背景:供体来源的地方性真菌病很少报道。我们总结了这些感染的临床特征和结果,为移植临床医生提供指导。
方法:从开始到2023年5月31日,使用地方性真菌作为关键词(例如,球虫,组织等离子体,胚芽,talaromyces,副球菌)。仅包括供体来源的感染(DDI)。
结果:从18份已发表的报告中确定了24例DDI;其中包括16例球孢子菌病,七个组织胞浆菌病,还有一个塔拉真菌病.没有发表胚真菌病和副宫颈真菌病的病例。大多数是男性(17/24,70.8%)。一半的病例是可能的(12/24,50%),七个是可能的(29.2%),只有五个被证明是DDI(20.8%)。在肾脏中观察到供体来源的球孢子菌病(n=11),肺(n=6),肝脏(n=3),心脏(n=2)和联合SOT接受者(1KP,1KL),中位时间为移植后.9(范围为2-35个月)。对于组织胞浆菌病,大多数为肾移植受者(7例中的6例),中位发病时间为移植后8个月(范围4~48个月).单例报告可能是供体衍生的距骨真菌病发生在一名器官供体有前往东南亚的危险的男子中。总的来说,大多数捐献者有高风险接触球虫(9/11)或组织胞浆。(6/6)。大多数供体来源的地方性真菌病已传播(18/24,75%),几乎一半的受者报告了死亡率(11/24,45.8%).
结论:供者来源的地方性真菌病常播散并与高死亡率相关。在器官捐赠之前,对捐赠者进行未诊断的真菌感染的可能性的详细评估对于减轻这些破坏性感染的风险至关重要。
Donor-derived endemic mycoses are infrequently reported. We summarized the clinical characteristics and outcomes of these infections to provide guidance to transplant clinicians.
Multiple databases were reviewed from inception through May 31, 2023 using endemic fungi as key words (e.g., Coccidioides, histoplasma, blastomyces, talaromyces, paracoccidioides). Only donor-derived infections (DDI) were included.
Twenty-four cases of DDI were identified from 18 published reports; these included 16 coccidioidomycosis, seven
histoplasmosis, and one talaromycosis. No cases of blastomycosis and paracoccidiodomycosis were published. The majority were male (17/24,70.8%). Half of the cases were probable (12/24, 50%), seven were possible (29.2%), and only five were proven DDI (20.8%). Donor-derived coccidioidomycosis were observed in kidney (n = 11), lung (n = 6), liver (n = 3), heart (n = 2) and combined SOT recipients (1 KP, 1 KL) at a median time of .9 (range .2-35) months after transplantation. For
histoplasmosis, the majority were kidney recipients (6 of 7 cases) at a median onset of 8 (range .4-48) months after transplantation. The single reported possible donor-derived talaromycosis occurred in a man whose organ donor had at-risk travel to Southeast Asia. Collectively, the majority of donors had high-risk exposure to Coccidioides (9/11) or Histoplasma sp. (6/6). Most donor-derived endemic mycoses were disseminated (18/24, 75%), and mortality was reported in almost half of recipients (11/24, 45.8%).
Donor-derived endemic mycoses are often disseminated and are associated with high mortality. A detailed evaluation of donors for the potential of an undiagnosed fungal infection prior to organ donation is essential to mitigate the risk of these devastating infections.