Torre-Cisneros J, Lopez O L, Kusne S, Martinez A J, Starzl T E, Simmons R L, Martin M
Presbyterian University Hospital, University of Pittsburgh, School of Medicine, Pennsylvania.
J Neurol Neurosurg Psychiatry. 1993 Feb;56(2):188-93. doi: 10.1136/jnnp.56.2.188.
The clinical characteristics and neuropathological findings of 22 organ transplant recipients with CNS aspergillosis were reviewed. Thirteen patients had liver, six kidney, two heart and one had cluster transplants. The most frequent neurological symptoms were alteration of mental status (86%), seizures (41%) and focal neurological deficits (32%). Meningeal signs were less common (19%). Aspergillus spp invasion of the blood vessels with subsequent ischaemic or haemorrhagic infarcts, and solitary or multiple abscesses were the predominant neuropathological findings. The lungs were the probable portal of entry; however, isolated CNS aspergillosis was seen in two patients. Antemortem diagnosis of the infection was made in half of the patients. Concomitant diabetes mellitus was noted in 59% of the patients and bacterial or other severe infections in 86%. No specific clinical or pathological pattern could be identified among patients with different types of organ transplants. In addition CNS aspergillosis was preceded by organ rejection and the need for intense immunosuppression and retransplantation in the majority of the patients.
回顾了22例患有中枢神经系统曲霉病的器官移植受者的临床特征和神经病理学发现。13例患者接受肝脏移植，6例接受肾脏移植，2例接受心脏移植，1例接受多器官联合移植。最常见的神经症状是精神状态改变（86%）、癫痫发作（41%）和局灶性神经功能缺损（32%）。脑膜刺激征较少见（19%）。曲霉属侵袭血管，随后出现缺血性或出血性梗死，以及单发或多发脓肿是主要的神经病理学发现。肺部可能是感染的入口；然而，2例患者出现孤立性中枢神经系统曲霉病。半数患者在生前确诊感染。59%的患者伴有糖尿病，86%的患者伴有细菌或其他严重感染。不同类型器官移植患者中未发现特定的临床或病理模式。此外，大多数患者在中枢神经系统曲霉病之前出现器官排斥反应，需要强化免疫抑制和再次移植。
