肾移植术后真菌感染的诊断与治疗进展
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摘要
肾移植是治疗终末期肾病的有效手段,随着各种免疫抑制剂和广谱抗生素的大量使用,肾移植受者术后真菌感染的问题日益突出,现在已经成为移植肾失功和患者死亡的重要原因之一。现在就真菌感染的发病、诊断及治疗进展作一综述。
Kidney transplantation is an effective means of treating end-stage kidney disease. With the extensive use of various immunosuppressive agents and broad-spectrum antibiotics, fungal infection has become an increasingly prominent problem in complications after kidney transplantation.Now it has become one of the important reasons for the loss of function of the transplanted kidney and patient death. This article reviews the progress in the pathogenesis, diagnosis and treatment of fungal infections.
Kidney transplantation is an effective means of treating end-stage kidney disease. With the extensive use of various immunosuppressive agents and broad-spectrum antibiotics, fungal infection has become an increasingly prominent problem in complications after kidney transplantation.Now it has become one of the important reasons for the loss of function of the transplanted kidney and patient death. This article reviews the progress in the pathogenesis, diagnosis and treatment of fungal infections.
引文
[1]中华医学会重症医学分会.重症患者侵袭性真菌感染诊断与治疗指南(2007)[J].中华内科杂志,2007,46(11):960-966
[2]中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第四次修订舨)[J].中华内科杂志,2013,52(8):704-709.
[3]Pappas PG,Alexander BD,Andes DR,et al.Invasive fungal infections among organ transplant recipients:results of the Transplant-Associated Infection Surveillance Network(TRANSNET)[J].Clin Infect Dis,2010,50(8):1101-1111.
[4]Neofytos D,Fishman JA,Horn D,et al.Epidemiolngy and outcome of invasive fungal infections in solid organ transplant recipients[J].Transpl Infect Dis,2010,12(3):220-229.
[5]中华医学会器官移植学分会,中国医师协会器官移植医师分会.中国实体器官移植受者侵袭性真菌病临床诊治指南(2016年版)[J].中华器官移植杂志,2016,37(5).
[6]Odabasi Z,Mattiuzzi G,Estey E,et al.Beta-D-glucan as a di-agnostic adjunct for invasive fungal infections:validation,cutoff development,and performance in patients with acute myeloge-nous leukemia and myelodysplastic syndrome[J].Clin Infect Dis,2004,39(2):199-205.
[7]Karageorgopoulos DE,Vouloumanou EK,Ntziora F,et al.β-D-glucan assay for the diagnosis of invasive fungal infections:a meta-analysis[J].Clin Infect Dis,2011,52:750-770.
[8]De Pauw B,Walsh TJ,Donnelly JP,et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group(EORTC/MSG)Consensus Group[J].Clin Infect Dis,2008,46:1813-1821.
[9]Ostrosky-Zeichner L,Alexander BD,Kett DH,et al.Multicenter clinical evaluation of the(1-3)β-D-glucan assay as an aid to diagnosis of fungal infections in humans[J].Clin Infect Dis,2005,41:654-659.
[10]Bretagne S,Marmorat Khuong A,M Kuentz,et al.Serum As pergillus galactomannan antigen testing by sandwich ELISA:practical use in neutropenic patients[J].J Infect,1997,35:7215.
[11]Singh N,Paterson DL.Aspergillus infections in transplant re-cipients[J].Clin Microbiol Rev,2005,18:44-69.
[12]Williamson EC,Oliver DA,Johnson EM,et al.Aspergillus anti-gen testing in bone marrow transplant recipients[J].J Clin Pathol,2000,53:362-366.
[13]Chumpitazi B F,Pinel C,Lebeau B,et al.Aspergillus Fumigatus antigen detection in sera from patients at risk for invasive aspergillosis[J].Journal of Clinical Microbiology,2000,38(1):438.
[14]Nicodemo A C,Odongo F C A,Doi A M,et al.Gordonia terrae kidney graft abscess in a renal transplant patient[J].Transplant Infectious Disease,2014,16(4):681-686.
[15]Gomez C A,Singh N.Donor-derived filamentous fungal infections in solid organ transplant recipients[J].Current Opinion in Infectious Diseases,2013,26(4):309-316.
[16]刘正印,盛瑞媛,李旭丽,等.院内真菌感染149例分析[J].中华医学杂志,2003,83:399-402.
[17]Pappas PG,Rotstein CM,Betts RF,et al.Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis[J].Clin Infect Dis,2007,45:883-893.
