Zhang Q, Liu H, Qiu S, Wang W, Yang L, Chen H, Chen X, Shen Z
Institute of Organ Transplantation, General Hospital of Chinese People's Armed Police Force, Beijing, China.
Institute of Organ Transplantation, General Hospital of Chinese People's Armed Police Force, Beijing, China.
Transplant Proc. 2019 Mar;51(2):551-555. doi: 10.1016/j.transproceed.2018.12.006. Epub 2018 Dec 12.
Pulmonary coinfection with Mucor and Aspergillus species has not been reported in organ transplant recipients. Here, we report a rare case of pulmonary coinfection with invasive fungal species in a renal transplant recipient with delayed graft function. The patient was first treated with a regime containing voriconazole, but the infection only worsened. Then, bronchoalveolar lavage fluid culture and internal transcribed spacer region sequencing were performed, and simultaneous pulmonary infection by Lichtheimia ramosa and Aspergillus fumigatus was clearly diagnosed. Susceptibility testing determined that the fungi were sensitive to amphotericin B and posaconazole. Therefore, a therapeutic regime containing posaconazole and amphotericin B liposome, which are less toxic to the kidney, was planned and resulted in resolution of the infectious symptoms. The present case demonstrates the importance of identifying fungal pathogens early and definitively, determining the effective anti-fungal medications, and administering the properly planned therapeutic regime in a timely manner to treat cases of coinfection in transplant recipients.
器官移植受者中尚未有毛霉与曲霉菌属肺部合并感染的报道。在此，我们报告一例肾移植受者出现移植肾功能延迟且发生侵袭性真菌合并肺部感染的罕见病例。该患者最初接受了含伏立康唑的治疗方案，但感染反而加重。随后进行了支气管肺泡灌洗 fluid 培养和内转录间隔区测序，明确诊断为同时感染了分支状根霉和烟曲霉。药敏试验确定这些真菌对两性霉素 B 和泊沙康唑敏感。因此，制定了一个对肾脏毒性较小的含泊沙康唑和两性霉素 B 脂质体的治疗方案，该方案使感染症状得到缓解。本病例表明，早期明确鉴定真菌病原体、确定有效的抗真菌药物并及时给予精心规划的治疗方案对于治疗移植受者的合并感染病例至关重要。
