机会性感染。为确定心脏移植患者中隐球菌病聚集是否具有医院感染性质，对3例原位心脏移植受者术后播散性隐球菌感染病例进行了调查，并在一家三级护理医院进行了环境调查。感染预防部门进行了多学科调查，未发现任何与医疗保健相关的环境暴露证据。此外，多位点序列分型显示，一个分离株是独特的，另外两个虽然相同，但在时间上没有关联，且属于美国南部最常见的类型。此外，所有3例患者胸部CT扫描均有既往异常，并有不同程度的急性和慢性排斥反应。所有3例患者均提示有复发。筛查方法可能有助于识别高危患者并触发预防性或先发制性措施。然而，还需要更多数据。
