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Том 8 №1 2006 год - Нефрология и диализ

Системные микозы у реципиентов почечного трансплантата

Прокопенко Е.И.

Аннотация: Системные (глубокие оппортунистические) микозы являются одним из самых серьезных, хотя и не самых частых, инфекционных осложнений после трансплантации почки. При глубоких оппортунистических микозах, развивающихся в условиях иммунодефицита, поражаются внутренние органы и глубоко лежащие ткани. Грибковые инфекции у реципиентов почечного трансплантата можно условно разделить на 2 группы. Это, во-первых, эндемичные системные микозы, встречающиеся в определенных географических регионах (гистоплазмоз, бластомикоз, кокцидиомикоз, паракокцидиомикоз), и во-вторых - оппортунистические грибковые инфекции, возбудители которых редко вызывают инвазивное заболевание у лиц с нормальным иммунитетом (аспергиллез, кандидоз, криптококкоз, мукороз и др.) [95]. Наиболее часто возбудителями системных микозов у больных после ТП являются Candida spp. и Aspergillus spp., существенное значение имеет также Cryptococcus [28, 54, 93, 105]. В ряде случаев у реципиентов РТ развиваются более редкие грибковые заболевания - зигомикоз (в том числе - мукороз), моноспоридиоз, сцедоспориоз, феогифомикоз и др. [10, 11, 38]. Кроме того, возбудитель тяжелой легочной инфекции Pneumocystis carinii относится к атипичным микрогрибам, поэтому в современных руководствах пневмоцистоз описывается в разделе грибковых инфекций [4, 32].

Для цитирования: Прокопенко Е.И. Системные микозы у реципиентов почечного трансплантата. Нефрология и диализ. 2006. 8(1):6-15. doi:

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Ключевые слова: микозы, трансплантация почки, иммуносупрессия

Список литературы:

1. Бурова С.А., Курбатова И.В. Лабораторная диагностика оппортунистических системных микозов. Успехи медицинской микологии. Материалы первого Всероссийского конгресса по медицинской микологии. М.: 2003; 2: 220-221.
2. Клясова Г.А., Петрова Н.А., Толкачева Т.В. и др. Лечение итраконазолом в суспензии орофарингеального кандидоза у иммуноскомпрометированных больных. Гематология 2003; 11: 18-24.
3. Никифорова З.Н., Шевченко В.Е., Щербаков С.Д. и др. Действие гранулоцитарно-макрофагального колониестимулирующего фактора на антикандидозную активность нейтрофилов у онкогематологических больных. Успехи медицинской микологии. Материалы первого Всероссийского конгресса по медицинской микологии. М.: 2003; 2: 262-263.
4. Руководство по трансплантации почки. Под ред. Данович Г.М., пер. с англ. под ред. Мойсюка Я.Г. 3-е изд. Тверь: Триада 2004: 472 с.
5. Сергеев А.Ю. Эволюция антимикотиков и революция в терапии микозов. Успехи медицинской микологии. Материалы первого Всероссийского конгресса по медицинской микологии. М.: 2003; 2: 111-112.
6. Сергеев А.Ю., Сергеев Ю.В. Грибковые инфекции. Руководство для врачей. М.: Бином-пресс 2003: 440 с.
7. Филатов Л.Б. Стратегия и тактика минимизации риска развития острой почечной недостаточности в результате лечения амфотерицином B. Успехи медицинской микологии. Материалы первого Всероссийского конгресса по медицинской микологии. М.: 2003; 2: 230-233.
8. Abbott K.C., Hypolite I., Poropatich R.K. et al. Hospitalizations for fungal infections after renal transplantation in the United States. Transpl Infect Dis 2001; 3(4): 203-211.
9. Ahmed J., Ditmars D.M., Sheppard T. et al. Recurrence of Scedosporium apiospermum infection following renal retransplantation. Am J Transplant 2004; 4(10): 1720-1724.
