Yoshino M T, Hillman B J, Galgiani J N
Department of Radiology, University of Arizona, College of Medicine, Tucson.
AJR Am J Roentgenol. 1987 Nov;149(5):989-92. doi: 10.2214/ajr.149.5.989.
Asymptomatic primary coccidioidal infection is common. After the initial infection is contained, the organism can remain dormant in the body for years. Immunosuppression related to renal transplantation or dialysis may reactivate dormant disease. Thus, symptomatic disease may be seen in those with no known history of previous coccidioidomycosis who have visited endemic areas only briefly. To determine if coccidioidomycosis produces characteristic radiographic findings in renal transplant and dialysis patients, we reviewed the records and radiographs of all patients in either of these two categories who are known to have developed active coccidioidal infection in southern Arizona since 1965. Thirty patients (12 undergoing dialysis and 18 transplant recipients) were identified. We conclude that the radiographic manifestations of pulmonary coccidioidomycosis in renal transplant and dialysis patients are highly variable. Interstitial and alveolar patterns of disease are equally likely to occur. Extrathoracic infection without evidence of pulmonary disease occurred in 11 patients (37%), but was radiographically demonstrable only as septic arthritis or perinephric abscess.
无症状原发性球孢子菌感染很常见。初始感染得到控制后，病原体可在体内潜伏数年。与肾移植或透析相关的免疫抑制可能会使潜伏疾病重新激活。因此，在仅短暂访问过流行地区且无既往球孢子菌病病史的人群中可能会出现症状性疾病。为了确定球孢子菌病在肾移植和透析患者中是否产生特征性影像学表现，我们回顾了自1965年以来在亚利桑那州南部已知发生活动性球孢子菌感染的这两类患者中的所有患者的记录和X线片。共确定了30例患者（12例接受透析，18例移植受者）。我们得出结论，肾移植和透析患者肺部球孢子菌病的影像学表现高度多变。间质性和肺泡性疾病模式同样可能出现。11例患者（37%）发生了无肺部疾病证据的胸外感染，但在影像学上仅表现为化脓性关节炎或肾周脓肿。
