Kanj S S, Welty-Wolf K, Madden J, Tapson V, Baz M A, Davis R D, Perfect J R
Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina 27710, USA.
Medicine (Baltimore). 1996 May;75(3):142-56. doi: 10.1097/00005792-199605000-00004.
We reviewed the pattern and incidence of fungal infections in patients undergoing lung and heart-lung transplantation at Duke University Medical Center from September 1992 until August 1995, and present here 9 illustrative cases. Of the 73 lung and heart-lung transplant recipients studied, 59 (81%) had positive fungal cultures at some point after transplantation. The cases presented here illustrate that lung transplant recipients are predisposed to a wide variety of fungal infections. The clinical pattern of these infections ranges from asymptomatic to rapidly progressive fatal disease. In addition to the reactivation of previous fungal infections and recent exposure to new environmental sources, the donor lung itself can be the source of fungal infection, as we showed by using molecular epidemiology techniques. Because of the associated morbidity and mortality, efforts should be directed at investigating prophylactic antifungal regimens in lung transplant recipients. Preliminary reports on the use of itraconazole and aerosolized amphotericin B have been encouraging. Prospective randomized studies are needed to assess the safety and cost effectiveness of different regimens. Fungal infections in patients after lung transplantation can significantly impede recovery and lead to substantial mortality.
我们回顾了1992年9月至1995年8月在杜克大学医学中心接受肺移植和心肺移植患者的真菌感染模式及发生率，并在此展示9个典型病例。在研究的73例肺移植和心肺移植受者中，59例（81%）在移植后的某个时间点真菌培养呈阳性。此处展示的病例表明，肺移植受者易发生多种真菌感染。这些感染的临床模式从无症状到迅速进展的致命疾病不等。除了既往真菌感染的复发和近期接触新的环境来源外，供体肺本身也可能是真菌感染的来源，正如我们通过分子流行病学技术所证明的那样。由于相关的发病率和死亡率，应致力于研究肺移植受者的预防性抗真菌方案。关于伊曲康唑和气雾剂型两性霉素B使用的初步报告令人鼓舞。需要进行前瞻性随机研究以评估不同方案的安全性和成本效益。肺移植患者的真菌感染会显著阻碍康复并导致相当高的死亡率。
