Grant Leah M, Vega Pool J Tobar, Yaman Reena N, Girardo Marlene E, Beam Elena, Razonable Raymund R, Saling Christopher F, Vikram Holenarasipur R
Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona, USA.
Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA.
Transpl Infect Dis. 2024 Dec;26(6):e14394. doi: 10.1111/tid.14394. Epub 2024 Oct 13.
Development of brain abscess following solid organ transplantation is associated with significant morbidity and mortality. We undertook a descriptive study to evaluate the etiology, clinical manifestations, diagnosis, management, and outcomes of brain abscess in solid organ transplant (SOT) recipients at three major transplant centers in the United States.
This is a retrospective study of adults with brain abscess following SOT between January 2000 and June 2021 at Mayo Clinic sites in Arizona, Minnesota, and Florida.
A total of 39 patients were diagnosed with a brain abscess following SOT. The most common pathogens were Nocardia sp. (24 cases, 61.5% [Nocardia farcinica, 37.5%]), followed by fungi (12 cases, 30.7% [Aspergillus sp., 83.3%]). The majority were kidney transplant recipients (59%). Median time to brain abscess diagnosis was 1.3 years (range, 29 days-12 years) after SOT; 10 of 12 patients (83%) with fungal brain abscess were diagnosed within 1 year after SOT. Twelve patients underwent brain biopsy for diagnosis (25% Nocardia vs. 50% fungal), eight (20.5%) underwent surgical resection of the abscess, and 31 (79.5%) received antimicrobial therapy alone. Median time to brain abscess resolution was 166 days for Nocardia and 356 days for fungal pathogens. Eleven of 39 patients (28.2%) died as a result of their brain abscess, including four of 24 patients (16%) with Nocardia and six of 10 patients (60%) with Aspergillus brain abscess. All-cause mortality was 43.6%.
Brain abscess remains an uncommon infectious complication following SOT. Nocardia and fungi accounted for 92% of pathogens in our cohort. Fungal brain abscess portends a poor prognosis.
实体器官移植后脑脓肿的发生与显著的发病率和死亡率相关。我们进行了一项描述性研究，以评估美国三个主要移植中心实体器官移植（SOT）受者脑脓肿的病因、临床表现、诊断、治疗及预后。
这是一项对2000年1月至2021年6月在亚利桑那州、明尼苏达州和佛罗里达州的梅奥诊所接受SOT后发生脑脓肿的成人患者的回顾性研究。
共有39例患者在SOT后被诊断为脑脓肿。最常见的病原体是诺卡菌属（24例，61.5%[鼻疽诺卡菌，37.5%]），其次是真菌（12例，30.7%[曲霉菌属，83.3%]）。大多数是肾移植受者（59%）。脑脓肿诊断的中位时间为SOT后1.3年（范围，29天至12年）；12例真菌性脑脓肿患者中有10例（83%）在SOT后1年内被诊断。12例患者接受脑活检以明确诊断（诺卡菌属占25%，真菌占50%），8例（20.5%）接受脓肿手术切除，31例（79.5%）仅接受抗菌治疗。诺卡菌属脑脓肿消退的中位时间为166天，真菌病原体为356天。39例患者中有11例（28.2%）因脑脓肿死亡，包括24例诺卡菌属感染患者中的4例（16%）和10例曲霉菌性脑脓肿患者中的6例（60%）。全因死亡率为43.6%。
脑脓肿仍然是SOT后一种罕见的感染性并发症。在我们的队列中，诺卡菌属和真菌占病原体的92%。真菌性脑脓肿预后不佳。