10. Al Soub H., El Deeb Y., Almaslaman I.M., Al Khuwaiter J.Y. Zygomycosis in Qatar: a retrospective review of six cases. Allerg Immunol (Paris) 2004; 36(10): 387-391.
11. Al-Abdely H.M., Alkhunaizi A.M., Al-Tawfiq J.A. et al. Successful therapy of cerebral phaeohyphomycosis due to Ramichloridium mackenziei with the new triazole posaconazole. Med Mycol 2005; 43(1): 91-95.
12. Alexander B.D. Diagnosis of fungal infection: new technologies for the mycology laboratory. Transpl Infect Dis 2002; 4 Suppl 3: 32-37.
13. Aliff T.B., Maslak P.G., Jurcic J.G. et al. Aspergiiillus pneumonia in patient with acute leukemia: successful therapy with combination caspofungin and liposomal amphotericin. 43rd annual meeting of American Society of Hematology (Orlando, Florida) 2001; Abstract 1381.
14. Altiparmak M.R., Apaydin S., Trablus S. Systemic fungal infections after renal transplantation. Scand J Infect Dis 2002; 34(4): 284-288.
15. Anaissie E.J., Stratton S.L., Dignani M.C. et al. Pathogenic Aspergillus species recovered from a hospital water system: a 3-year prospective study. Clin Infect Dis 2002; 34(6): 780-789.
16. Anttila V.J., Piilonen A., Valtonen M. et al. Co-administration of caspofungin and cyclosporine to a kidney transplant patient with pulmonary Aspergillus infection. Scand J Infect Dis 2003; 35(11-12): 893-894.
17. Arathoon E.G., Gotuzzo E., Noriega L.M. et al. Randomized, double-blind, multicenter study of Caspofungin versus amphotericin Bfor treatment of oropharyngeal and esophageal candidiasis. Antimicrob Agents Chemother 2002; 46: 451-457.
18. Arikan S., Lozano-Chiu M., Paetznick V., Rex J.H. In vitro synergy of caspofungin and amphotericin B against Aspergillus and Fusarium spp. Antimicrob Agents Chemother 2002; 46: 245-247.
19. Azevedo L.S., Castro M.C., Paula F.J. et al. Mycophenolate mofetil may protect against Pneumocystis carinii pneumonia in renal transplanted patients. Rev Inst Med Trop Sao Paulo 2005; 47(3): 143-145.
20. Basaran O., Emiroglu R., Arikan U. et al. Cryptococcal necrotizing fasciitis with multiple sites of involvement in the lower extremities. Dermatol Surg 2003; 29(11): 1158-1160.
21. Battaglia M., Ditonno P., Selvaggio O. et al. Kidney transplants from infected donors: our experience. Transplant Proc 2004; 36(3): 491-492.
22. Beck J.M., Harmsen A.G. Lymphocytes in host defense against Pneumocystis carinii. Semin Respir Infect 1998; 13(4): 330-338.
23. Blair J.E. Coccidioidal pneumonia, arthritis, and soft-tissue infection after kidney transplantation. Transpl Infect Dis 2004; 6(2): 74-76.
24. Blin N., Morineau N., Gaillard F., Morin O. et al. Disseminated mucormycosis associated with invasive pulmonary aspergillosis in a patient treated for post-transplant high-grade non-Hodgkin's lymphoma. Leuk Lymphoma 2004; 45(10): 2161-2163.
25. Branten A.J., Beckers P.J., Tiggeler R.G., Hoitsma A.J. Pneumocystis carinii pneumonia in renal transplant recipients. Nephrol Dial Transplant 1995; 10: 1194-1197.
26. Campagnaro E.L., Woodside K.J, Early M.G. et al. Disseminated Pseudallescheria boydii (Scedosporium apiospermum) infection in a renal transplant patient. Transpl Infect Dis 2002; 4(4): 207-211.
27. Coates M., Wilson J. Central nervous system aspergillus infection complicating renal transplantation. Australas Radiol 2001; 45(3): 338-342.
