Renal transplant hastalarında görülen fungal enfeksiyonların retrospektif olarak incelenmesi
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Date
2011
Authors
Şahin, Sezin Zorlu
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
İnvazif fungal enfeksiyonlar fırsatçı enfeksiyonlara açık olan renal transplant alıcılarında önemli bir morbidite ve mortalite nedenidir. Solid organ transplantasyonu sonrası fungal enfeksiyon insidansı bakteriyel ve viral enfeksiyonlardan daha düşük olmasına rağmen, fungal enfeksiyonlar daha yüksek mortaliteye sahiptir. Bu çalışmanın amacı renal transplant alıcılarında görülen fungal enfeksiyonların sıklığını ve risk faktörlerini belirlemektir.Uludağ Üniversitesi Tıp Fakültesi'nde 29.12.1988 ile 03.06.2010 tarihleri arasında renal transplantasyon yapılan 344 hastanın bilgileri elde edilerek, fungal enfeksiyonların epidemiyolojik özellikleri ve risk faktörleri retrospektif olarak analiz edildi.Çalışmada 63 hastada 77 fungal efeksiyon saptandı. Fungal enfeksiyona en sık neden olan etkenler Candida ve Aspergillus türleriydi; 8 oral kandidiyazis ve Candida spp. ile oluşan 14 üriner sistem enfeksiyonu, 4 özefajit, 4 pnömoni, 2 vulvovajinit, 6 intraabdominal enfeksiyon ve 3 kandidemi saptandı. 2 hastada fungal osteomiyelit, 2 hastada rinoserebral mukormikoz, 2 hastada santral sinir sistemi enfeksiyonu mevcuttu, 30 hastada invazif pulmoner aspergilloz gelişmişti. Fungal enfeksiyon gelişen hastalarda mortalite diğer hastalara göre belirgin şekilde yüksekti (sırasıyla %38,1 ve %17,8; p=0,001). Rejeksiyon, DM, bakteriyel enfeksiyonlar, CMV reaktivasyonu, immünsüpresif ilaç serum düzeyi yüksekliği fungal enfeksiyon gelişiminde bağımsız risk faktörü olarak saptandı.Renal transplantasyon hastalarında görülen fungal enfeksiyonların mortalitesi yeni ve güçlü antifungal ilaçlara rağmen yüksek seyretmeye devam etmektedir. Bu hastalarda gelişen fungal enfeksiyonların erken tanı ve tedavisi kolay olmadığından bu enfeksiyonların bağımsız risk faktörlerinin belirlenmesi, yüksek riskli hastaların erken tanı ve tedavisinde faydalı olabilir.
Invasive fungal infections are a major cause of morbidity and mortality among renal transplant recipients who are susceptible to opportunistic infections. Although the incidence of fungal infections after solid organ transplantation is lower than bacterial and viral infections, fungal infections have the highest mortality rate. The aim of this study was to investigate the frequencies and risk factors of fungal infections in renal transplant recipients.We collected data from 344 patients who underwent kidney transplantation between 29.12.1988 and 03.06.2010 at Uludag University Faculty of Medicine. A retrospective analysis was made on the epidemiology, spectrum, risk factors and mortality of fungal infections.We observed 77 fungal infections in 63 patients. The most common pathogens causing fungal infections were Candida spp. and Aspergillus spp. in our patients. There were 8 oral candidiasis, 14 urinary tract infections, 4 esophagitis, 4 pneumonia, 2 vulvovaginitis, 6 intraabdominal infections and 3 candidemia caused by several Candida species. Two patients had fungal osteomyelitis, two patients had rhino-cerebral mucormycosis, two patients had fungal infections of the central nervous system and 30 patients developed invasive pulmonary aspergillosis. Mortality was significantly higher among patients with fungal infections than other patients (%38,1 and %17,8 respectively; p=0,001). The independent risk factors for fungal infection were rejection, DM, bacterial infections, CMV infection and high serum levels of immunsuppressive drugs.Even with the advent of powerful antifungal drugs the mortality rates of fungal infections in transplant recipients remains high. It is difficult to disagnose and treat fungal infections early and that can be useful to determine independent risk factors to identify and treat high risk patients.
Invasive fungal infections are a major cause of morbidity and mortality among renal transplant recipients who are susceptible to opportunistic infections. Although the incidence of fungal infections after solid organ transplantation is lower than bacterial and viral infections, fungal infections have the highest mortality rate. The aim of this study was to investigate the frequencies and risk factors of fungal infections in renal transplant recipients.We collected data from 344 patients who underwent kidney transplantation between 29.12.1988 and 03.06.2010 at Uludag University Faculty of Medicine. A retrospective analysis was made on the epidemiology, spectrum, risk factors and mortality of fungal infections.We observed 77 fungal infections in 63 patients. The most common pathogens causing fungal infections were Candida spp. and Aspergillus spp. in our patients. There were 8 oral candidiasis, 14 urinary tract infections, 4 esophagitis, 4 pneumonia, 2 vulvovaginitis, 6 intraabdominal infections and 3 candidemia caused by several Candida species. Two patients had fungal osteomyelitis, two patients had rhino-cerebral mucormycosis, two patients had fungal infections of the central nervous system and 30 patients developed invasive pulmonary aspergillosis. Mortality was significantly higher among patients with fungal infections than other patients (%38,1 and %17,8 respectively; p=0,001). The independent risk factors for fungal infection were rejection, DM, bacterial infections, CMV infection and high serum levels of immunsuppressive drugs.Even with the advent of powerful antifungal drugs the mortality rates of fungal infections in transplant recipients remains high. It is difficult to disagnose and treat fungal infections early and that can be useful to determine independent risk factors to identify and treat high risk patients.
Description
Keywords
Renal transplantasyon, Fungal enfeksiyon, Renal transplantation, Fungal infection
Citation
Şahin, S. Z. (2011). Renal transplant hastalarında görülen fungal enfeksiyonların retrospektif olarak incelenmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.