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Cytomegalovirus and Aspergillus spp. coinfection in organ transplantation: a case report and review of the literature

机译：巨细胞病毒和曲霉属。器官移植中的共感染：一例报道并文献复习

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摘要

With the advent of potent immunosuppressive options, acute rejection episodes have decreased at the expense of increased incidence of opportunistic infections in solid organ recipients. In the absence of any preventive therapy, 30–75 % of transplant recipients develop cytomegalovirus (CMV) infection. Candida spp. and Aspergillus spp. account for more than 80 % of invasive fungal infections in solid organ recipients. This co-occurrence of two commonly seen opportunistic infections may end up in fatality. Here, we present a case of concomitant Aspergillus spp. and CMV infection and discuss the relevant literature. A 54-year-old male patient presented with fever, shortness of breath, and chest pain on the 9th posttransplant week after renal transplantation. CMV-DNA by polymerase chain reaction (PCR) was 1,680,000 copies/ml, thus, valganciclovir dose was increased. There were inspiratory crackles at both lung bases, and chest computed tomography (CT) revealed multiple fungal balls throughout the right lung. Galactomannan antigen was positive, and voriconazole and other antimicrobials were subsequently added to the treatment. At the end of the therapy, on control CT, pneumonic consolidation had disappeared, sputum cultures didn’t show Aspergillus spp., and CMV-DNA reduced to 700 copies/ml. The patient showed a favorable clinical response to combined treatment; fever, dyspnea, and pleuritic chest pain disappeared. Both CMV disease and aspergillosis may present as pulmonary disease; thus, the characterization of one may not preclude the search for the other and the timely initiation of treatment is of paramount importance for good outcomes.
机译：随着有效的免疫抑制选择的出现，急性排斥反应的发生率降低了，但以增加了实体器官接受者机会感染的发生为代价。在没有任何预防性治疗的情况下，有30–75％的移植受者会发展成巨细胞病毒（CMV）感染。念珠菌属和曲霉属。占实体器官接受者侵袭性真菌感染的80％以上。两种常见的机会性感染的并发可能导致死亡。在这里，我们介绍一例伴生曲霉。与CMV感染有关并讨论相关文献。一名54岁的男性患者在肾移植后第9周出现发烧，呼吸急促和胸痛。通过聚合酶链反应（PCR）得到的CMV-DNA为1,680,000拷贝/ ml，因此增加了缬更昔洛韦的剂量。在两个肺基部都有吸气性裂纹，胸部计算机断层扫描（CT）显示整个右肺有多个真菌球。半乳甘露聚糖抗原是阳性的，随后将伏立康唑和其他抗微生物药添加到治疗中。在治疗结束时，在对照CT上，肺炎巩固消失，痰培养物中未显示曲霉菌，CMV-DNA降至700拷贝/ ml。患者对联合治疗表现出良好的临床反应。发烧，呼吸困难和胸膜炎胸痛消失。 CMV病和曲霉病均可能表现为肺部疾病；因此，一个人的特征可能并不排除寻找另一个人的可能性，及时开始治疗对于取得良好结果至关重要。

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  • 来源
    《CEN Case Reports》 |2013年第1期|59-67|共9页
  • 作者

    Yalcin Solak; Zeynep Biyik; Ahmet Cizmecioglu; Nejdet Genc; Orhan Ozbek; Abduzhappar Gaipov; Mehdi Yeksan;

  • 作者单位

    Division of Nephrology Department of Internal Medicine Meram School of Medicine Selcuk University">(1);

    Hemodiyaliz Sekreterligi Meram Tip Fakultesi Selcuk Universitesi">(5);

    Division of Nephrology Department of Internal Medicine Meram School of Medicine Selcuk University">(1);

    Department of Internal Medicine Meram School of Medicine Selcuk University">(2);

    Department of Infectious Diseases Meram School of Medicine Selcuk University">(3);

    Department of Radiology Meram School of Medicine Selcuk University">(4);

    Division of Nephrology Department of Internal Medicine Meram School of Medicine Selcuk University">(1);

    Division of Nephrology Department of Internal Medicine Meram School of Medicine Selcuk University">(1);

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  • 关键词

    Aspergillosis; Concomitant infection; Cytomegalovirus; Renal transplant recipient;

    机译：曲霉病;伴随感染;巨细胞病毒;肾移植受者;

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