Fungal Infections in Lung and Heart-Lung Transplant Recipients: Report of 9 Cases and Review of the Literature

Kanj, Souha S.; Welty-Wolf, Karen E.; Madden, John F.; Tapson, Victor F.; Baz, Maher A.; Davis, Robert D.; Perfect, John R.

doi:10.1097/00005792-199605000-00004

Cited by 181 publications

(117 citation statements)

References 95 publications

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“…The incidence of postoperative fungal infections in lung transplant recipients is reportedly 15 to 35% (8,11). In this patient population, the most commonly isolated fungal organisms are Candida and Aspergillus spp.…”

Section: Case Reportmentioning

confidence: 99%

Posttransplantation Disseminated Coccidioidomycosis Acquired from Donor Lungs

Miller

Hendren²,

Gilligan

2004

J Clin Microbiol

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A North Carolinian developed fatal coccidioidomycosis immediately after bilateral lung transplantation. The donor had previously traveled to Mexico, and the recipient had no travel history to an area where Coccidioides immitis is endemic. Immunosuppresive therapy of the transplant recipient likely reactivated latent Coccidioides infection in the donor lungs, leading to posttransplant coccidioidomycosis. CASE REPORTA 61-year-old North Carolina resident with chronic obstructive pulmonary disease and emphysema received a bilateral lung transplant. Subsequent immunosuppressive therapy included methylprednisone, azathioprine, and cyclosporine. During hospitalization, the patient also received cefuroxime, clindamycin, piperacillin-tazobactam, and acyclovir as prophylaxis, but no antifungal prophylaxis was initiated. Posttransplantation, the patient was poorly responsive and had complications, including coagulopathy, hypotension, and hypoxia, resulting in increased oxygen requirements. Laboratory findings were consistent with liver, pancreas, and kidney dysfunction, and the patient ultimately required hemodialysis. Chest X-ray images during the first postoperative week indicated bilateral diffuse pulmonary opacities consistent with edema or infection.At 2 weeks posttransplantation, cerebrospinal fluid (CSF) was obtained. CSF analysis showed Ͻ1 red blood cell/mm 3 and 1 total nucleated cell/mm 3 (22% lymphocytes, 63% monocytes, 15% other cells). The CSF contained 32 mg of protein/dl (normal, 15 to 45 mg/dl). A glucose level determination was not performed. The Gram stain showed no polymorphonuclear leukocytes and no organisms. The CSF culture was reported as no growth at 7 days, and peripheral blood cultures were negative after 5 days of incubation. Bronchial washings from the donor lungs at the time of transplantation grew oxacillin-susceptible Staphylococcus aureus. Stenotrophomonas maltophilia and coagulase-negative Staphylococcus spp. were recovered from subsequent washings. The patient's chest X-ray images showed persistent bilateral infiltrates and worsening alveolar consolidation.During the third week posttransplantation, chest X-ray images demonstrated extensive, progressive bilateral air space and interstitial opacities, as well as bilateral apical and lateral pleural thickening. In addition, a brain magnetic resonance image showed multiple areas of enhancement in the region of the gray-white matter junction thought to be consistent with a fungal infection. The patient had multiple line-drawn blood cultures positive with Candida parapsilosis. Further, a KOH preparation of the patient's bronchial washing showed budding yeast with pseudohyphae, and the Gram stain showed polymorphonuclear leukocytes and yeast. Interestingly, this culture not only grew Candida and S. maltophilia but also Coccidioides immitis. In less than 1 month postoperatively, the patient died, and an autopsy was performed.

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Section: Case Reportmentioning

confidence: 99%

Posttransplantation Disseminated Coccidioidomycosis Acquired from Donor Lungs

Miller

Hendren²,

Gilligan

2004

J Clin Microbiol

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“…Estas cifras reflejan la magnitud del problema en series publicadas mayoritariamente durante la década de los 90 [13][14][15][16] . Recientemente Pappas y cols., publicaron resultados de un registro prospectivo de EFI en 15 centros de trasplante en E.U.A., entre los años 2001 y 2006.…”

Section: Trasplantes De óRganos Sólidosunclassified

Profilaxis antifúngica en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos

Rabagliati¹,

Santolaya²

2012

Rev. chil. infectol.

