Guimarães L F A, Halpern M, de Lemos A S, de Gouvêa E F, Gonçalves R T, da Rosa Santos M A A, Nucci M, Santoro-Lopes G
Department of Preventive Medicine, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil.
Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Transplant Proc. 2016 Sep;48(7):2306-2309. doi: 10.1016/j.transproceed.2016.06.019.
Invasive fungal disease (IFD) is an important complication after solid organ transplantation (SOT). A marked geographic variation in the epidemiology of IFD after kidney transplantation (KT) has been suggested by the results of previous studies. Nevertheless, data from Latin American centers are scarce.
This study sought to describe the epidemiology of IFD at a Brazilian KT center.
This study was a retrospective single-center cohort study that included patients who underwent KT between 1998 and 2009 and were followed up until July 2015. Cases of simultaneous kidney-pancreas transplantation were excluded. The primary study outcome was the occurrence of proven or probable IFD.
Among 908 KT recipients, 44 cases of IFD occurred in 42 patients (4.6%). Cryptococcus spp. infection, diagnosed in 16 cases (36.3%), was the leading cause of IFD, followed by histoplasmosis in 10 cases (22.7%) and invasive candidiasis in 10 (22.7%). Sporotrichosis, mucormycosis, invasive aspergillosis, pulmonary Cladophialophora sp. infection, trichosporonosis and Saccharomyces cerevisiae fungemia occurred in 1 recipient each (2.3%). Two additional (4.5%) cases of unspecified mold infections were identified by histopathological analysis. Most cases of IFD (67%) occurred later than 6 months after transplantation. Previous use of antilymphocyte antibodies (P = .008) and corticosteroid pulse therapy (P < .001) were more frequent among cases of IFD occurring within the first 6 months after transplantation.
The epidemiology of IFD in this Brazilian cohort was characterized by a large predominance of late infections and a high proportion of cases of cryptococcosis and histoplasmosis. These results highlight the considerable geographic variability of IFD epidemiology after KT.
侵袭性真菌病（IFD）是实体器官移植（SOT）后的一种重要并发症。先前研究结果表明，肾移植（KT）后IFD的流行病学存在显著的地域差异。然而，来自拉丁美洲中心的数据很少。
本研究旨在描述巴西一家KT中心IFD的流行病学情况。
本研究是一项回顾性单中心队列研究，纳入了1998年至2009年间接受KT并随访至2015年7月的患者。同时进行肾胰腺移植的病例被排除。主要研究结局是确诊或疑似IFD的发生情况。
在908例KT受者中，42例患者发生了44例IFD（4.6%）。隐球菌属感染16例（36.3%），是IFD的主要原因，其次是组织胞浆菌病10例（22.7%）和侵袭性念珠菌病10例（22.7%）。孢子丝菌病、毛霉病、侵袭性曲霉病、肺部枝孢霉属感染、毛孢子菌病和酿酒酵母菌血症各发生在1例受者中（2.3%）。通过组织病理学分析又发现了2例（4.5%）未明确的霉菌感染病例。大多数IFD病例（67%）发生在移植后6个月以后。移植后前6个月内发生的IFD病例中，先前使用抗淋巴细胞抗体（P = 0.008）和皮质类固醇脉冲疗法（P < 0.001）更为常见。
该巴西队列中IFD的流行病学特征是晚期感染占主导，隐球菌病和组织胞浆菌病的比例很高。这些结果凸显了KT后IFD流行病学存在相当大的地域差异。