28. Colomba C., Antinori S. Fungal infections in transplantation patients. Recenti Prog Med 2003; 94(11): 516-528.
29. Costa C., Costa J.M., Desterke C. et al. Real-time PCR coupled with automated DNA extraction and detection of galactomannan antigen in serum by enzyme-linked immunosorbent assay for diagnosis of invasive aspergillosis. J Clin Microbiol 2002; 40: 2224-2227.
30. Crompton J.A., Alexander D., Somerville T., Shihab F.S. Lipid-based amphotericin in pulmonary zygomycosis: safety and efficacy of high exposure in a renal allograft recipient. Transpl Infect Dis 2004; 6(4): 183-187.
31. David S.M. Making best use of the newer antifungal drugs. Infect Med 2003; 20: 392-399.
32. Dei-Cas E. Pneumocystis infections: the iceberg? Med Mycol 2000; 38 Suppl 1: 23-32.
33. Denning D.W., Dupont B., Pauw B. Invasive fungal infection. London: Royal Society of Medicine Press 1999: 386 p.
34. Denning D.W., Evans E.G., Kibbler C.C. Guidelines for the investigation of invasive fungal infections in haematological malignancy and solid organ transplantation. British Society for Medical Mycology. Eur J Clin Microbiol Infect Dis 1997; 16(6): 424-436.
35. Derici U., Ayerdem F., Arinsoy T. et al. The use of granulocyte colony-stimulating factor in a neutropenic renal transplant recipient. Haematologia (Budap) 2002; 32(4): 557-560.
36. Dominiguez J., Mahalati K., Kiberd B. et al. Conversion to rapamycin immunosuppression in renal transplant recipients: report of an initial experience. Transplantation 2000; 70: 1244-1247.
37. EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.7.1 Late infections. Pneumocystis carinii pneumonia. Nephrol Dial Transplant 2002; 17 Suppl 4: 36-39.
38. Echo A., Hovsepian R.V., Shen G.K. Localized cecal zygomycosis following renal transplantation. Transpl Infect Dis 2005; 7(2): 68-70.
39. Elzi L., Laifer G., Bremeric G., Vosbeck J., Mair M. Invasive aspergillosis with myocardial involvement after kidney transplantation. NDT 2005; 20: 631-634.
40. Ergin F., Arslan H., Azap A. et al. Invasive aspergillosis in solid-organ transplantation: report of eight cases and review of the literature. Transpl Int 2003; 16: 280-286.
41. Feinberg J. Pneumocystis carinii pneumonia. In: Goldman L., Bennet J.C., eds Cecil Textbook of Medicine, 21 st edn. 2000; 1877-1883.
42. Flahaut M., Sanglard D., Monod M. et al. Rapid detection of Candida albicans in clinical samples by DNA amplification of common regions from C. albicans-secreted aspartic proteinase genes. J Clin Microbiol 1998; 36(2): 395-401.
43. Florea N.R., Capitano B., Nightingale C.H. et al. Beneficial pharmacokinetic interaction between cyclosporine and itraconazole in renal transplant recipients. Transplant Proc 2003; 35(8): 2873-2877.
44. Gari-Toussaint M., Ngoc L.H., Gigante M. et al. Kidney transplant and Candida albicans arteritis. The importance of analysing the transplant conservation liquid. Presse Med 2004; 33(13): 866-868.
45. Garrido J., Labrador P.J., Lerma L. et al. Vascular Aspergillus infection in two recipients of kidneys from the same donor. Nefrologia 2004; 24 Suppl 3: 30-34.
46. Gordon S.M., LaRosa S.P., Kalmadi S. et al. Should prophylaxis for Pneumocystis carinii pneumonia in solid organ transplant recipients ever be discontinued? Clin Infect Dis 1999; 28: 240-246.
47. Guermazi A., Benchaib N., Zagdanski A.M. et al. Cerebral and spinal cord involvement resulting from invasive aspergillosis. Eur Radiol 2002; 12(1): 147-150.
48. Gupta R.K., Khan Z.U., Nampoory M.R. et al. Cutaneous cryptococcosis in a diabetic renal transplant recipient. J Med Microbiol 2004; 53(Pt 5): 445-449.
