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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].

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Ключевые слова: микозы, трансплантация почки, иммуносупрессия

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