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Prophylaxis against fungal infections in solid organ and hematopoietic stem cells transplantationInvasive fungal infections are an important cause of morbidity and mortality in SOT and HSCT recipients. The main species involved are Candida spp. and Aspergillus spp, less frequently Cryptococcus spp., causal agents of mucormycosis and Fusarium spp. Usually occur within the first six months post-transplant, but they do it later, especially during episodes of rejection, which maintains the state of immune system involvement. Prophylaxis recommendations are specific to each type of transplant. In liver transplantation use of fluconazole is recommended only in selected cases by high risk factor for invasive fungal infections (A1). If the patient has a high risk of aspergillosis, there are some suggestions for adults population to use amphotericin B-deoxycholate, liposomal amphotericin B or caspofungin (C2) without being validated none of these recommendations in pediatric population. In adult lung transplant patients where the risk of aspergillosis is higher than in other locations, we recommend universal prophylaxis with itraconazole 200 mg/day, nebulised liposomal amphotericin B or voriconazole (C2), no validated recommendations for pediatrics. In HSCT, universal prophylaxis is recommended only in allogeneic and autologous selected cases. The most accepted indication is fluconazole (A1), and posaconazole (A1) or micafungin (A1) in selected cases with high risk of aspergillosis.Key words: Fungus, Candida, Aspergillus, yeasts, moulds, prophylaxis, amphotericin, fl uconazole, voriconaamphotericin, fluconazole, voriconazole, posaconazole, caspofungin, micafungin, transplants, solid organ transplantation, hematopoietic stem cells transplantation.Palabras clave: Hongos, Candida, Aspergillus, levaduras, hongos filamentosos, profilaxis, anfotericina, fluconazol, voriconazol, posaconazol, caspofungina, micafungina, trasplante, trasplante de órganos sólidos, trasplante de precursores hematopoyéticos. IntroducciónL as infecciones fúngicas constituyen una importante causa de morbilidad en los pacientes receptores de trasplantes de órganos sólidos (TOS) y trasplante de precursores hematopoyéticos (TPH) 1 , generando desafíos diagnósticos y terapéuticos, elevación de los costos de manejo y elevada mortalidad 2,3 . En los receptores de trasplantes, la enfermedad fúngica invasora (EFI) es provocada tanto por hongos levaduriformes como filamentosos, destacando Candida spp. y Aspergillus spp. 2-4 , menos frecuentemente Cryptococcus spp., agentes causales de mucormicosis 5,6 y Fusarium spp. 7 , infecciones por hongos endémicos como Histoplasma capsulatum, Coccidioides immitis, Paracoccidioides brasiliensis, y con menor cuantía dematiáceos como Cladosporium, Cladophialophora, Scopulariopsis, Alternaria, Curvularia y Bipolaris spp 8 .Existen diferencias en la frecuencia de EFI entre los distintos tipos de TOS y TPH; no obstante, algunas características son comunes: en ambos grupos la mayoría de las EFI son producidas por Candida spp. o ...

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“…or Candida spp., is less common than is CMV pneumonia but is associated with higher mortality. (11,16,17) Fungal pneumonia most often donor lung and becomes severe in 50-60% of such cases. (11) Secondary infection results from exposure to a different CMV strain or from reactivation of a latent infection in the recipient and is usually less severe than is primary infection.…”

Section: Infectionsmentioning

confidence: 99%

“…(16,17) Aspergillus infection can also cause ulcerative tracheobronchitis that is often radiographically occult and can lead to anastomotic dehiscence. (11,17) Although Candida spp.…”

Section: Chronic Rejectionmentioning

confidence: 99%

Computed tomography findings of postoperative complications in lung transplantation

et al. 2009

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improved as a result of advances in surgical technique, careful harvesting/preservation of donor organs, improvements in immunosuppressive therapy and earlier recognition of complications with the use of various imaging techniques. The reported one-, five-, ten-and fifteen-year survival rates are 75%, 50%, 35% and 25%, respectively. (3,4) The most common cause of mortality in the first 6 months is bacterial infection, which is thereafter supplanted by chronic graft dysfunction. The clinical and radiological manifestations of postoperative complications can be nonspeLung transplantation has become an established technique for the treatment of end-stage pulmonary diseases in adults.(1,2) The number of transplantations performed annually and the number of centers performing lung transplantations continue to increase.(1,2) Although single lung transplantation was previously more common, double lung transplantation is currently the preferred option for all patients with end-stage pulmonary disease, due to the better long-term survival of patients submitted to the latter procedure. AbstractDue to the increasing number and improved survival of lung transplant recipients, radiologists should be aware of the imaging features of the postoperative complications that can occur in such patients. The early treatment of complications is important for the long-term survival of lung transplant recipients. Frequently, HRCT plays a central role in the investigation of such complications. Early recognition of the signs of complications allows treatment to be initiated earlier, which improves survival. The aim of this pictorial review was to demonstrate the CT scan appearance of pulmonary complications such as reperfusion edema, acute rejection, infection, pulmonary thromboembolism, chronic rejection, bronchiolitis obliterans syndrome, cryptogenic organizing pneumonia, posttransplant lymphoproliferative disorder, bronchial dehiscence and bronchial stenosis.Keywords: Tomography, X-ray computed; Lung transplantation; Postoperative complications. ResumoCom o número cada vez maior e uma melhor sobrevida dos pacientes submetidos ao transplante pulmonar, os radiologistas devem estar cientes das diversas possibilidades de complicações associadas ao transplante de pulmão. O tratamento precoce das complicações é importante para a sobrevida a longo prazo dos receptores de transplante pulmonar. Com frequência, a TCAR desempenha um papel central na investigação de tais complicações. O reconhecimento precoce dos sinais de complicações proporciona um tratamento rápido e melhora a sobrevida. O objetivo desta revisão pictórica foi proporcionar uma visão sobre as complicações mais prevalentes na TC, tais como edema de reperfusão, rejeição aguda, infecção, tromboembolismo pulmonar, rejeição crônica, síndrome da bronquiolite obliterante, pneumonia em organização criptogênica, doença linfoproliferativa pós-transplante, deiscência brôn-quica e estenose brônquica Descritores: Tomografia computadorizada por raios X; Transplante de pulmão; Complicações...

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Fungal Infections in Lung and Heart-Lung Transplant Recipients: Report of 9 Cases and Review of the Literature

Cited by 181 publications

References 95 publications

Posttransplantation Disseminated Coccidioidomycosis Acquired from Donor Lungs

Posttransplantation Disseminated Coccidioidomycosis Acquired from Donor Lungs

Profilaxis antifúngica en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos

Computed tomography findings of postoperative complications in lung transplantation

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