49. Gupta S., Dash S.C., Sharma S. et al. Pneumocystis carinii pneumonia: role of high resolution computed tomography. J Assoc Physicians India 2002; 50(5): 726-728.
50. Hagerty J.A., Ortiz J., Reich D., Manzarbeitia C. Fungal infections in solid organ transplant patients. Surg Infect (Larchmt) 2003; 4(3): 263-271.
51. Haight D.O., Esperanza L.E., Greene J.N. et al. Case report: cutaneous manifestations of cryptococcosis. Am J Med Sci 1994; 308(3): 192-195.
52. Herbrecht R., Denning D.W., Patterson T.F. et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002; 347: 408-415.
53. Herbrecht R., Zamfir A., Letscher-Bru V. Visceral candidiasis. Rev Prat 2001; 51(7): 725-730.
54. Hibberd P.L., Rubin R.H. Clinical aspects of fungal infection in organ transplant recipients. Clin Infect Dis 1994; 19 Suppl 1: S33-40.
55. High K.P., Washburn R.G. Invasive aspergillosis in mice immunosuppressed with cyclosporine A, tacrolimus (FK506) or sirolimus (rapamycin). J Infect Dis 1977; 175: 222-225.
56. Hiyoshi M., Tagawa S., Hashimoto S. et al. Evaluation of a new laboratory test measuring plasma (1-->3)-beta-D-glucan in the diagnosis of Candida deep mycosis: comparison with a serologic test. Kansenshogaku Zasshi 1999; 73(1): 1-6.
57. Jha V., Chugh K.S. Posttransplant infections in the tropical countries. Artif Organs 2002; 26(9): 770-777.
58. John G.H., Shankar V., Talaulicar G. et al. Epidemiology of systemic mycoses among renal-transplant recipients in India. Transplantation 2003; 75: 1544-1551.
59. Kim S.W., Nah M.Y., Yeum C.H. et al. Pelvic aspergillosis with tubo-ovarian abscess in a renal transplant recipient. J Infect 2001; 42(3): 215-217.
60. Kontoyiannis D.P., Hachen R., Lewis R.E. Efficacy and toxicity of caspofungin in combination with liposomal amphotericin B as primary or salvage treatment of invasive aspergillosis in patients hematologic malignancies. Cancer 2003; 98: 292-299.
61. Ladurner R., Brandacher G., Steurer W. et al. Lessons to be learned from a complicated case of rhino-cerebral mucormycosis in a renal allograft recipient. Transpl Int 2003; 16(12): 885-889.
62. Le Moing V., Lortholary O., Timsit J.F. et al. Aspergillus pericarditis: report of a successfully treated case with tamponade and literature review. Clin Infect Dis 1998; 26: 451-460.
63. Lee Y.A., Kim H.J., Lee T.W. et al. First report of Cryptococcus albidus-induced disseminated cryptococcosis in a renal transplant recipient. Korean J Intern Med 2004; 19(1): 53-57.
64. Lin S.J., Schranz J., Teutsch S.M. Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis 2001; 32: 358-366.
65. Luff V., Kliem V., Behrend M. et al. Incidence of Pneumocystis carinii pneumonia after renal transplantation. Impact of immunosuppression. Transplantation 1996; 62: 421-423.
66. Maertens J., Verhaegen J., Lagrou K. et al. Screening of circulating galactomannan as noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem sell transplantation recipients: a prospective validation. Blood 2001; 97: 1604-1610.
67. Maesaki S. Serodiagnosis for deep-seated mycoses. Nippon Ishinkin Gakkai Zasshi 2002; 43(4): 233-237.
68. Mennink-Kersten M.A., Donnelly J.P., Verweij P.E. Detection of circulating galactomannan for the diagnosis and management of invasive aspergillosis. Lancet Infect Dis 2004; 4: 349-357.
69. Morgenstern G.R., Prentice A.G., Prentice H.G. et al. A randomized controlled trial of itraconazole versus fluconazole for the prevention of fungal infections in patients with hematological malignancies. Br J Hematol 1999; 105: 901-911.
