球虫血清阳性实体器官移植受者自我停止抗真菌预防后的结果:仅eia - igm的难题。

IF 5.3 2区 医学 Q1 IMMUNOLOGY
Simran Gupta, Matt V Biondi, Priyal J Shah, Matthew R Buras, Lavanya Kodali, David M H Chascsa, Holenarasipur R Vikram, Janis E Blair
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引用次数: 0

摘要

背景:实体器官移植受者有严重球孢子菌病的风险,并给予预防以减轻风险。血清检测呈阳性的患者通常接受终身预防;目前,这种预防策略包括仅通过酶免疫测定(EIA-IgM-only)检测IgM阳性的患者,尽管该结果可能是假阳性。方法:我们在一个地方性球虫菌病地区的一个大容量移植中心进行了一项回顾性研究,比较球虫血清阳性但停止预防的非肺移植受者(病例患者)和继续预防的患者(对照组)的结果。结果:随访期间,无病例及对照组出现活动性球孢子菌病。移植前,77例患者中62例(80.5%)血清学检测单项阳性,其中27例(43.5%)仅为eia - igm阳性。相比之下,77例对照中有57例(74.0%)有单一血清阳性结果(16/57[28.1%]仅为eia - igm)。与所有其他球虫血清学结果(13/111[11.7%])相比,43例患者中有20例(46.5%)的单一ea - igm结果被传染病咨询师分类为假阳性。P结论:对于反复ea - igm阳性且无血清转化证据、符合临床疾病或影像学表现的患者,在移植后第一年后停止抗真菌预防可能是合理的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcomes of Coccidioides Seropositive Solid Organ Transplant Recipients After Self-discontinuation of Antifungal Prophylaxis: The EIA-IgM-only Conundrum.

Background: Solid organ transplant recipients are at risk of severe coccidioidomycosis and are given prophylaxis to mitigate the risk. Patients with seropositive testing typically receive lifelong prophylaxis; currently, this prophylaxis strategy includes patients who are positive only for IgM by enzyme immunoassay (EIA-IgM-only), although this result may be falsely positive.

Methods: We conducted a retrospective study at a large-volume transplant center in an endemic coccidioidomycosis region to compare outcomes of non-lung transplant recipients who were seropositive for Coccidioides but discontinued prophylaxis (case patients) to outcomes of patients who continued prophylaxis (controls).

Results: No case or control patients developed active coccidioidomycosis during the follow-up period. Before transplant, 62 of 77 case patients (80.5%) had a single positive serologic test, of whom 27 of 62 were EIA-IgM-only positive (43.5%). In contrast, 57 of 77 controls (74.0%) had a single seropositive result (16/57 [28.1%] were EIA-IgM-only). The single EIA-IgM-only result was classified as falsely positive by infectious disease consultants in 20 of 43 patients (46.5%) compared with all other Coccidioides serologic results (13/111 [11.7%], P < 0.001). Lifetime antifungal prophylaxis was felt to be unnecessary for 28 of 43 patients (65.1%) who were EIA-IgM-only versus 31 of 111 patients (27.9%) with other serologic results (P < 0.001).

Conclusions: For patients repeatedly positive for EIA-IgM-only and no evidence of seroconversion, compatible clinical illness, or radiographic findings, discontinuing antifungal prophylaxis may be reasonable after the first posttransplant year.

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来源期刊
Transplantation
Transplantation 医学-免疫学
CiteScore
8.50
自引率
11.30%
发文量
1906
审稿时长
1 months
期刊介绍: The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation. ​
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