Epidemiology of invasive fungal infections in lung transplant recipients in Western Australia

Chang, Andrew; Musk, M.; Lavender, Melanie; Wrobel, Jérémy; Yaw, Meow-Chong; Lawrence, Scott L.; Chirayath, Shiji; Boan, Peter

doi:10.1111/tid.13085

Cited by 30 publications

(35 citation statements)

References 18 publications

(38 reference statements)

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“…In the present study, 1-year all-cause mortality was significantly higher in the IFD group (47.6%) than in the NIFD group (25.2%). Previous investigations have reported mortality rates ranging from 19 to 72% (4,6,23,(32)(33)(34). Since IFD often develops in patients with a more serious disease, it is difficult to establish whether IFD per se contributes to the poor outcome in LTRs.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Prognosis of Invasive Fungal Disease in Chinese Lung Transplant Recipients

Chen

Lian

et al. 2021

Front. Med.

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This study explored the epidemiology, risk factors, and prognosis of invasive fungal disease (IFD) in Chinese lung transplant recipients (LTRs). This retrospective cohort study included patients who received lung transplants at four hospitals in South China between January 2015 and June 2019. The participants were divided into IFD and non-IFD (NIFD) groups. The final analysis included 226 LTRs (83.2% males) aged 55.0 ± 14.2 years old. Eighty-two LTRs (36.3%) developed IFD (proven or probable diagnosis). The most common pathogens were Aspergillus (57.3%), Candida (19.5%), and Pneumocystis jiroveci (13.4%). Multivariate logistic regression revealed that anastomotic disease [odds ratio (OR): 11.86; 95% confidence interval (95%CI): 4.76–29.54; P < 0.001], cytomegalovirus (CMV) pneumonia (OR: 3.85; 95%CI: 1.88–7.91; P = 0.018), and pre-transplantation IFD (OR: 7.65; 95%CI: 2.55–22.96; P < 0.001) were associated with higher odds of IFD, while double-lung transplantation (OR: 0.40; 95%CI: 0.19–0.79; P = 0.009) was associated with lower odds of IFD. Logistic regression analysis showed that anastomotic disease was associated with higher odds of death (OR: 5.01; 95%CI: 1.24–20.20; P = 0.02) and that PJP prophylaxis was associated with lower odds of death (OR: 0.01; 95%CI: 0.001–0.11; P < 0.001). Invasive fungal disease is prevalent among LTRs in southern China, with Aspergillus the most common pathogen. Prophylaxis should be optimized based on likely pathogens.

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Section: Discussionmentioning

confidence: 99%

Epidemiology and Prognosis of Invasive Fungal Disease in Chinese Lung Transplant Recipients

Chen

Lian

et al. 2021

Front. Med.

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“…Furthermore, the delayed diagnosis and initiation of therapy for IFIs result in poor treatment outcomes. Patients colonized with pathogenic fungi are the at-risk group in this regard; therefore, fungal colonization should not be overlooked [23].…”

Section: Discussionmentioning

confidence: 99%

Molecular characterization of fungi causing colonization and infection in organ transplant recipients: a one-year prospective study