[18]Pappas PG,Kauffman CA,Andes D,et al.Clinical practice guidelines for the management of candidiasis:2009 update by the Infectious Diseases Society of America[J].Clin Infect Dis,2009,48:503-535.
[19]Gavalda J,Meije Y,Len O,Pahissa A.Invasive fungal infection in solid organ transplant[J].Enferm Infecc Microbiol Clin,2012,30:645-653.
[20]Singh N,Paterson DL.Aspergillus infections in transplant re-cipients[J].Clin Microbiol Rev,2005,18:44-69.
[21]Kleinberg M.Aspergillosis in the CLEAR outcomes trial:working toward a real-world clinical perspective[J].Med Mycol,2005,43(1):289-294.
[22]Maertens J,Egerer G,Shin WS,et al.Caspofungin use in daily clinical practice for treatment of invasive aspergillosis:results of a prospective observational registry[J].BMC Infect Dis,2010,10:182.
[23]Winkler M,Pratschke J,Schulz U,et al.Caspofungin for post solid organ transplant invasive fungal disease:results of a retrospective observational study[J].Transpl Infect Dis,2010,12:230-237.
[24]Singh N,Limaye AP,Forrest G,et al.Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients:a prospective,multicenter,observational study[J].Transplantation,2006,81:320-326.
[25]Alexander BD,Perfect JR,Daly JS,et al.Posaconazole as salvage therapy in patients with invasive fungal infections after solid organ transplant[J].Transplantation,2008,86:791-796.
[26]Maricela V,Marina M,Santiago C,et al.Donor-derived invasive aspergillosis after kidney transplant[J].Medical Mycology Case Reports,2018,22:24-26.
[27]Perfect JR,Dismukes WE,Dromer F,et al.Clinical practice guidelines for the management of cryptococcal disease:2010 update by the infectious diseases society of America[J].Clin Infect Dis,2010,50:291-322.
[28]Day JN,Chau TT,Wolbers M,et al.Combination antifungal therapy for cryptococcal meningitis[J].N Engl J Med,2013,368:1291-1302.
[29]Barrett JP,Vardulaki KA,Conlon C,et al.A systematic review of the antifungal effectiveness and tolerability of amphotericin B formulations[J].Clin Ther,2003,25:1295-1320.
[30]Sun HY,Alexander BD,Lortholary O,et al.Lipid formulations of amphotericin B significantly improve outcome in solid organ transplant recipients with central nervous system cryptococcosis[J].Clin Infect Dis,2009,49:1721-1728.
[31]Singh N,Lortholary O,Alexander BD,et al.An immune reconstitution syndrome-like illness associated with Cryptococcus neoformans infection in organ transplant recipients[J].Clin Infect Dis,2005,40:1756-1761.
[32]Bava AJ,Negroni R.Flucytosine+fluconazole association in the treatment of a murine experimental model of cryptococcosis[J].Rev Inst Med Trop Sao Paulo,1994,36:551-554.
[33]Nagappan V,Deresinski S.Reviews of anti-infective agents:posaconazole:a broad-spectrum triazole antifungal agent[J].Clin Infect Dis,2007,45:1610-1617.
[34]Bandettini R,Castagnola E,Calvillo M,et al.Voriconazole for cryptococcal meningitis in children with leukemia or receiving allogeneic hemopoietic stem cell transplant[J].J Chemother,2009,21:108-109.
[35]Singh N,Lortholary O,Alexander BD,et al.Allograft loss in renal transplant recipients with cryptococcus neoformans associated immune reconstitution syndrome[J].Transplantation,2005,80:1131-1133.
[36]S u n H Y,W a g e n e r M M,S i n g h N.C r y p t o c o c c o s i s i n s o l i dorgan,hematopoietic stem cell,and tissue transplant recipients:evidencebased evolving trends[J].Clin Infect Dis,2009,48:1566-1576.
[37]Saad AH,DePestel DD,Carver PL.Factors influencing the magnitude and clinical significance of drug interactions between azole antifungals and select immunosuppressants[J].Pharmacotherapy,2006,26:1730-1744.
[38]Mathis AS,Shah NK,Friedman GS.Combined use of sirolimus and voriconazole in renal transplantation:a report of two cases[J].Transplant Proc,2004,36:2708-2709.
[39]Sansone-Parsons A,Krishna G,Martinho M,et al.Effect of oral posaconazole on the pharmacokinetics of cyclosporine and tacrolimus[J].Pharmacotherapy,2007,27:825-834.
