Invasive Fungal Disease in Renal Transplant Recipients at a Brazilian Center: Local Epidemiology Matters

Guimarães, Luiz Felipe; Halpern, Márcia; Lemos, Alberto dos Santos de; Gouvêa, Érika Ferraz de; Gonçalves, Raquel Calado da Silva; Santos, Miriam de Oliveira; Nucci, Márcio; Santoro‐Lopes, Guilherme

doi:10.1016/j.transproceed.2016.06.019

Cited by 33 publications

(24 citation statements)

References 12 publications

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“…106 Brazilian investigators reported only one case of mucormycosis among 908 renal transplant recipients between 1998 and 2009 who were followed until July 2015. 107 Only one case of mucormycosis (Lichtheimia) was identified among 362 heart transplant recipients at a single center from 1995 to 2012. 108 Numerous case reports and small series of mucormycosis in SOTRs including liver, 80,[109][110][111][112][113][114][115] kidney, 107,[116][117][118][119][120][121][122][123][124][125] heart, 108,126,127 and lung recipients [128][129][130][131] have been published.…”

Section: Solid Organ Transplant Recipientsmentioning

confidence: 99%

Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

132

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Mucormycosis is an infection caused by a group of filamentous molds within the order Mucorales. Infections may result from ingestion of contaminated food, inhalation of spores into the nares or lungs, or inoculation into disrupted skin or wounds. In developed countries, mucormycosis occurs primarily in severely immunocompromised hosts (e.g., those with hematological malignancies, organ transplantation, neutropenia, autoimmune disorders, or other impairments in immunity). Only 6 to 10% of cases occur in subjects with no underlying disease. In contrast, in developing countries, most cases of mucormycosis occur in persons with poorly controlled diabetes mellitus or in immunocompetent subjects following trauma. Mucormycosis exhibits a marked propensity to invade blood vessels, leading to thrombosis, necrosis, and infarction of tissue. Mortality associated with invasive mucormycosis is high (> 30–50%), with 90% mortality associated with disseminated disease. Mortality rates are much lower, though still significant (10–30%), among patients with localized cutaneous disease.The diagnosis of mucormycosis relies upon histopathology and culture. Blood tests are of limited diagnostic value. Even with disseminated disease, blood cultures are usually negative. Mucorales have a distinct histological appearance, with irregular, nonseptate hyphae that branch at right angles. Cultures and/or polymerase chain reaction (PCR) are important to identify the genera.Based on anatomic localization, mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM), (2) pulmonary, (3) cutaneous, (4) gastrointestinal (GI), (5) disseminated, and (6) mucormycosis of uncommon sites. Among diabetics, ROCM is the most common clinical presentation, whereas lung involvement is uncommon. In contrast, among organ transplant recipients or patients with hematological malignancies (HemeM), pulmonary and disseminated diseases are most common. Mucormycosis can progress rapidly, and delay in initiation of treatment by even a few days markedly worsens outcomes.Due to the rarity of mucormycosis, randomized controlled therapeutic trials have not been performed. Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy, but the newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate), may be effective in patients refractory to or intolerant of LFAB. Early surgical debridement or excision plays an important adjunctive role. Additional studies are required to assess the optimal duration of therapy as well as the specific roles of LFAB and the triazoles in the treatment of mucormycosis.

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Section: Solid Organ Transplant Recipientsmentioning

confidence: 99%

Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

132

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“…147 Brazilian investigators reported only one case of mucormycosis among 908 subjects receiving renal transplants between 1998 and 2009 who were followed until July 2015. 148 Similarly, only one case of mucormycosis (Lichtheimia) was identified among 362 heart transplant recipients at a single center from 1995 to 2012. 149 Numerous case reports and small series of mucormycosis in SOT recipients including liver, 42,[150][151][152][153][154][155][156] kidney, 148,[157][158][159][160][161][162][163][164][165][166] heart, 149,167,168 and lung 55,[169][170][171] have been published.…”

Section: Organ Transplant Recipientsmentioning

confidence: 99%

Fungal Infections Complicating Lung Transplantation

Clark

Weigt

Fishbein³

et al. 2018

Semin Respir Crit Care Med

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Lung transplantation is an increasingly utilized modality for treating advanced lung disease. However, lung transplant recipients (LTRs) experience high rates of infection-related mortality and, compared with other solid organ transplant recipients, are at increased risk of infectious complications given the intensity of immunosuppression employed, the presence of airway abnormalities after surgery and exposure of the allograft to the environment. Fungal infections, particularly mold infections, are problematic after transplantation as they are often associated with limited treatment options and poor outcomes. We describe the non- fungal infections occurring in LTRs, including their epidemiology, clinical features, and treatment.

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“…In the current literature there are numerous reports of viral, parasitic, fungal and bacterial transmission (including Polyomavirus, Cytomegalovirus, Cryptococcosis, Mucormycosis, Acinetobacters, and non-tuberculous Mycobacteriums) through transplants. [1,[6][7][8][9] Among these Cytomegalovirus is the most common viral infection after renal Tx and is associated with significant morbidity including acute rejection and mortality. It is closely related to effective immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of early and late-term infections after renal transplantation: Clinical experiences of Sanko University Medical Faculty Transplantation Center

Kazımoğlu

Harman

Mercimek

et al. 2019

Turkish Journal of Urology

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The most common complication after renal transplantation are infections. The majority of the infections are seen within the first year especially between 1-6 months. Post-transplant infections are often related to urinary system. E.coli is the most frequently isolated agent and it may be responsible for urosepsis in renal transplant patients. Infection more often seen in renal transplantations from cadavers.

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Invasive Fungal Disease in Renal Transplant Recipients at a Brazilian Center: Local Epidemiology Matters

Abstract: The epidemiology of IFD in this Brazilian cohort was characterized by a large predominance of late infections and a high proportion of cases of cryptococcosis and histoplasmosis. These results highlight the considerable geographic variability of IFD epidemiology after KT.

Cited by 33 publications

References 12 publications

Mucormycosis

Mucormycosis

Fungal Infections Complicating Lung Transplantation

Evaluation of early and late-term infections after renal transplantation: Clinical experiences of Sanko University Medical Faculty Transplantation Center

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