Fungal Infections Complicating Lung Transplantation

Clark, Nina M.; Weigt, S. Samuel; Fishbein, Michael C.; Kubak, B.; Belperio, John A.; Lynch, Joseph P.

doi:10.1055/s-0037-1617443

Cited by 21 publications

(27 citation statements)

References 440 publications

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“…The incidence and type of fungal infections may vary depending on different transplantations and geographical regions. Invasive mold infections, particularly aspergillosis, are more common in lung transplant recipients [27]. Marjani et al [12] reported 8 (40%) cases of aspergillosis among 20 lung transplant recipients.…”

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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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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“…The beginning date cutoff was January 1, 2001, and the search was last updated on December 10, 2019. In addition, the bibliographies of 2 pertinent reviews 33,37 were assessed for references not identified by the aforementioned search strategy. Pertinent unpublished studies were identified from transplant conferences' meeting abstracts; authors were contacted to obtain full study details as available.…”

Section: Literature Searchmentioning

confidence: 99%

Antifungal prophylaxis in lung transplant recipients: A systematic review and meta‐analysis

Pennington

Baqir

Erwin

et al. 2020

Transplant Infectious Dis

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Background No consensus exists regarding optimal strategy for antifungal prophylaxis following lung transplant. Objective To review data regarding antifungal prophylaxis on the development of fungal infections. Study selection/Appraisal We searched MEDLINE, Embase, and Scopus for eligible articles through December 10, 2019. Observational or controlled trials published after January 1, 2001, that pertained to the prevention of fungal infections in adult lung recipients were reviewed independently by two reviewers for inclusion. Methods Of 1702 articles screened, 24 were included. Data were pooled using random effects model to evaluate for the primary outcome of fungal infection. Studies were stratified by prophylactic strategy, medication, and duration (short term < 6 months and long term ≥ 6 months). Results We found no difference in the odds of fungal infection with universal prophylaxis (49/101) compared to no prophylaxis (36/93) (OR 0.76, CI: 0.03‐17.98; I2 = 93%) and preemptive therapy (25/195) compared to universal prophylaxis (35/222) (OR 0.91, CI: 0.06‐13.80; I2 = 93%). The cumulative incidence of fungal infections within 12 months was not different with nebulized amphotericin (0.08, CI: 0.04‐0.13; I2 = 87%) compared to systemic triazoles (0.07, CI: 0.03‐0.11; I2 = 21%) (P = .65). Likewise, duration of prophylaxis did not impact the incidence of fungal infections (short term: 0.11, CI: 0.05‐0.17; I2 = 89%; long term: 0.06, CI: 0.03‐0.08; I2 = 51%; P = .39). Conclusions We have insufficient evidence to support or exclude a benefit of antifungal prophylaxis.

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“…The transplanted organ is an important determinant in this assessment. For example, although Candida infection is the most common infection in SOT overall, infection with Aspergillus is most common in lung transplant recipients [25]. Evaluation of the PATH alliance registry in the US and Canada from 2004 -2008 demonstrated patients with liver transplantation experienced the shortest time to invasive mold infections and had the highest rate of dissemination [19].…”

Section: Figure 1 Drivers Of Pre-test Probability For Invasive Fungal Infections In Solid Organmentioning

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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Fungal Infections Complicating Lung Transplantation

Cited by 21 publications

References 440 publications

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

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

Antifungal prophylaxis in lung transplant recipients: A systematic review and meta‐analysis

An Approach to Fungal Diagnostics in Solid Organ Transplantation

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