[40]Sable CA,Nguyen BY,Chodakewitz JA,DiNubile MJ.Safety and tolerability of caspofungin acetate in the treatment of fungal infections[J].Transpl Infect Dis,2002,4:25-30.
[41]Chandrasekar PH,Sobel JD.Micafungin:a new echinocandin.Clin Infect Dis,2006,42:1171-1178.
[42]Dowell JA,Stogniew M,Krause D,et al.Assessment of the safety and pharmacokinetics of anidulafungin when administered with cyclosporine[J].JClin Pharmacol,2005,45:227-233.
[2]中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第四次修订舨)[J].中华内科杂志,2013,52(8):704-709.
[3]Pappas PG,Alexander BD,Andes DR,et al.Invasive fungal infections among organ transplant recipients:results of the Transplant-Associated Infection Surveillance Network(TRANSNET)[J].Clin Infect Dis,2010,50(8):1101-1111.
[4]Neofytos D,Fishman JA,Horn D,et al.Epidemiolngy and outcome of invasive fungal infections in solid organ transplant recipients[J].Transpl Infect Dis,2010,12(3):220-229.
[5]中华医学会器官移植学分会,中国医师协会器官移植医师分会.中国实体器官移植受者侵袭性真菌病临床诊治指南(2016年版)[J].中华器官移植杂志,2016,37(5).
[6]Odabasi Z,Mattiuzzi G,Estey E,et al.Beta-D-glucan as a di-agnostic adjunct for invasive fungal infections:validation,cutoff development,and performance in patients with acute myeloge-nous leukemia and myelodysplastic syndrome[J].Clin Infect Dis,2004,39(2):199-205.
[7]Karageorgopoulos DE,Vouloumanou EK,Ntziora F,et al.β-D-glucan assay for the diagnosis of invasive fungal infections:a meta-analysis[J].Clin Infect Dis,2011,52:750-770.
[8]De Pauw B,Walsh TJ,Donnelly JP,et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group(EORTC/MSG)Consensus Group[J].Clin Infect Dis,2008,46:1813-1821.
[9]Ostrosky-Zeichner L,Alexander BD,Kett DH,et al.Multicenter clinical evaluation of the(1-3)β-D-glucan assay as an aid to diagnosis of fungal infections in humans[J].Clin Infect Dis,2005,41:654-659.
[10]Bretagne S,Marmorat Khuong A,M Kuentz,et al.Serum As pergillus galactomannan antigen testing by sandwich ELISA:practical use in neutropenic patients[J].J Infect,1997,35:7215.
[11]Singh N,Paterson DL.Aspergillus infections in transplant re-cipients[J].Clin Microbiol Rev,2005,18:44-69.
[12]Williamson EC,Oliver DA,Johnson EM,et al.Aspergillus anti-gen testing in bone marrow transplant recipients[J].J Clin Pathol,2000,53:362-366.
[13]Chumpitazi B F,Pinel C,Lebeau B,et al.Aspergillus Fumigatus antigen detection in sera from patients at risk for invasive aspergillosis[J].Journal of Clinical Microbiology,2000,38(1):438.
[14]Nicodemo A C,Odongo F C A,Doi A M,et al.Gordonia terrae kidney graft abscess in a renal transplant patient[J].Transplant Infectious Disease,2014,16(4):681-686.
[15]Gomez C A,Singh N.Donor-derived filamentous fungal infections in solid organ transplant recipients[J].Current Opinion in Infectious Diseases,2013,26(4):309-316.
[16]刘正印,盛瑞媛,李旭丽,等.院内真菌感染149例分析[J].中华医学杂志,2003,83:399-402.
[17]Pappas PG,Rotstein CM,Betts RF,et al.Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis[J].Clin Infect Dis,2007,45:883-893.
[18]Pappas PG,Kauffman CA,Andes D,et al.Clinical practice guidelines for the management of candidiasis:2009 update by the Infectious Diseases Society of America[J].Clin Infect Dis,2009,48:503-535.
[19]Gavalda J,Meije Y,Len O,Pahissa A.Invasive fungal infection in solid organ transplant[J].Enferm Infecc Microbiol Clin,2012,30:645-653.
[20]Singh N,Paterson DL.Aspergillus infections in transplant re-cipients[J].Clin Microbiol Rev,2005,18:44-69.
