Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center.
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine.
Curr Opin Infect Dis. 2020 Apr;33(2):205-213. doi: 10.1097/QCO.0000000000000626.
Despite progress in the management of pulmonary infections in the hematopoietic cell transplant (HCT) population, substantial diagnostic, and therapeutic uncertainty remains.
A growing HCT population reflects more transplants and improved long-term survival. We continue to learn about the epidemiologic and prognostic significance of posttransplant pulmonary infections. Mold-active triazoles have removed invasive fungal pneumonia as a barrier to transplant eligibility. Ibrutinib and respiratory viruses are newly recognized risk factors for invasive fungal disease. Prophylaxis has elevated concerns of resistance in invasive fungal species and late onset Cytomegalovirus. The impact of human herpesviruses, community-associated respiratory viruses, and the microbiome is increasingly appreciated. Multiple antiviral therapies are currently in clinical trials and novel molecular diagnostics may improve the performance of bronchoscopy for infectious causes.
Fungal and viral pneumonias remain an important cause of morbidity and mortality in the HCT population. Despite our increased understanding of the epidemiology and outcomes of species-specific diagnoses, the utility of invasive diagnostic testing continues to be debated and effective therapies for many clinically relevant pathogens remain limited. Pulmonary infections are a priority for research efforts in this immunocompromised population.
尽管造血细胞移植（HCT）人群肺部感染的管理取得了进展，但仍存在大量诊断和治疗方面的不确定性。
HCT 人群的不断增加反映了更多的移植和更好的长期生存。我们继续了解移植后肺部感染的流行病学和预后意义。新型三唑类药物可治疗侵袭性肺部真菌感染，降低了其对移植资格的影响。伊布替尼和呼吸道病毒是侵袭性真菌感染的新的危险因素。预防措施增加了侵袭性真菌物种和迟发性巨细胞病毒耐药的担忧。人类疱疹病毒、社区相关呼吸道病毒和微生物组的影响越来越受到重视。目前有多种抗病毒疗法正在临床试验中，新型分子诊断方法可能会提高支气管镜检查对感染原因的诊断性能。
真菌和病毒性肺炎仍然是 HCT 人群发病率和死亡率的重要原因。尽管我们对特定物种的诊断的流行病学和结果有了更多的了解，但侵袭性诊断检测的实用性仍存在争议，许多具有临床相关性的病原体的有效治疗方法仍然有限。肺部感染是该免疫功能低下人群研究工作的重点。
