BACKGROUND:Invasive Aspergillus is an important cause of morbidity and mortality among lung transplant recipients. The diagnosis can be difficult and treatment is often unsuccessful so many centers preemptively treat all Aspergillus airway isolates to prevent invasive disease. This approach is untested as little is known about the relationship between Aspergillus airway colonization and invasive disease. This study was undertaken to evaluate the incidence of Aspergillus airway colonization after lung transplantation and the risk of invasive disease after colonization.

DESIGN:All cultures and histologic specimens obtained from a consecutive series of 151 lung transplant cases were reviewed for the presence of Aspergillus and compared with clinical data.

RESULTS:Aspergillus was isolated from the airway in 69 (46%) of 151 transplant recipients. Invasive disease occurred in five cases and was uniformly fatal, accounting for 13% of all posttransplant deaths. Results of cytologic examination of BAL fluid were normal in all cases of invasive disease and cultures were positive in only one of five patients prior to invasion. Invasive disease occurred exclusively in patients who died or were colonized with Aspergillus fumigatus within the first 6 months posttransplant. Patients growing A. fumigatus from the airway during the first 6 months were 11 times more likely to develop invasive disease relative to those not colonized.

CONCLUSION:Aspergillus airway colonization after lung transplantation is common and in most cases, transient. In contrast, invasive Aspergillus disease is less common, but fatal. Bronchoscopy with cytologic examination and fungal culture are not sensitive or timely predictors of invasive disease. Invasive Aspergillus occurred only in patients initially colonized with A. fumigatus within the first 6 months posttransplant. A trial of empiric anti-Aspergillus therapy limited to the first 6 months posttransplant may be warranted.

译文

背景 : 侵袭性曲霉菌是肺移植受者发病和死亡的重要原因。诊断可能很困难,治疗通常不成功,因此许多中心抢先治疗所有曲霉气道分离株以预防侵袭性疾病。这种方法未经测试,因为对曲霉菌气道定植与侵袭性疾病之间的关系知之甚少。这项研究旨在评估肺移植后曲霉菌气道定植的发生率和定植后侵袭性疾病的风险。
设计 : 回顾了从连续一系列151例肺移植病例中获得的所有培养物和组织学标本,以了解曲霉的存在,并与临床数据进行了比较。
结果 : 从气道中分离出曲霉在69名 (46% 名) 151移植受者中。5例发生了侵袭性疾病,并且是致命的,占所有移植后死亡的13%。在所有浸润性疾病病例中,BAL液的细胞学检查结果均正常,并且在浸润前的五名患者中只有一名培养阳性。浸润性疾病仅发生在移植后头6个月内死亡或被烟曲霉定植的患者中。与未定植的患者相比,在最初的6个月内从气道中生长出烟曲霉的患者发生侵袭性疾病的可能性高11倍。
结论 : 肺移植后曲霉气道定植是常见的,在大多数情况下是短暂的。相比之下,侵袭性曲霉菌病较少见,但会致命。纤支镜检查和细胞学检查和真菌培养不能敏感或及时预测侵袭性疾病。侵袭性曲霉菌仅发生在最初在移植后的前6个月内被烟曲霉定植的患者中。可能需要进行仅限于移植后前6个月的经验性抗曲霉治疗试验。

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