Singh N, Gayowski T, Wagener M M, Marino I R
VA Medical Center, Infectious Disease Section, Pittsburgh, PA 15240, USA.
Clin Transplant. 1997 Feb;11(1):66-70.
Invasive cryptococcal infections have been reported in 0.3-1% of the patients undergoing liver transplantation in the previous reports. In contrast, invasive cryptococcosis developed in 6% of 102 consecutive liver transplants at our institution receiving tacrolimus as primary immunosuppression. Cutaneous and/or osteoarticular infections due to cryptococcus were detected in 67% of the patients with cryptococcosis, whereas meningitis was present only in 17%. One of the six patients with cryptococcosis presented with refractory shock and multiorgan system failure attributable solely to cryptococcosis. Patients with cryptococcal infections were significantly older than all other liver transplant recipients (p = 0.017), suggesting reactivation as opposed to primary infection as pathogenesis of cryptococcosis. 100% of the patients with cryptococcosis resided on the Eastern coast of the United States as compared to 59% of the patients without cryptococcosis (p = 0.08). There was no difference in the severity of underlying liver disease, degree of immunosuppression or CMV infection or disease between patients who did and did not develop cryptococcosis. Atypical manifestations, e.g. cutaneous diseases or sepsis syndrome, as opposed to subclinical meningitis, may be a clinical feature of cryptococcal infection in liver transplant recipients.
既往报道显示，在接受肝移植的患者中，侵袭性隐球菌感染的发生率为0.3%-1%。相比之下，在我院连续102例接受他克莫司作为主要免疫抑制剂的肝移植患者中，侵袭性隐球菌病的发生率为6%。67%的隐球菌病患者检测到隐球菌引起的皮肤和/或骨关节炎感染，而脑膜炎仅占17%。6例隐球菌病患者中有1例出现难治性休克和多器官系统功能衰竭，且仅由隐球菌病引起。隐球菌感染患者的年龄显著高于所有其他肝移植受者（p=0.017），提示隐球菌病的发病机制是复发而非原发性感染。与未患隐球菌病的患者中59%居住在美国东海岸相比，100%的隐球菌病患者居住在美国东海岸（p=0.08）。发生和未发生隐球菌病的患者在潜在肝病的严重程度、免疫抑制程度或巨细胞病毒感染或疾病方面没有差异。与亚临床脑膜炎相反，非典型表现，如皮肤疾病或脓毒症综合征，可能是肝移植受者隐球菌感染的临床特征。