70. Mueller N.J., Fishman J.A. Asymptomatic pulmonary cryptococcosis in solid organ transplantation: report of four cases and review of the literature. Transpl Infect Dis 2003; 5(3): 140-143.
71. Ndimbie O.K., Dekker A., Martinez A.J., Dixon B. Prostatic sequestration of Cryptococcus neoformans in immunocompromised persons treated for cryptococcal meningoencephalitis. Histol Histopathol 1994; 9(4): 643-648.
72. Neuville S., Dromer F., Chretien F. et al. Physiopathology of meningoencephalitis caused by Cryptococcus neoformans. Ann Med Interne (Paris) 2002; 153(5): 323-328.
73. Nosanchuk J.D., Shoham S., Fries B.C. et al. Evidence of zoonotic transmission of Cryptococcus neoformans from a pet cockatoo to an immunocompromised patient. Ann Intern Med 2000; 132(3): 205-208.
74. O'Gara M.J., Lee C.H., Weinberg G.A. et al. IMP dehydrogenase from Pneumocystis carinii as a potential drug target. Antimicrob Agents Chemother 1997; 41: 40-48.
75. Pai M., Allen S. Voriconazole inhibition of tacrolimus metabolism. Clin Infect Dis 2003; 36: 1089-1091.
76. Panackal A.A., Dahlman A., Keil K.T. et al. Outbreak of invasive aspergillosis among renal transplant recipients. Transplantation 2003; 75(7): 1050-1053.
77. Paterson D.L., Singh N. Invasive aspergillosis in transplant recipients. Medicine 1999; 78: 123-138.
78. Quinio D., Karam A., Leroy J.P. et al. Zygomycosis caused by Cunninghamella bertholletiae in a kidney transplant recipient. Med Mycol 2004; 42(2): 177-180.
79. Rabodonirina M., Vanhems P., Couray-Targe S. et al. Molecular evidence of interhuman transmission of Pneumocystis pneumonia among renal transplant recipients hospitalized with HIV-infected patients. Emerg Infect Dis 2004; 10(10): 1766-1773.
80. Radisic M., Lattes R., Chapman J.F. et al. Risk factors for Pneumocystis carinii pneumonia in kidney transplant recipients: a case-control study. Transpl Infect Dis 2003; 5(2): 84-93.
81. Reichenberger F., Dickenmann M., Binet I. et al. Diagnostic yield of bronchoalveolar lavage following renal transplantation. Transpl Infect Dis 2001; 3(1): 2-7.
82. Rocamora N., Tormo A.M., Franco A. et al. Fever and cavitary infiltrate in a renal transplant recipient. Nefrologia 2004; 24 Suppl 3: 16-20.
83. Salvalaggio P.R., Bassetti M., Lorber M.I. et al. Aspergillus vertebral osteomyelitis after simultaneous kidney-pancreas transplantation. Transpl Infect Dis 2003; 5(4): 187-190.
84. Sanati H., Belanger P., Fratti B., Ghannoum M. A new triazole, voriconazole (Uk-09, 496), blocks sterol biosyntheis in Candida albicans and Candida krusei. Antimicrob Agents Chemother 1997; 41: 2492-2496.
85. Scanagatta P., Terzi A., Boschiero L. et al. Invasive pulmonary aspergillosis after renal transplantation treated by surgery. Asian Cardiovasc Thorac Ann 2004; 12(1): 83-85.
86. Schelenz S., Goldsmith D.J. Aspergillus endophthalmitis: an unusual complication of disseminated infection in renal transplant patients. J Infect 2003; 47(4): 336-343.
87. Schmidt S., Reiter-Owona I., Hotz M. et al. An unusual case of central nervous system cryptococcosis. Clin Neurol Neurosurg 1995; 97(1): 23-27.
88. Shorr A.F., Susla G.M., O'Grady N.P. Pulmonary infiltrates in the non-HIV-infected immunocompromised patients: etiologies, diagnostic strategies, and outcomes. Chest 2004; 125: 260-271.
