实体器官移植受者的中枢神经系统感染。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-11 DOI:10.1016/j.transproceed.2024.12.032

Oscar Morado-Aramburo, Leeja Joseph, Harmanpreet Kaur, Rodrigo Hasbun

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引用次数: 0

摘要

背景：中枢神经系统（CNS）感染是实体器官移植（SOT）受者可能发生的严重和危及生命的并发症。我们描述了SOT中中枢神经系统感染的流行病学、临床表现、诊断、病程和结果。方法：我们分析了2012年9月至2023年2月在我们位于德克萨斯州休斯顿的医院诊断和治疗的因中枢神经系统感染而接受移植的患者的数据。数据回顾性收集自医学图表。结果：1345例接受SOT的患者中，30例（2.23%）被诊断为中枢神经系统感染，中位年龄63岁，60%为男性。移植后中枢神经系统感染的发病时间为1年后，占53.3%。真菌感染15/30例（50%），病毒感染8/30例（26.7%），细菌感染7/30例（23.3%）。没有未知的原因。最常见的病因是新型隐球菌14/30（46.6%）和诺卡菌病3/30（10%）。入院时，22例（73.4%）患者精神状态正常，但21例（70%）报告头痛，18例（60%）有发热。CT扫描5例（16.6%），MRI扫描10例（33.3%）。33%的患者在出院时出现不良临床结果，6.7%的患者死亡。发热与不良临床结果的风险增加相关(OR 11；P = .018)。结论：SOT受者中枢神经系统感染的发生率较低，但与大量不良临床结果相关。最常见的原因是真菌，在本研究中没有发现未知的病因。

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Central Nervous System Infections in Recipients of Solid Organ Transplant

Background

Central nervous system (CNS) infections are severe and life-threatening complications that can occur in solid organ transplant (SOT) recipients. We describe the epidemiology, clinical presentation, diagnosis, disease course, and outcome of CNS infections in SOT.

Methods

We analyzed data of patients who underwent transplantation from September 2012 to February 2023, diagnosed and treated for CNS infections at our institution in Houston, TX. Data were retrospectively collected from medical charts.

Results

Of 1,345 patients who received a SOT, 30 (2.23%) were diagnosed with CNS infection, with a median age of 63 years, 60% were male. Time to CNS infection onset after transplant in 53.3% of the cases was after the first year. There were 15/30 (50%) cases of fungal infection, 8/30(26.7%) of viral infection, 7/30 (23.3%) of bacterial infection. There were no unknown causes. The most common etiologies were Cryptococcus neoformans 14/30(46.6%), and nocardiosis 3/30 (10%). On presentation, 22 (73.4%) patients had normal mental status, but 21 (70%) reported headaches, and 18 (60%) were febrile. Abnormal neuroimaging was found in 5 cases (16.6%) on computed tomography (CT)-scans and 10 cases (33.3%) on magnetic resonance imaging (MRI) scans. An adverse clinical outcome on discharge was noticed in 33%, and 6.7% died. Fever was associated with an increased risk of adverse clinical outcomes (OR 11; P = .018).

Conclusion

The incidence of CNS infections in SOT recipients is low but associated with substantial adverse clinical outcomes. The most common causes are fungal, with no unknown etiologies seen in this study.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.