[21]Kleinberg M.Aspergillosis in the CLEAR outcomes trial:working toward a real-world clinical perspective[J].Med Mycol,2005,43(1):289-294.
[22]Maertens J,Egerer G,Shin WS,et al.Caspofungin use in daily clinical practice for treatment of invasive aspergillosis:results of a prospective observational registry[J].BMC Infect Dis,2010,10:182.
[23]Winkler M,Pratschke J,Schulz U,et al.Caspofungin for post solid organ transplant invasive fungal disease:results of a retrospective observational study[J].Transpl Infect Dis,2010,12:230-237.
[24]Singh N,Limaye AP,Forrest G,et al.Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients:a prospective,multicenter,observational study[J].Transplantation,2006,81:320-326.
[25]Alexander BD,Perfect JR,Daly JS,et al.Posaconazole as salvage therapy in patients with invasive fungal infections after solid organ transplant[J].Transplantation,2008,86:791-796.
[26]Maricela V,Marina M,Santiago C,et al.Donor-derived invasive aspergillosis after kidney transplant[J].Medical Mycology Case Reports,2018,22:24-26.
[27]Perfect JR,Dismukes WE,Dromer F,et al.Clinical practice guidelines for the management of cryptococcal disease:2010 update by the infectious diseases society of America[J].Clin Infect Dis,2010,50:291-322.
[28]Day JN,Chau TT,Wolbers M,et al.Combination antifungal therapy for cryptococcal meningitis[J].N Engl J Med,2013,368:1291-1302.
[29]Barrett JP,Vardulaki KA,Conlon C,et al.A systematic review of the antifungal effectiveness and tolerability of amphotericin B formulations[J].Clin Ther,2003,25:1295-1320.
[30]Sun HY,Alexander BD,Lortholary O,et al.Lipid formulations of amphotericin B significantly improve outcome in solid organ transplant recipients with central nervous system cryptococcosis[J].Clin Infect Dis,2009,49:1721-1728.
[31]Singh N,Lortholary O,Alexander BD,et al.An immune reconstitution syndrome-like illness associated with Cryptococcus neoformans infection in organ transplant recipients[J].Clin Infect Dis,2005,40:1756-1761.
[32]Bava AJ,Negroni R.Flucytosine+fluconazole association in the treatment of a murine experimental model of cryptococcosis[J].Rev Inst Med Trop Sao Paulo,1994,36:551-554.
[33]Nagappan V,Deresinski S.Reviews of anti-infective agents:posaconazole:a broad-spectrum triazole antifungal agent[J].Clin Infect Dis,2007,45:1610-1617.
[34]Bandettini R,Castagnola E,Calvillo M,et al.Voriconazole for cryptococcal meningitis in children with leukemia or receiving allogeneic hemopoietic stem cell transplant[J].J Chemother,2009,21:108-109.
[35]Singh N,Lortholary O,Alexander BD,et al.Allograft loss in renal transplant recipients with cryptococcus neoformans associated immune reconstitution syndrome[J].Transplantation,2005,80:1131-1133.
[36]S u n H Y,W a g e n e r M M,S i n g h N.C r y p t o c o c c o s i s i n s o l i dorgan,hematopoietic stem cell,and tissue transplant recipients:evidencebased evolving trends[J].Clin Infect Dis,2009,48:1566-1576.
[37]Saad AH,DePestel DD,Carver PL.Factors influencing the magnitude and clinical significance of drug interactions between azole antifungals and select immunosuppressants[J].Pharmacotherapy,2006,26:1730-1744.
[38]Mathis AS,Shah NK,Friedman GS.Combined use of sirolimus and voriconazole in renal transplantation:a report of two cases[J].Transplant Proc,2004,36:2708-2709.
[39]Sansone-Parsons A,Krishna G,Martinho M,et al.Effect of oral posaconazole on the pharmacokinetics of cyclosporine and tacrolimus[J].Pharmacotherapy,2007,27:825-834.
[40]Sable CA,Nguyen BY,Chodakewitz JA,DiNubile MJ.Safety and tolerability of caspofungin acetate in the treatment of fungal infections[J].Transpl Infect Dis,2002,4:25-30.
[41]Chandrasekar PH,Sobel JD.Micafungin:a new echinocandin.Clin Infect Dis,2006,42:1171-1178.
[42]Dowell JA,Stogniew M,Krause D,et al.Assessment of the safety and pharmacokinetics of anidulafungin when administered with cyclosporine[J].JClin Pharmacol,2005,45:227-233.