Nair Vaisak O, Johnson Bradley, Vergidis Paschalis, Ranganath Nischal
Department of Medicine, Section of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Department of Quantitative Health Sciences, Division of Clinical Trials & Biostatistics, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Transpl Infect Dis. 2025 Mar-Apr;27(2):e14430. doi: 10.1111/tid.14430. Epub 2024 Dec 28.
With reports of expanding epidemiology of blastomycosis across the United States, the purpose of this study was to evaluate the incidence and outcomes associated with blastomycosis in solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients.
We conducted a retrospective case series of adult SOT and HCT recipients at a tertiary care medical center between January 1, 2005 and September 30, 2023. Cases were defined as culture-proven blastomycosis. We performed descriptive statistical analysis to evaluate diagnosis, management, and outcomes (mortality) of blastomycosis in SOT.
The cumulative incidence of blastomycosis was 0.11% with a median time to infection following transplant of 743 days. Of the 19 cases, the majority of patients were SOT recipients (90%). Supratherapeutic immunosuppression within 30 days of diagnosis was observed in 42% of cases with documented drug monitoring. Urine antigen testing was highly sensitive (100%). Fourteen (73.7%) patients received induction therapy with liposomal amphotericin B followed by azole therapy for a minimum of 12 months. Despite appropriate treatment, 1-year mortality was high at 26.3%, with attributable mortality of 21.1%.
While rates of blastomycosis remain low among SOT and HCT recipients, infection is associated with poor posttransplant outcomes. Antigen testing can aid in timely assessment of disease severity and initiation of appropriate therapy. Among survivors, no relapses were observed while on lifelong secondary suppression. Future studies should aim to better define risk factors associated with developing blastomycosis and establish effective strategies for prevention.
随着美国芽生菌病流行病学范围不断扩大的报道，本研究旨在评估实体器官移植（SOT）和造血细胞移植（HCT）受者中芽生菌病的发病率及相关结局。
我们对一家三级医疗中心在2005年1月1日至2023年9月30日期间的成年SOT和HCT受者进行了一项回顾性病例系列研究。病例定义为经培养证实的芽生菌病。我们进行了描述性统计分析，以评估SOT中芽生菌病的诊断、管理和结局（死亡率）。
芽生菌病的累积发病率为0.11%，移植后感染的中位时间为743天。在这19例病例中，大多数患者为SOT受者（90%）。在有药物监测记录的病例中，42%在诊断后30天内出现超治疗性免疫抑制。尿抗原检测高度敏感（100%）。14例（73.7%）患者接受了脂质体两性霉素B诱导治疗，随后接受唑类治疗至少12个月。尽管进行了适当治疗，但1年死亡率仍高达26.3%，归因死亡率为21.1%。
虽然SOT和HCT受者中芽生菌病的发病率仍然较低，但感染与移植后不良结局相关。抗原检测有助于及时评估疾病严重程度并启动适当治疗。在幸存者中，终身接受二级抑制治疗期间未观察到复发。未来的研究应旨在更好地确定与芽生菌病发生相关的危险因素，并制定有效的预防策略。