89. Singh H., Heitman J. Antifungal attributes of immunosuppressive agents: new paradigms in management and elucidating the pathophysiologic basis of opportunistic mycosis in organ transplant recipients. Transplantation 2004; 77: 795-800.
90. Singh N., Gayowski T., Wagener M.M. et al. Invasive fungal infections in renal transplant recipients receiving tacrolimus as the primary immunosuppressive agent. Clin Infect Dis 1997; 24: 179-185.
91. Summers S.A., Dorling A., Boyle J.J., Shaunak S. Cure of disseminated cryptococcal infection in a renal allograft recipient after addition of gamma-interferon to anti-fungal therapy. Am J Transplant 2005; 5(8): 2067-2069.
92. Sung S.A., Ko G.J., Kim J.Y. et al. Desquamative interstitial pneumonia associated with concurrent cytomegalovirus and Aspergillus pneumonia in a renal transplant recipient. Nephrol Dial Transplant 2005; 20: 635-638.
93. Takahashi K. Mycosis in kidney transplant patients. Nippon Ishinkin Gakkai Zasshi 2001; 42(4): 201-204.
94. Tintillier V., Kirch L., Goffin E. et al. Interaction between voriconazole and tacrolimus in a kidney-transplanted patients. Nephrol Dial Transplant 2005; 20: 664-665.
95. Tolkoff-Rubin N.E., Rubin R.H. Opportunistic fungal and bacterial infection in the renal transplant recipient. J Am Soc Nephrol 1992; 2(12 Suppl): S264-269.
96. Tolkoff-Rubin N.E., Rubin R.H. Recent advances in the diagnosis and management of infection in the organ transplant recipient. Semin Nephrol 2000; 20(2): 148-163.
97. Vaideeswar P., Prasad S., Deshpande J.R., Pandit S.P. Invasive pulmonary aspergillosis: A study of 39 cases at autopsy. J Postgrad Med 2004; 50(1): 21-26.
98. Vargas S.L., Ponce C.A., Gigliotti F. et al. Transmission of Pneumocystis carinii DNA from a patient with P. carinii pneumonia to immunocompetent contact health care workers. J Clin Microbiol 2000; 38(4): 1536-1538.
99. Venkataramanan R., Zang S., Gayowski T., Singh N. Voriconazole inhibition of the metabolism of tacrolimus in a liver transplant recipient and in liver microsomes. Antimicrob Agents Chemother 2002; 46: 3091-3093.
100. Villanueva A., Arathoon E.G., Gotuzzo E. et al. A randomized double-blind study of Caspofungin versus fluconazole for treatment of esophageal candidiasis. Am J Med 2002; 113: 294-299.
101. Walsh T., Teppler H., Donowitz G.R. et al. Caspofungin versus lipisomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med 2004; 351: 1391-1402.
102. Wegner B., Baer P., Gauer S. et al. Caspofungin is less neptrotoxic than amphotericin B in vitro and ptedominantly damages distal renal tubular cells. Nephrol Dial Transplant 2005; 20: 2971-2079.
103. Weig M., Klinker H., Bogner B.H. et al. Usefulness of PCR for diagnosis of Pneumocystis carinii pneumonia in different patient groups. J Clin Microbiol 1997; 35(6): 1445-1449.
104. Wingard J.R., Kubilis P., Lee L. et al. Clinical significance of nephrotoxicity in patients treated with amphotericin B for suspected or proven of aspergillosis. Clin Infect Dis 1999; 29: 1402-1407.
105. Wu G., Vilchez R.A., Eidelman B., Fung J., Kormos R., Kusne S. Cryptococcal meningitis: an analysis among 5,521 consecutive organ transplant recipients. Transpl Infect Dis. 2002; 4(4): 183-188.
106. Yamada K., Shrier D.A., Rubio A. et al. Imaging findings in intracranial aspergillosis. Acad Radiol 2002; 9(2): 163-171.

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