Immunosuppression for organ transplantation results in increased susceptibility to opportunistic infections including fungal, such as Scedosporium apiospermum. Even though many reported cases of this infection had both local and systemic manifestations, majority of the systemic infections had a fatal outcome. We report a case of a 50-year-old Caucasian male with lymphocutaneous and presumed pulmonary Scedosporium infection 4 years after renal transplantation that was successfully treated with voriconazole and discontinuation of immunosuppression. He received a second transplant 3 years later in the absence of clinical evidence of S. apiospermum infection. Unfortunately, 4 months after transplantation he developed recurrence of the same infection localizing to the soft tissues. Presently this infection is under control with surgical excision and voriconazole therapy. To our knowledge this is the first reported case of recurrent S.apiospermum infection in a renal transplant recipient. We suggest prophylactic antifungal therapy in all re-transplants with this infection.
Nocardia infections are an important cause of morbidity and mortality in renal transplant recipients. There are no recent studies evaluating the characteristics of nocardiosis using current immunosuppressants. To determine the incidence and risk factors for infection, we performed a 5-year retrospective review and case control study of renal transplant recipients with nocardiosis at 2 renal transplant centers. Four cases of Nocardia infection were identified at each center (incidence of 0.86% and 1.35%). There was no difference between cases and controls in terms of underlying medical conditions, cytomegalovirus-associated infection, or number of rejection episodes. There was a trend toward a shorter time to develop infection with short-course trimethoprim/sulfamethoxazole prophylaxis versus more prolonged prophylaxis (8 months vs. 67 months; P = 0.056) and with tacrolimus-based versus cyclosporinebased regimens (7.8 months vs. 100 months; P = 0.06). Further multicenter studies need to be done to confirm the effects of current immunosuppressant regimens on the incidence and time to develop infections. (Infect Dis Clin Pract 2007;15:171-173)
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