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[免疫功能低下患者的感染(二)。移植患者]

[Infections in immunocompromised patients (II). The transplanted patient].

作者信息

Ramos Martínez A, Pintos Pascual I, Múñez Rubio E

机构信息

Unidad de Enfermedades Infecciosas. Servicio de Medicina Interna. Hospital Universitario Puerta de Hierro. Madrid. España.

Servicio de Medicina Interna. Hospital Universitario Fundación Jiménez Díaz. Madrid. España.

出版信息

Medicine (Madr). 2018 May;12(55):3245-3252. doi: 10.1016/j.med.2018.04.011. Epub 2018 May 8.

Abstract

Recipients of the different types of transplantation are at high risk of infection. Nosocomial infections predominate in patients who have undergone haematopoietic stem cell transplantation during the early post-engraftment period (30-100 days after the infusion); the incidence of infection is higher in graft-versus-host disease. Nodular lesions can appear in the lungs due to invasive fungal infection. A diffuse pattern is usually secondary to viral infection or pneumonia. After the first 100 days a moderate risk of infection by conventional and opportunistic infections persists, such as late CMV infection. Advances in surgical techniques and the use of calcineurinics have reduced mortality from infections in recipients of solid organ transplantations. Nosocomial infections are common during the first month; opportunistic infections that are dependent on cellular immunity are more common between the first and the sixth month, from the sixth month the risk lowers and community-based infections similar to those of immunocompetent patients predominate.

摘要

不同类型移植的受者感染风险很高。医院感染在造血干细胞移植受者植入后的早期(输注后30 - 100天)占主导;移植物抗宿主病患者的感染发生率更高。侵袭性真菌感染可导致肺部出现结节性病变。弥漫性病变通常继发于病毒感染或肺炎。100天后,存在常规感染和机会性感染的中度风险,如晚期巨细胞病毒感染。手术技术的进步和钙调神经磷酸酶抑制剂的使用降低了实体器官移植受者因感染导致的死亡率。医院感染在第一个月很常见;依赖细胞免疫的机会性感染在第一个月至第六个月之间更常见,从第六个月起风险降低,社区获得性感染类似于免疫功能正常患者的感染占主导。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1248/7143593/95eba4e923d9/gr1_lrg.jpg

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