■地理上特有的真菌可以在实体器官移植(SOT)接受者中引起重大疾病。我们提供了流行病学的最新情况,临床表现,SOT受体中5例地方性真菌病的结果。
■从成立到2023年5月,使用地方性真菌的关键词对多个数据库进行了审查(例如,球孢子菌病或球虫,组织胞浆菌病或组织胞浆菌病,etc).我们包括成人SOT收件人和出版物的英文或英文翻译。
■在16项关于胚真菌病的队列研究中(n=3),球孢子菌病(n=5),组织胞浆菌病(n=4),和各种地方性真菌病(n=4),发病率各不相同,如下:球孢子菌病,1.2%-5.8%;芽生菌病,0.14%-0.99%;和组织胞浆菌病,0.4%-1.1%。有204份报告描述了268例地方性真菌病的独特病例,包括172个组织胞浆菌病,31芽生菌病,34球孢子菌病,6副角菌病,和25例塔拉真菌病。大多数患者为男性(261人中有176人[67.4%])。移植的同种异体移植物主要是肾脏(268中的192个[71.6%]),其次是肝脏(n=39[14.6%]),心脏(n=18[6.7%]),肺(n=13[4.9%]),合并肾肝和肾胰(n=6[2.7%])。在所有5种地方性真菌病中,大多数患者出现发热(232例中的162例[69.8%])和播散性疾病(268例中的179例[66.8%]).细胞减少症经常报告为组织胞浆菌病(91中的71例[78.0%]),球孢子菌病(11个中的8个[72.7%])和塔拉真菌病(8个中的7个[87.5%])。136例患者中有12例(8.8%)报道移植物丢失。据报道,267人中有71人(26.6%)死于各种原因的死亡;一半的死亡(n=34[50%])与潜在的霉菌病有关。
■地方性真菌病常伴有发热,SOT接受者的血细胞减少和传播疾病。全因死亡率比较高,包括许多归因于地方性真菌病的死亡。
UNASSIGNED: Geographically endemic fungi can cause significant disease among solid organ transplant (SOT) recipients. We provide an update on the epidemiology, clinical presentation, and outcomes of 5 endemic mycoses in SOT recipients.
UNASSIGNED: Multiple databases were reviewed from inception through May 2023 using key words for endemic fungi (eg, coccidioidomycosis or Coccidioides, histoplasmosis or Histoplasma, etc). We included adult SOT recipients and publications in English or with English translation.
UNASSIGNED: Among 16 cohort studies that reported on blastomycosis (n = 3), coccidioidomycosis (n = 5), histoplasmosis (n = 4), and various endemic mycoses (n = 4), the incidence rates varied, as follows: coccidioidomycosis, 1.2%-5.8%; blastomycosis, 0.14%-0.99%; and histoplasmosis, 0.4%-1.1%. There were 204 reports describing 268 unique cases of endemic mycoses, including 172 histoplasmosis, 31 blastomycosis, 34 coccidioidomycosis, 6 paracoccidioidomycosis, and 25 talaromycosis cases. The majority of patients were male (176 of 261 [67.4%]). Transplanted allografts were mostly kidney (192 of 268 [71.6%]), followed by liver (n = 39 [14.6%]), heart (n = 18 [6.7%]), lung (n = 13 [4.9%]), and combined kidney-liver and kidney-pancreas (n = 6 [2.7%]). In all 5 endemic mycoses, most patients presented with fever (162 of 232 [69.8%]) and disseminated disease (179 of 268 [66.8%]). Cytopenias were frequently reported for histoplasmosis (71 of 91 [78.0%]), coccidioidomycosis (8 of 11 [72.7%]) and talaromycosis (7 of 8 [87.5%]). Graft loss was reported in 12 of 136 patients (8.8%). Death from all-causes was reported in 71 of 267 (26.6%); half of the deaths (n = 34 [50%]) were related to the underlying mycoses.
UNASSIGNED: Endemic mycoses commonly present with fever, cytopenias and disseminated disease in SOT recipients. There is a relatively high all-cause mortality rate, including many deaths that were attributed to endemic mycoses.