Kauffman Carol A, Miceli Marisa H
Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
J Fungi (Basel). 2015 Jun 30;1(2):94-106. doi: 10.3390/jof1020094.
Histoplasmosis and blastomycosis are geographically restricted dimorphic fungi that cause infection after the conidia produced in the mold phase are inhaled into the lungs. In the lungs, at 37 °C, these organisms undergo transformation into the yeast phase. In transplant recipients, infection can occur by exposure to the mold in the environment, by reactivation of infection that had occurred previously and had been controlled by the host until immunosuppressive medications were given post-transplantation, and finally by transmission from the donor organ in the case of histoplasmosis. In transplant recipients, disseminated infection is common, and pulmonary infection is more likely to be severe than in a non-immunosuppressed person. Diagnosis has been improved, allowing earlier treatment, with the use of rapid antigen tests performed on serum and urine. Initial treatment, for all but the mildest cases of acute pulmonary histoplasmosis, should be with a lipid formulation of amphotericin B. After clinical improvement has occurred, step-down therapy with itraconazole is recommended for a total of 12 months for most transplant recipients, but some patients will require long-term suppressive therapy to prevent relapse of disease.
组织胞浆菌病和芽生菌病是受地理限制的双相真菌，在霉菌期产生的分生孢子被吸入肺部后会引发感染。在肺部，这些微生物在37℃时会转变为酵母期。在移植受者中，感染可通过接触环境中的霉菌、既往发生过且在移植前宿主已控制住的感染重新激活，以及在组织胞浆菌病的情况下通过供体器官传播而发生。在移植受者中，播散性感染很常见，肺部感染比非免疫抑制者更可能严重。诊断方法有所改进，通过对血清和尿液进行快速抗原检测得以更早进行治疗。对于除最轻微的急性肺组织胞浆菌病病例外的所有病例，初始治疗应使用两性霉素B的脂质制剂。在临床症状改善后，对于大多数移植受者，建议用伊曲康唑进行降阶梯治疗，疗程共12个月，但有些患者需要长期抑制性治疗以预防疾病复发。
