肝移植候选者中的隐球菌病:发病率、表现和风险因素

IF 4.5 2区 医学 Q2 IMMUNOLOGY Journal of Microbiology Immunology and Infection Pub Date : 2024-08-23 DOI:10.1016/j.jmii.2024.08.001
Wan-Ting Tsai, Aristine Cheng, Yu-Chung Chuang, Cheng-Maw Ho, Yao-Ming Wu, Ming-Chih Ho, Hsin-Yun Sun, Ray-Hung Hu, Yee-Chun Chen
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引用次数: 0

摘要

肝硬化损害了对隐球菌病的免疫力,而肝移植受者往往在移植后更早发病,这可能是由于移植前感染未被发现所致。我们评估了肝移植受者中隐球菌病的发病率和特征,以及移植前隐球菌抗原(CrAg)是否能在移植前检测出这种疾病。我们回顾性纳入了 2017-2022 年间一家三甲医院的肝移植候选者。血清 CrAg 和肺部计算机断层扫描被纳入常规移植评估。如有必要,还进行了其他检查。隐球菌病通过培养或CrAg阳性确诊。还对隐球菌病的风险因素进行了评估。在中位 MELD-Na 评分为 18 分的 377 名候选者中,84.4% 感染了乙型肝炎病毒 (HBV)。只有 3 人发烧,3 人无症状;7 人患有肺隐球菌病。在患有隐球菌病的 10 名候选者中,有一人在服用了 143 天的抗真菌药物后接受了移植手术。在 87 名接受肝移植的候选者中,有一名(1.2%)受者在移植后 14 天患了隐球菌病,而在移植前三周 CrAg 阴性。经 MELD-Na 评分调整后,HBsAg 阳性且 HBV DNA 负荷小于 2000 IU/mL 的慢性 HBV 感染与隐球菌病显著相关(几率比 4.4,95% 置信区间 1.2-16.5,p = 0.03)。在我们的肝移植患者中,隐球菌病的发病率为 2.6%,而 CrAg 检测出的病例占 80%。患者病情较轻,以肺部疾病为主。HBsAg 阳性的慢性 HBV 感染且 HBV DNA 负荷小于 2000 IU/mL,与隐球菌病明显相关。
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Cryptococcosis in wait-listed liver transplant candidates: Prevalence, manifestations, and risk factors
Liver cirrhosis compromises immunity against cryptococcosis, and liver transplant recipients tend to develop the disease earlier after transplantation, possibly due to unrecognized pretransplant infection. We assessed the prevalence and characteristics of cryptococcosis among liver transplant candidates and whether pre-transplant cryptococcal antigen (CrAg) can detect the disease before transplantation. We retrospectively included liver transplant candidates in a tertiary hospital during 2017–2022. Serum CrAg and pulmonary computed tomography were incorporated in routine transplant evaluation. Other investigations were done if indicated. Cryptococcosis was diagnosed by positive culture or CrAg. Risk factors for cryptococcosis were also assessed. Of the 377 candidates with a median MELD-Na score of 18, 84.4% had hepatitis B virus (HBV) infection. Cryptococcosis was diagnosed in 10 (2.6%) candidates, by CrAg in 6, culture in 2, or both in 2. Only 3 had fever, and 3 were asymptomatic; 7 had pulmonary cryptococcosis. Of the 10 candidates with cryptococcosis, one underwent transplantation after 143-day antifungals. Of the 87 candidates undergoing liver transplantation, one (1.2%) recipient developed cryptococcosis 14 days post-transplant with negative CrAg three weeks before transplantation. HBsAg-positive chronic HBV infection with HBV DNA loads <2000 IU/mL was significantly associated with cryptococcosis (odds ratio 4.4, 95% confidence interval 1.2–16.5, p = 0.03) after the adjustment of MELD-Na score. The prevalence of cryptococcosis was 2.6% among our liver transplant candidates and CrAg detected 80% of the cases. Disease presentation was mild and pulmonary disease predominated. HBsAg-positive chronic HBV infection with HBV DNA loads <2000 IU/mL was significantly associated with cryptococcosis.
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来源期刊
Journal of Microbiology Immunology and Infection
Journal of Microbiology Immunology and Infection IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
15.90
自引率
5.40%
发文量
159
审稿时长
67 days
期刊介绍: Journal of Microbiology Immunology and Infection is an open access journal, committed to disseminating information on the latest trends and advances in microbiology, immunology, infectious diseases and parasitology. Article types considered include perspectives, review articles, original articles, brief reports and correspondence. With the aim of promoting effective and accurate scientific information, an expert panel of referees constitutes the backbone of the peer-review process in evaluating the quality and content of manuscripts submitted for publication.
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