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一名肾移植患者的粟粒性组织胞浆菌病

Miliary Histoplasmosis in a Renal Transplant Patient.

作者信息

Verdecia Jorge, Kunz Coyne Ashlan J, Patel Shaorinkumar, Oye Melissa, Ravi Malleswari, Sands Michael

机构信息

Infectious Disease, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.

Pharmacology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.

出版信息

Cureus. 2021 Nov 7;13(11):e19338. doi: 10.7759/cureus.19338. eCollection 2021 Nov.

DOI:10.7759/cureus.19338
PMID:34909299
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8653925/
Abstract

Solid organ transplant (SOT) recipients are at increased risk of opportunistic infections due to significant T-cell immune dysfunction. The incidence of clinical disseminated histoplasmosis is rare, and its variable clinical presentation and response to therapy make it challenging to treat with resultant high mortality. A high index of clinical suspicion is necessary, especially in non-endemic areas. We report our clinical experience treating a 63-year-old renal transplant patient on immunosuppressive therapy with late-onset acute miliary histoplasmosis initiated on liposomal amphotericin B (L-AmB).

摘要

由于严重的T细胞免疫功能障碍，实体器官移植（SOT）受者发生机会性感染的风险增加。临床播散性组织胞浆菌病的发病率很低，其临床表现多样且对治疗的反应不一，导致治疗具有挑战性，死亡率很高。高度的临床怀疑很有必要，尤其是在非流行地区。我们报告了我们治疗一名63岁肾移植患者的临床经验，该患者接受免疫抑制治疗，因迟发性急性粟粒性组织胞浆菌病开始使用脂质体两性霉素B（L-AmB）治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ef5/8653925/91d9e3ea8bf2/cureus-0013-00000019338-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ef5/8653925/c75720da8e4e/cureus-0013-00000019338-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ef5/8653925/5b92d7ba0353/cureus-0013-00000019338-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ef5/8653925/91d9e3ea8bf2/cureus-0013-00000019338-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ef5/8653925/c75720da8e4e/cureus-0013-00000019338-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ef5/8653925/5b92d7ba0353/cureus-0013-00000019338-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ef5/8653925/91d9e3ea8bf2/cureus-0013-00000019338-i03.jpg

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本文引用的文献

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Monitoring Tacrolimus Trough Concentrations During the First Year After Kidney Transplantation: A National Retrospective Cohort Study.肾移植术后第一年他克莫司谷浓度监测：一项全国性回顾性队列研究
Front Pharmacol. 2020 Nov 20;11:566638. doi: 10.3389/fphar.2020.566638. eCollection 2020.
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Factor analysis of acute kidney injury in patients administered liposomal amphotericin B in a real-world clinical setting in Japan.日本真实临床环境中应用脂质体两性霉素 B 的患者急性肾损伤的因子分析。
Sci Rep. 2020 Sep 14;10(1):15033. doi: 10.1038/s41598-020-72135-y.
3
Current Concepts in the Epidemiology, Diagnosis, and Management of Histoplasmosis Syndromes.
当前关于组织胞浆菌病综合征的流行病学、诊断和治疗的概念。
Semin Respir Crit Care Med. 2020 Feb;41(1):13-30. doi: 10.1055/s-0039-1698429. Epub 2020 Jan 30.
4
Endemic fungal infections in solid organ transplant recipients-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice.实体器官移植受者的地方性真菌感染——美国移植感染病学会实践社区指南。
Clin Transplant. 2019 Sep;33(9):e13553. doi: 10.1111/ctr.13553. Epub 2019 Apr 23.
5
Mapping Histoplasma capsulatum Exposure, United States.绘制荚膜组织胞浆菌暴露风险地图，美国。
Emerg Infect Dis. 2018 Oct;24(10):1835-1839. doi: 10.3201/eid2410.180032.
6
Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment.中枢神经系统组织胞浆菌病：关于临床特征、诊断方法及治疗结果的多中心回顾性研究
Medicine (Baltimore). 2018 Mar;97(13):e0245. doi: 10.1097/MD.0000000000010245.
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Multistate Epidemiology of Histoplasmosis, United States, 2011-2014.2011-2014 年美国组织胞浆菌病的多州流行病学研究。
Emerg Infect Dis. 2018 Mar;24(3):425-431. doi: 10.3201/eid2403.171258.
8
Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients.抗真菌药物的药代动力学：优化患者治疗的实际意义。
Infection. 2017 Dec;45(6):737-779. doi: 10.1007/s15010-017-1042-z. Epub 2017 Jul 12.
9
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J Neurol Sci. 2015 May 15;352(1-2):125-6. doi: 10.1016/j.jns.2015.03.037. Epub 2015 Mar 30.
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Can J Infect Dis Med Microbiol. 2014 Nov-Dec;25(6):327-43. doi: 10.1155/2014/340586.