Graham S M, Flowers J L, Schweitzer E, Bartlett S T, Imbembo A L
Department of Surgery, University of Maryland Medical Center, Baltimore 21201 USA.
Surg Endosc. 1995 Feb;9(2):146-50. doi: 10.1007/BF00191955.
Opportunistic infection of the upper gastrointestinal tract by cytomegalovirus (CMV) or invasive fungal infection was studied in 219 consecutive kidney and kidney/pancreas transplant recipients with regard to incidence, presentation, and clinical outcome. Prompt upper endoscopy was done in all patients with these symptoms: dyspepsia, dysphagia, or bleeding. Multiple biopsies were obtained for fungal culture, CMV culture, CMV assay, and histologic examination for fungal invasion. Between April 1991 and July 1993, 57/219 (26%) transplant patients developed upper gastrointestinal symptoms. At endoscopy, gross mucosal abnormality was evident in 48/57 (84%). Opportunistic infection was found in 21/48 (44%); however, CMV infection was also detected in 2/9 (22%) who had a normal study. Overall, CMV was present in 15/57 (26%) and invasive fungal infection in 8/57 (14%). All 23 infections were successfully eradicated. Opportunistic infection occurred in 12/31 (39%) with dyspepsia, 9/14 (64%) with dysphagia, and 2/12 (17%) with bleeding. Graft loss occurred in 5/23 (22%) with opportunistic infection vs 23/196 (12%) other recipients. Upper gastrointestinal symptoms are indicative of serious opportunistic infection in a significant number of transplant recipients. As opportunistic infection may jeopardize allograft function, all patients with upper gastrointestinal tract symptoms require prompt endoscopy and biopsy to effect appropriate therapy. Random biopsy is also recommended in the face of a normal endoscopic examination.
对219例连续性肾移植和肾/胰腺移植受者的巨细胞病毒（CMV）所致上消化道机会性感染或侵袭性真菌感染的发病率、表现及临床结局进行了研究。所有出现消化不良、吞咽困难或出血等症状的患者均迅速接受了上消化道内镜检查。获取多份活检组织进行真菌培养、CMV培养、CMV检测以及真菌侵袭的组织学检查。在1991年4月至1993年7月期间，57/219（26%）的移植患者出现了上消化道症状。内镜检查时，48/57（84%）有明显的黏膜大体异常。在48例中有21例（44%）发现机会性感染；然而，在检查结果正常的9例中有2例（22%）也检测到CMV感染。总体而言，57例中有15例（26%）存在CMV感染，8例（14%）存在侵袭性真菌感染。所有23例感染均成功根除。消化不良患者中12/31（39%）发生机会性感染，吞咽困难患者中9/14（64%）发生，出血患者中2/12（17%）发生。机会性感染患者中有5/23（22%）发生移植肾失功，而其他受者中为23/196（12%）。上消化道症状表明相当一部分移植受者存在严重的机会性感染。由于机会性感染可能危及移植肾功能，所有出现上消化道症状的患者都需要迅速进行内镜检查和活检以实施恰当治疗。在内镜检查结果正常时，也建议进行随机活检。
