肾移植术后肺部蠊缨滴虫感染——附4例报道

Pulmonary lophonomas blattarum infection in patients with kidney allograft transplantation

目的：回顾性分析4例。肾移植术后肺部蠊缨滴虫感染患者的临床表现及预后。方法：4例。肾移植术后肺部感染患者经纤维支气管镜和支气管肺泡灌洗液检查确诊蠊缨滴虫感染，分析其临床特点，影像学特征和治疗、预后。结果：（1）4例。肾移植术后肺部蠊缨滴虫感染均在术后2-3个月出现，其中2例合并其他病原体感染（细菌和巨细胞病毒）。（2）病程早期均表现为单纯发热，胸片和CT显示肺门轮廓模糊、密度增高、结构不清，部分支气管影增粗，紊乱；病程中可出现咳嗽、咯痰、胸闷、气短。（3）4例经甲硝唑治疗及撤减免疫抑制剂后4-7天3例体温降至正常，1例降至37．5℃；胸片和CT上的渗出性改变明显吸收消散；2例患者治疗后行重复支气管镜检查，肺泡灌洗液镜检可见大量死亡的蠊缨滴虫。结论：（1）肺部蠊缨滴虫感染早期表现隐匿，对于病原学诊断不明确和治疗反应不佳的术后肺部感染患者，需注意蠊缨滴虫感染的可能；（2）支气管肺泡灌洗液镜检是诊断蠊缨滴虫肺部感染的确切手段，撤减免疫抑制剂同时进行甲硝唑治疗可以迅速有效地缓解病情。

Objective ：To analyse the clinical manifestation and management of pulmonary lophonomas blattarum （L. blattarum） infection in allograft kidney transplantation respectively. Methodology ：Seven patients with allograft kidney transplantation suffered from pneumonia without the symptom of cough and breathlessness in the 2^nd to the 3^rd month after operation. They received fiberoptic bronchoscopy（FOB） and bronchoalveolar lavage （BAL） examinations. The L. blattarum infection was confirmed in four of them. These four cases were cured and followed-up for 6 - 12 months. Results： A large number of alive L. blattarum can be observed in the BAL of these four patients. Three of them had co-infection of cytomegalovirus （CMV） , tubercolous bacillus （TB） and pseudo monasaeruginosa. Two cases received tapered immunosuppressants and antibiotics except metronidazole. Fever continued and SpO2 dropped to 90%. 5 -7 days after the metronidazole treatment, fever decreased and SpO2 rebounded to 98%. Pulmomary L. blattarum infection was confirmed in the other two patients soon after the re-admission （ 1 - 3 days） , and metronidazole was prescribed upon the diagnosis. Fever stopped 4 -5 days after metronidazole treatment and the SpO2 maintained at normal level （98% - 100% ）. Conclusion： L. blattarum is an infectious pathogen of the pulmonary infection in patients with allograft kidney transplantation. （2） Pulmonary L. blattarum infection in kidney transplantation recipients presents in the 2^nd to the 3^rd month after operation. Co-infection of different pathogen may be involved. Common manifestation includes fever （ often more than 37.5℃ ） without cough and breathlessness; （3） FOB and BAL examinations are effective in the diagnosis of pulmonary infection with L. blattarum. （4） Metronidazole and tapered immunosuppressants can cure pulmonary L. blattarum infection quickly.