Endemic Mycoses in Solid Organ Transplant Recipients

Nel, Jeremy; Bartelt, Luther A.; Duin, David van; Lachiewicz, Anne

doi:10.1016/j.idc.2018.04.007

Cited by 24 publications

(18 citation statements)

References 98 publications

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“…Even though some fungi can trigger pathologies in health subjects, most of these agents provoke illness in previously immunocompromised hosts (Góralska et al, 2018). High risk groups include HIV-infected persons and aids patients, transplant receivers and patients under immunosuppression therapy (Lionakis and Kontoyiannis, 2003; Chastain et al, 2017; Nel et al, 2018). The involvement of the CNS during fungal infections is primarily found in immunocompromised hosts being Cryptococcus , Aspergillus , and Candida more frequently identified (Henao and Vagner, 2011; Gavito-Higuera et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Differential Behavior of Non-albicans Candida Species in the Central Nervous System of Immunocompetent and Immunosuppressed Mice

et al. 2019

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The genus Candida includes commensal fungi that can cause local and systemic infections, frequently involving vital organs as the central nervous system (CNS). Candida spp. occupy the fourth place among infections that affect the CNS. Although the incidence of Candida albicans is decreasing among patients under immunosuppressive therapies, the incidence of non-albicans Candida is increasing. In this context, the objective of this work was to evaluate the ability of non-albicans Candida species to spread to the CNS of immunocompetent and immunosuppressed mice. Adult female C57BL/6 mice were treated with prednisolone, intravenously infected with Candida glabrata, Candida krusei and Candida parapsilosis yeasts and then evaluated at the 3rd and 14th days after infection. All Candida species disseminated to the brain from immunocompetent animals and induced local inflammation at the third day post-infection. The immunosuppression resulted in body weight loss, leukopenia and reduced IL-2 production by spleen cell cultures. Higher fungal loads were recovered from the CNS of immunosuppressed mice. Inflammatory infiltration associated to a Th1 subset profile was higher in brain samples from C. krusei immunosuppressed mice compared with immunocompetent ones. Additionally, C. krusei was able to transform into pseudohypha inside microglia in vitro infected cells and also to induce elevated nitric oxide production. Altogether, these results indicate that C. glabrata, C. krusei and C. parapsilosis are able to disseminate to the CNS and promote local inflammation in both immunocompetent and immunosuppressed mice. C. krusei displayed a distinct behavior at the CNS triggering a local Th1 profile. The possible contribution of these non-albicans Candida species to other CNS pathologies as multiple sclerosis, Parkinson’s and Alzheimer’s diseases deserves further attention.

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Section: Discussionmentioning

confidence: 99%

Differential Behavior of Non-albicans Candida Species in the Central Nervous System of Immunocompetent and Immunosuppressed Mice

et al. 2019

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“…Patients who have had prior histoplasmosis exposure, even decades before, are at risk of suffering a reactivation of the disease if their immunity subsequently declines, whether from SOT, HCT, immunosuppressant medications, old age, HIV, or other immunosuppressing conditions [15]. In many cases, whether a case of histoplasmosis represents disease reactivation or a new acquisition can be difficult to determine, although some evidence suggests that new acquisition may predominate [13,16,17].…”

Section: Pathogenesismentioning

confidence: 99%

“…Similar to histoplasmosis, risk factors for acquiring the disease include activities that disturb the soil and thereby aerosolize Blastomyces conidia. Known associations include camping, forestry work, fishing, cutting trees, or clearing brush in endemic areas [16,38,39].…”

Section: Blastomycosis Disease Epidemiologymentioning

confidence: 99%

Emerging Epidemics in Transplant: Histoplasmosis, Blastomycosis, and Paracoccidioidomycosis

Nel¹,

Lachiewicz²,

Duin³

2020

Emerging Transplant Infections

Self Cite

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The endemic fungi are a group of thermally dimorphic fungi that occupy specific defined environmental ranges. They count Histoplasma, Blastomyces, Paracoccidioides, Coccidioides, Talaromyces, Emergomyces, and Sporothrix among their number. In the environment, they exist as molds, and at body temperature, they transform into their pathogenic yeast form (or, in the case of coccidioidomycosis, into a specialized structure called a spherule). Histoplasma, Blastomyces, and Paracoccidioides are covered in this chapter. Transplant recipients are at increased risk for severe and disseminated infection with these pathogens. Histoplasmosis and blastomycosis usually manifest as pulmonary disease. Extrapulmonary disease can occur with or without concomitant pulmonary disease in immunocompromised hosts. Commonly infected sites include the liver, spleen, lymph nodes, bone marrow, gastrointestinal tract, and skin. Skin involvement is especially common in blastomycosis. Paracoccidioidomycosis may present in an acute disseminated form in young patients. However, in 90% of symptomatic paracoccidioidomycosis, pulmonary chronic disease is observed, which is a reactivation of prior acquired infection. Oral mucosa and skin are common sites of dissemination in chronic disease. Diagnosis of endemic mycoses is difficult and often delayed. Combining various diagnostic modalities is usually needed. The treatment of choice for all the endemic mycoses are amphotericin B and the azoles. In general, treatment must be given for a prolonged period (frequently a year or more) in order to prevent a relapse.

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“…Aspergillus species and Cryptococcus species are the next most common invasive fungi in this population [11,12]. Endemic mycoses (Histoplasma capsulatum, Blastomyces dermatitis, and Coccidiodes immitis / posadasii) are less common overall, with the risk impacted primarily by geographic exposure [9,13,14]. Mucorales infections are relatively uncommon, but carry a higher degree of morbidly and mortality given their fulminant clinical courses and limited available effective treatment options [10,15].…”

Section: General Introductionmentioning

confidence: 99%

An Approach to Fungal Diagnostics in Solid Organ Transplantation

Gaston¹,

Azar²

2018

obm transplant

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The approach to diagnosing fungal infections following solid organ transplantation (SOT) is patient-specific. An assessment of an individual's risk for particular infections, also understood as the pre-test probability, should guide appropriate diagnostic testing whereas diagnostic stewardship is needed to produce interpretable, actionable and cost-sensitive results. This review provides a cognitive framework for practitioners aiming to diagnose fungal infections in recipients of SOT, taking into consideration the benefits and limitations of currently available diagnostic platforms. In order to better characterize diagnostic utility for this population, we focus on clinical studies that include patients with SOT in full or in part. The goal of this review is to improve the diagnosis of fungal infections in patients with SOT by encouraging a thoughtful, systematic diagnostic approach.

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Endemic Mycoses in Solid Organ Transplant Recipients

Cited by 24 publications

References 98 publications

Differential Behavior of Non-albicans Candida Species in the Central Nervous System of Immunocompetent and Immunosuppressed Mice

Differential Behavior of Non-albicans Candida Species in the Central Nervous System of Immunocompetent and Immunosuppressed Mice

Emerging Epidemics in Transplant: Histoplasmosis, Blastomycosis, and Paracoccidioidomycosis

An Approach to Fungal Diagnostics in Solid Organ Transplantation

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