Ference Elisabeth H, Kubak Bernard M, Zhang Paul, Suh Jeffrey D
Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California.
Allergy Rhinol (Providence). 2019 Feb 5;10:2152656719827253. doi: 10.1177/2152656719827253. eCollection 2019 Jan-Dec.
fungal infection is an emerging disease which is difficult to diagnose and treat. Patients undergoing lung transplant may be colonized prior to transplantation and are at risk for lethal allograft infection after transplantation.
To identify and evaluate treatment options.
This study is a retrospective review of patients treated at a tertiary academic medical center from 2007 to 2017 with positive sinonasal cultures. A review of the literature was also performed to identify additional cases.
Two lung transplant patients had a positive culture for . The literature search resulted in 37 citations, which yielded only 2 prior cases of paranasal sinus colonization or infection in lung transplant recipients. Three of the 4 patients had cystic fibrosis. Two of the patients were colonized before initial transplant, while 1 patient was colonized before subsequent transplant. Three of the 4 patients survived, and all 3 had disease isolated to their sinuses and lungs treated with sinus surgery, while the fourth had disseminated disease and did not undergo sinus surgery. All patients were treated with multiple antifungals due to resistance patterns. One surviving patient cleared both sinus and lung cultures in less than 1 month, while the other 2 surviving patients achieved negative cultures after a minimum of 6 months.
Surgery may be especially important in patients with fungal sinus colonization or infection before or after lung transplantation. Chronic sinusitis is an important source for persistent fungal colonization and reinfection of the allograft which could be removed with surgical debridement before causing highly morbid pulmonary disease.
真菌感染是一种难以诊断和治疗的新发疾病。接受肺移植的患者在移植前可能已被真菌定植，移植后有发生致命性同种异体移植感染的风险。
识别和评估治疗方案。
本研究对2007年至2017年在一家三级学术医学中心接受治疗且鼻窦培养呈阳性的患者进行回顾性分析。还进行了文献检索以识别其他病例。
两名肺移植患者的培养结果呈阳性。文献检索得到37篇引文，仅发现2例肺移植受者鼻窦旁窦定植或感染的先前病例。4名患者中有3名患有囊性纤维化。2名患者在初次移植前被定植，1名患者在后续移植前被定植。4名患者中有3名存活，所有3名患者的疾病均局限于鼻窦和肺部，接受了鼻窦手术治疗，而第四名患者有播散性疾病，未接受鼻窦手术。由于耐药模式，所有患者均接受了多种抗真菌药物治疗。1名存活患者在不到1个月的时间内鼻窦和肺部培养结果均转阴，而其他2名存活患者至少6个月后培养结果转阴。
手术对于肺移植前后发生真菌性鼻窦定植或感染的患者可能尤为重要。慢性鼻窦炎是同种异体移植持续真菌定植和再感染的重要来源，在导致严重肺部疾病之前可通过手术清创去除。
