■总结临床特征,感染马尔尼菲塔拉酵母(TM)的移植受者的治疗和结果。
■对广西医科大学第一附属医院2例马内菲塔拉真菌病(TSM)和移植患者进行了回顾性分析,同时进行了系统的文献综述。
■本文报道了两名肾移植术后出现发热的患者,3-4个月内咳嗽。他们的血红蛋白下降了。他们的胸部计算机断层扫描(CT)显示结节。通过下一代测序(NGS)在其血液或支气管肺泡灌洗液样品中检测到TM。伏立康唑(VOR)抗真菌治疗后,一名患者病情恶化,另一个病人死了。文献综述共报道21例移植后TSM患者。14人接受了肾移植,4人接受了肝移植,2例接受肺移植,1例接受骨髓移植。从开始术后免疫抑制治疗到出现症状或疾病变化的中位时间为18(0.5-140)个月。其中,9例患者出现发热,7例患者出现咳嗽或咳痰,4例患者出现呼吸困难。10例患者血红蛋白下降。7例患者发现肺结节。在21名患者中,7人被阳性培养诊断,6活检,5通过培养和活检。在21名患者中,13例患者通过抗真菌治疗得到改善,8例患者恶化或死亡。接受两性霉素B后接受伊曲康唑(ITR)治疗的7例患者均得到改善。关于12例患者使用免疫抑制剂,9名患者不得不停止或减少药物治疗(6名患者有所改善,3名患者恶化或死亡)。
■移植后的TSM患者通常有播散性感染,涉及呼吸,造血等等。发烧,咳嗽,血红蛋白下降和肺结节常发生在手术后约18个月.文化的联合应用,活检,NGS有助于早期诊断。建议使用两性霉素B和伊曲康唑进行抗真菌治疗,免疫抑制剂的用量应及时调整。
UNASSIGNED: To summarize the clinical characteristics, treatment and outcomes of transplant recipients infected with Talaromyces marneffei (TM).
UNASSIGNED: A retrospective analysis was performed on 2 patients with Talaromycosis marneffei (TSM) and transplants at the First Affiliated Hospital of Guangxi Medical University, and a systematic literature
review was conducted simultaneously.
UNASSIGNED: This article reported two patients after kidney transplantation who developed fever, cough within 3-4 months. Their haemoglobin was decreased. Their chest computed tomography (CT) showed nodules. TM was detected in their blood or bronchoalveolar lavage fluid samples by next-generation sequencing (NGS). After antifungal treatment with voriconazole (VOR), one patient worsened, the other patient died. A total of 21 patients with TSM after transplants were reported in the literature
review. Fourteen underwent kidney transplantation, 4 underwent liver transplantation, 2 underwent lung transplantation, and 1 underwent bone marrow transplantation. The median time from initiating the postoperative immunosuppressive therapy to the onset of symptoms or disease changes was 18 (0.5-140) months. Among them, 9 patients developed fever, 7 patients developed cough or expectoration and 4 patients developed dyspnoea. Haemoglobin was decreased in 10 patients. Pulmonary nodules were found in 7 patients. Among the 21 patients, 7 were diagnosed by positive culture, 6 by biopsy, 5 by culture and biopsy. Of the 21 patients, 13 patients improved by antifungal therapy, 8 patients worsened or died. Seven patients who received amphotericin B followed by itraconazole (ITR) therapy all improved. Regarding the use of immunosuppressants in 12 patients, 9 patients had to discontinue or reduce their medications (6 patients improved, 3 patients worsened or died).
UNASSIGNED: Patients with TSM after transplant often have disseminated infections, involving the respiratory, hematopoietic and so on. Fever, cough, decreased haemoglobin and pulmonary nodules often occur approximately 18 months after surgery. The combined applications of culture, biopsy, NGS are helpful for an early diagnosis. Antifungal therapy with amphotericin B followed by itraconazole is recommended, and the dosage of the immunosuppressant should be adjusted timely.