Guillemain R, Lavarde V, Amrein C, Chevalier P, Guinvarc'h A, Glotz D
Département d'Anesthésie, Réanimation chirurgicale, Hôpital Broussais, Paris, France.
Pathol Biol (Paris). 1994 Sep;42(7):661-9.
The increase of organ transplantations during the last decades conjointly with the prescription of heavy immunosuppressive drugs, has led to an increased incidence of new invasive aspergillosis (IA). This study is a report of the Broussais Hospital experience from 1968 to 1993 on kidney, heart and heart and lungs transplantations. It concerns 21 IA cases. Incidence was 0.5% for kidney, 4.5% for heart and 18% for heart and lungs transplantations. The most important risk factors were the increase of immunosuppressive therapy (66% of the cases), neutropenia (19%), and renovation of the hospital wards (36%). Lung was the most frequent site of infection (95% of the cases), clinical symptoms were no significant. Diagnosis procedures were realised on biopsy (23%) and on bronchoalveolar lavage (66%). Usual amphotericin B treatment was disappointing: mortality rate of 77%, the liposomal preparation of the drug seemed to be more efficient: mortality rate of 50%. Itraconazole appeared to be used in succession with a careful adaptation of posology. Prophylactic amphotericin B in a local way (sprays and aerosols) led to a good efficiency jointly with the patient isolation during constructions in the hospital area.
在过去几十年中，器官移植数量的增加以及强效免疫抑制药物的使用，导致新发性侵袭性曲霉病（IA）的发病率上升。本研究报告了1968年至1993年布罗赛医院在肾脏、心脏以及心肺移植方面的经验。该研究涉及21例IA病例。肾脏移植的发病率为0.5%，心脏移植为4.5%，心肺移植为18%。最重要的危险因素是免疫抑制治疗增加（66%的病例）、中性粒细胞减少（19%）以及医院病房翻新（36%）。肺部是最常见的感染部位（95%的病例），临床症状不明显。诊断程序通过活检（23%）和支气管肺泡灌洗（66%）来实现。常规两性霉素B治疗效果不佳：死亡率为77%，该药物的脂质体制剂似乎更有效：死亡率为50%。伊曲康唑似乎在根据剂量仔细调整后相继使用。局部预防性使用两性霉素B（喷雾和气雾剂）与在医院区域施工期间对患者进行隔离相结合，取得了良好的效果。
