Zhuang Huanwei, Xiang Kun, Gong Shuji, Zhou Yangang, Chen Jinlan
Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
Department of Cardiac Surgery, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou, China.
Front Cardiovasc Med. 2023 Jan 6;9:1042631. doi: 10.3389/fcvm.2022.1042631. eCollection 2022.
There are limited cases of heart-lung transplantation (HLT) in children worldwide owing to lack of donors, demanding surgical teamwork, and arduous post-operative management. Post-transplant management difficulties stem from the possible development of several post-operative complications, with infection being a common complication. Intracranial fungal infections are difficult to diagnose and prone to treatment delays because of their relatively insidious onset and atypical clinical presentation. Here, we present a case of a cerebral infection developed 3 months after HLT in a 10-year-old child, showing no positive results on conventional imaging or cerebrospinal fluid (CSF) examination and culture. On metagenomic next-generation sequencing of the cerebrospinal fluid, the causative organism was finally determined as . After administering 1-year anti- treatment, no recurrence of intracranial fungal infection was noted during the 3-year follow-up. This case illustrates the multifaceted diagnostic techniques for cerebral aspergillosis after HLT and shows the significance of dynamic monitoring of symptoms, such as headache, and of metagenomic sequencing results, trends in intracranial pressure and (1-3)-β-D-glucan levels for guiding diagnosis and treatment.
由于供体缺乏、手术团队要求高以及术后管理艰巨，全球范围内儿童心肺移植（HLT）的病例有限。移植后管理困难源于可能出现的多种术后并发症，感染是常见并发症。颅内真菌感染因其发病相对隐匿且临床表现不典型，难以诊断且容易延误治疗。在此，我们报告一例10岁儿童在HLT术后3个月发生脑感染的病例，常规影像学检查、脑脊液（CSF）检查及培养均未显示阳性结果。通过脑脊液宏基因组下一代测序，最终确定病原体为 。给予1年抗 治疗后，在3年随访期间未发现颅内真菌感染复发。该病例说明了HLT后脑曲霉病的多方面诊断技术，并显示了动态监测头痛等症状以及宏基因组测序结果、颅内压趋势和（1-3）-β-D-葡聚糖水平对指导诊断和治疗的重要性。
