<i>Aspergillus</i>Infections in Transplant Recipients

Singh, Nina; Paterson, David L.

doi:10.1128/cmr.18.1.44-69.2005

Cited by 541 publications

(505 citation statements)

References 309 publications

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“…In most cases, this occurs after bilateral lung or right single-lung transplantation 14 , as described in the present report. Aspergillus tracheobronchitis should not be seen as a benign condition, since it might progress or coexist with invasive pulmonary aspergillosis 5 , as described in this report.…”

Section: Discussionmentioning

confidence: 92%

Aspergillus niger causing tracheobronchitis and invasive pulmonary aspergillosis in a lung transplant recipient: case report

Xavier

Sales

Camargo

et al. 2008

Rev. Soc. Bras. Med. Trop.

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A case of invasive aspergillosis caused by Aspergillus niger in a lung transplant recipient is described. The patient presented hyperglycemia starting postoperatively, with other complications such as cytomegalovirus infection. The associated predisposing factors and other implications are discussed. Aspergillus niger seems to be a fungal species of low virulence that requires the presence of a severely immunosuppressed host to cause invasive disease.Key-words: Aspergillosis. Tracheobronchitis. Aspergillus niger. Lung transplantation.Lung transplantation. RESUMODescreve-se um caso de aspergilose invasiva causada por Aspergillus niger em um paciente transplantado de pulmão com quadros hiperglicêmicos desde o pós-operatório e outras complicações como infecção por citomegalovírus. Os fatores predisponentes associados e outras implicações são discutidos. Aspergillus niger parece ser uma espécie fúngica de baixa virulência, necessitando a presença de um hospedeiro gravemente imunodeprimido para causar doença invasiva. Aspergillus tracheobronchitis and invasive pulmonary aspergillosis are frequent clinical presentations of Aspergillus infections in lung transplant recipients 11 . It has been documented that aspergillosis is associated with at least 9% of the deaths following lung transplant procedures. The vast majority of infections are caused by Aspergillus fumigatus 8 10 , followed by other species such as Aspergillus flavus, Aspergillus terreus and Aspergillus niger. Here, we report the unusual occurrence of Aspergillus niger infection following lung transplantation. The implications of these findings are discussed. Palavras CASE REPORTA 48-year-old woman had undergone right lung transplantation in 1993 due to idiopathic pulmonary fibrosis. Her early postoperative period was marked by the occurrence of hyperglycemia.Acute rejection was suspected five days after the surgical procedure because of oxygen desaturation events. Broad-spectrum antibacterial therapy was started, including amikacin, ceftazidime and vancomycin. She was also started on a three-day course of high-dose methylprednisolone (1,000mg/day). A transbronchial biopsy revealed the presence of hyaline hyphae infiltrating the lung parenchyma. The hyphae were septate, with acute-angle branching, which was consistent with aspergillosis. Lung biopsy culturing revealed growth of Aspergillus niger. This mould was also recovered from sputum and bronchoalveolar lavage, both cultivated on Sabouraud dextrose agar with chloramphenicol at 25ºC. She was put on a combination of itraconazole (400mg daily) and amphotericin B (1.5mg/kg/day), which she took for two months. Further cultures for fungi were all negative.Over the next months, the patient presented cytomegalovirus pneumonia associated with steroid-resistant rejection. She was RELATO DE CASO/CASE REPORT

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Section: Discussionmentioning

confidence: 92%

Aspergillus niger causing tracheobronchitis and invasive pulmonary aspergillosis in a lung transplant recipient: case report

Xavier

Sales

Camargo

et al. 2008

Rev. Soc. Bras. Med. Trop.

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“…[1][2][3] The mortality rate usually exceeds 50% and can reach 90% in allogeneic hematopoietic stem cell transplantations recipients. 1,4,5 IA occurs mainly in immunosuppressed patients with prolonged neutropenia induced by chemotherapy and/or patients who undergo hematopoietic stem cell transplantation. 4,[6][7][8] IA prevention and treatment remain important issues.…”