Zarei¹,

Hashemi²,

Salehi³

et al. 2020

CMM

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Background and Purpose: Organ transplant recipients are vulnerable to fungal infections. The aim of this study was to determine the prevalence of fungal colonization and infections among patients who underwent various transplantations and molecularly characterize the etiological agents. Materials and Methods: This study was conducted on candidates for transplantation in Imam Khomeini Hospital, Tehran, Iran, from April 2017 to April 2018. All patients were monitored for fungal colonization or infections before and after transplantation. Isolated fungi were identified using molecular methods. Results: A total of 125 patients, including 86 males and 39 females, with the mean age of 52.2 years participated in the study (age range: 15-75 years). Out of 125 patients, 84 (67.2%) cases had fungal colonization that appeared pre- and post-transplantation in 21 and 63 cases, respectively (alone or concurrent with another infection in 55 and 29 cases, respectively). In addition, a total of 39 episodes of fungal infections were diagnosed in 36 (28.8%) recipients (alone or concurrent with colonization in 7 and 29 cases, respectively). Out of the 39 fungal infections, 9 cases appeared pre-transplantation, while the other 30 cases occurred post-transplantation. However, no fungal colonization or infection was observed in 34 (27.2%) patients. Oral candidiasis (n=20) was the most common type of infection, followed by funguria (n=7), onychomycosis (n=5), candidemia (n=3), rhinocerebral mucormycosis (n=1), cutaneous mucormycosis (n=1), cutaneous aspergillosis (n=1), and peritonitis (n=1). Six yeast species were recovered from colonization cases with the dominance of Candida albicans both before and after transplantation. The observed fungal infections were caused by 11 distinct species, including the members of Candida (i.e., C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei), Aspergillus (i.e., A. oryzae and A. candidus), Rhizopus (i.e., R. oryzae and R. microsporus), Trichosporon asahii, and Trichophyton interdigitale. The results also indicated that the development of a fungal infection post-transplantation was associated with fungal colonization (r=0.0184; P=0.043). Conclusion: Based on the results, fungal colonization was a common finding in transplant recipients at Imam Khomeini Hospital. However, the incidence of fungal infections was comparable with those of other centers. As the oral cavity was the most common site of colonization and infection, it might be beneficial to take further care about the oral health of patients using effective mouthwash.

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“…A Lomentospora, respectively among a cohort of 137 patients who were followed up for median of 4 years. 14 Our first isolate of Scedosporium/Lomentospora from respiratory microbiology was in 2014, from a patient who underwent LTx in 1995. The most common technique for Scedosporium/Lomentospora isolation has been the Sabouraud dextrose agar, which has been the sole technique used in our center over the duration of our follow up.…”

Section: Discussionmentioning

confidence: 99%

Scedosporium apiospermum and Lomentospora prolificans in lung transplant patients – A single center experience over 24 years

Vazirani

Westall

Snell

et al. 2021

Transplant Infectious Dis

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Introduction: Scedosporium apiospermum and Lomentospora prolificans (Scedosporium/ Lomentospora) species are emerging, multi-resistant pathogens that cause life-threatening illnesses among lung transplant (LTx) recipients. The current epidemiology and management in LTx are unknown. Methods:We performed a retrospective single center audit of all sputum/bronchoscopy samples for Scedosporium/Lomentospora species in LTx patients over a 24-year period . Patients were diagnosed as colonized or with invasive fungal disease.Results: From a cohort of 962 LTx recipients, 30 patients (3.1%) cultured Scedosporium/ Lomentospora (1.2%, 1.9%, respectively). There were no isolates from 1995 to 2013, with multiple yearly isolates thereafter. Nineteen (63%) cases were classified as IFD, and 11 (37%) as colonization. The median time to first culture from transplantation was 929 days (Interquartile-range [IQR] 263-2960). Most patients (63%) had received antifungals prior to the first positive culture of Scedosporium/Lomentospora for other fungal infection. The most common antifungal used for treatment of Scedosporium/ Lomentospora was posaconazole (n = 16; 53%). Median duration of therapy was 364 days . Treatment was associated with improved lung function over 6 months (median FEV1 increased from 1.3L[IQR 0.9-1.8L] to 1.8L[IQR 1.1-2.3] P = .05). Six patients cultured Scedosporium/Lomentospora prior to transplantation, and no survival disadvantage was seen as compared to our whole LTx cohort (P = .8). Conclusion:Our single center 24-year experience suggests that the incidence of Scedosporium/Lomentospora is increasing. Scedosporium/Lomentospora is typically isolated several years after LTx, and requires prolonged anti-fungal treatment that is usually associated with improved in lung function. Culture of Scedosporium/ Lomentospora prior to LTx did not pose a survival disadvantage. Further surveillance is required to fully characterize implications of these organisms for LTx recipients.

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Epidemiology of invasive fungal infections in lung transplant recipients in Western Australia

Cited by 30 publications

References 18 publications

Epidemiology and Prognosis of Invasive Fungal Disease in Chinese Lung Transplant Recipients

Epidemiology and Prognosis of Invasive Fungal Disease in Chinese Lung Transplant Recipients

Molecular characterization of fungi causing colonization and infection in organ transplant recipients: a one-year prospective study

Scedosporium apiospermum and Lomentospora prolificans in lung transplant patients – A single center experience over 24 years

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