Hadley S, Karchmer A W
Harvard Medical School, Boston, Massachusetts, USA.
Infect Dis Clin North Am. 1995 Dec;9(4):1045-74.
Invasive fungal infections occur in 5% to 45% of solid organ transplant recipients, and are a major cause of morbidity and mortality in the immunocompromised population. The net depression of host defenses and environmental factors, such as preoperative exposures to endemic mycoses or nosocomial and specific surgery-associated exposures, affect the development of invasive infection. Most fungal infections in solid organ transplant recipients occur within the first 2 months after transplantation. The most common pathogens in the majority of solid organ transplant recipients are Candida spp, followed by Aspergillus sp. Diagnosis is best made by a high index of suspicion and aggressive acquisition of specimens for culture; serologic tests are useful for infections due to Cryptococcus neoformans and Histoplasma capsulatum. Amphotericin B is the drug of choice for life-threatening infections. The triazoles, fluconazole and itraconazole, may be effective alternatives for less serious infections due to susceptible organisms. Prophylactic and preemptive treatment strategies require further study.
实体器官移植受者中侵袭性真菌感染的发生率为5%至45%，是免疫功能低下人群发病和死亡的主要原因。宿主防御功能的净抑制以及环境因素，如术前暴露于地方性真菌病或医院感染及特定手术相关暴露，会影响侵袭性感染的发生。实体器官移植受者的大多数真菌感染发生在移植后的头2个月内。大多数实体器官移植受者中最常见的病原体是念珠菌属，其次是曲霉菌属。诊断最好通过高度怀疑并积极采集标本进行培养来进行；血清学检测对新型隐球菌和荚膜组织胞浆菌引起的感染有用。两性霉素B是治疗危及生命感染的首选药物。三唑类药物氟康唑和伊曲康唑可能是治疗由易感病原体引起的不太严重感染的有效替代药物。预防性和先发制人的治疗策略需要进一步研究。