Section: Introductionmentioning

confidence: 99%

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Nicolle¹,

Bénet²,

Thiébaut³

et al. 2011

Haematologica

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BackgroundThe study objectives were: 1) to report on invasive aspergillosis patients in a hematology department; and 2) to estimate its incidence according to the hematologic diagnosis. Design and MethodsA prospective survey of invasive aspergillosis cases was undertaken between January 2004 and December 2009 in the hematology department of a university hospital. Meetings with clinicians, mycologists and infection control practitioners were organized monthly to confirm suspected aspergillosis cases. Demographic characteristics, clinical and complementary examination results were recorded prospectively. Information on hospitalization was extracted from administrative databases. Invasive aspergillosis diagnosis followed the European Organization for Research and Treatment of Cancer criteria, and proven and probable IA cases were retained. A descriptive analysis was conducted with temporal trends of invasive aspergillosis incidence assessed by adjusted Poisson regression. ResultsOverall, 4,073 hospitalized patients (78,360 patient-days) were included in the study. In total, 127 (3.1%) patients presented invasive aspergillosis. The overall incidence was 1.6 per 1,000 patient-days (95% confidence interval: 1.4, 1.9) with a decrease of 16% per year (-1%, -28%). The incidence was 1.9 per 1,000 patient-days (1.5, 2.3) in acute myeloid leukemia patients with a decrease of 20% per year (-6%, -36%). Serum Aspergillus antigen was detected in 89 (71%) patients; 29 (23%) had positive cultures, and 118 (93%), abnormal lung CT scans. One-month mortality was 13%; 3-month mortality was 42%. Mortality tended to decrease between 2004 and 2009. ConclusionsInvasive aspergillosis incidence and mortality declined between 2004 and 2009. Knowledge of invasive aspergillosis characteristics and its clinical course should help to improve the management of these patients with severe disease.Key words: invasive aspergillosis, surveillance, hematologic disease, incidence, hospital. 2004 . Haematologica 2011 96(11):1685-1691. doi:10.3324/haematol.2011 Citation: Nicolle M-C, Bénet T, Thiebaut A, Bienvenu A-L, Voirin N, Duclos A, Sobh M, Cannas G, Thomas X, Nicolini F-E, De Monbrison F, Piens M-A, Picot S, Michallet M, and Vanhems P. Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from

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“…The frequency is higher in allogeneic than in autologous transplant recipients. 1 Other important risk factors for invasive aspergillosis are protracted neutropenia and immunosuppressive treatment of GVHD. Mortality from invasive aspergillosis is high, ranging between 66.6 and 80% in HSCT patients.…”

Section: Introductionmentioning

confidence: 99%

“…Mortality from invasive aspergillosis is high, ranging between 66.6 and 80% in HSCT patients. 1 Antimycotic drugs for first-line treatment of invasive aspergillosis are amphotericin B and voriconazole, whereas caspofungin and itraconazole are considered as second-line treatment options. 2,3 Amphotericin B deoxycholate (conventional amphotericin B) has long been considered as the gold standard, 2,3 but its use is limited by nephrotoxicity.…”

Section: Introductionmentioning

confidence: 99%

Drug interactions and adverse events associated with antimycotic drugs used for invasive aspergillosis in hematopoietic SCT

Egger

Meier

Leu

et al. 2009

Bone Marrow Transplant

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The aim of this study was to assess the frequency of potential drug-drug interactions (pDDIs) and adverse drug events (ADEs) associated with antimycotics in hospitalized patients with hematopoietic SCT (HSCT). Of the 120 HSCT recipients evaluated, 36 received antimycotics. A total of 124 ADEs were recorded in 32 of the 36 patients treated, with 54 ADEs being possibly and 9 probably related to antimycotics. Of the treatments with amphotericin B, 93% were associated with one or more possible and 36% with probable ADEs. The corresponding figures for lipid-based amphotericin B were 100% and 7%, for voriconazole 68% and 11% and for caspofungin 70% and 0%. A total of 57 potentially severe DDIs associated with antimycotics were detected in 31 of the 36 patients. Of these, 14 DDIs were a possible cause of an ADE and 5 (4 times a combination of voriconazole with CYA and once a combination of CYA with conventional amphotericin B) were probably related. Although the prevalence of pDDIs and ADEs is high in HSCT patients, ADEs related with a high probability to treatment with antimycotics are rare. Regarding the high prevalence of pDDIs, our findings underscore the importance of close monitoring of laboratory and clinical parameters, as well as dose adjustment for critical drugs, in patients with HSCT.

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AspergillusInfections in Transplant Recipients

Cited by 541 publications

References 309 publications

Aspergillus niger causing tracheobronchitis and invasive pulmonary aspergillosis in a lung transplant recipient: case report

Aspergillus niger causing tracheobronchitis and invasive pulmonary aspergillosis in a lung transplant recipient: case report

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Drug interactions and adverse events associated with antimycotic drugs used for invasive aspergillosis in hematopoietic SCT

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