Invasive Fungal Infections After Kidney Transplantation: A Single-center Experience

Santos, Tiago; Aguiar, Brigite; Santos, Lídia; Romãozinho, Catarina; Tomé, Raphael Alves Ferreira; Macário, Fernando; Alves, Rui; Campos, M.; Mota, Alexandre

doi:10.1016/j.transproceed.2015.03.040

Cited by 42 publications

(35 citation statements)

References 18 publications

(17 reference statements)

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“…Bir kismi organizma için zararsiz, hatta yararli olan bu mikroorganizmalar, transplant alicilarinda olduğu gibi konağin immünsüprese olmasi durumunda patojen hale gelebilir (19) . İT'nin RTx alicilarinda meydana getirdiği genel immünsüpres-yonun, bu olgularda enfeksiyonlara yatkinlik oluştur-masi, dolayisiyla dermatofitozlarin siklik ve şiddetini arttirmasi, dahasi atipik prezentasyonlarla seyreden ve invazyon gösteren sistemik fungal enfeksiyonlarin ortaya çikmasina neden olmasi genel kabul gören gö-rüşlerdendir (17,18,20) .…”

Section: Discussionunclassified

Dermatological Manifestations in Renal Transplant Recipients: A Single-centre Prospective Follow-up Study

Yorulmaz¹,

Bayrakci²,

Güneş³

et al. 2018

Okmeydani Medical Journal

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Section: Discussionunclassified

Dermatological Manifestations in Renal Transplant Recipients: A Single-centre Prospective Follow-up Study

Yorulmaz¹,

Bayrakci²,

Güneş³

et al. 2018

Okmeydani Medical Journal

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Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Unlike recipients of liver or lung transplants who are especially vulnerable to invasive candidiasis and aspergillosis, the risk of IFI in kidney transplant recipients is low. [1][2][3][4] Zygomycosis comprises only 0.2%-1.2% of infections in renal transplant recipients. [1][2][3][4] As per another large sized study mucormycosis occurred in 3 of 8,494 renal transplants between 2001 and 2006 and accounted for 28 of 1,208 cases of IFI among all SOT recipients.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Zygomycosis comprises only 0.2%-1.2% of infections in renal transplant recipients. [1][2][3][4] As per another large sized study mucormycosis occurred in 3 of 8,494 renal transplants between 2001 and 2006 and accounted for 28 of 1,208 cases of IFI among all SOT recipients. [5] Currently, there are no recommendations regarding routine prophylaxis against fungal infections in renal transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

“…[5] Currently, there are no recommendations regarding routine prophylaxis against fungal infections in renal transplant recipients. [1][2][3][4] The risk factors include T cell depleting drugs, neutropenia, renal failure, poorly controlled diabetes, prior voriconzole or caspofungin use, hematological malignancies, hematopoetic stem cell transplant (HSCT) and iron overload states. [2] Incidence is also higher in males.…”

Section: Introductionmentioning

confidence: 99%

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Invasive fungal infections: A diagnostic challenge

Puri

Chesser

Lidner

2017

CRCP

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Introduction: Overall incidence of invasive fungal infections in solid organ transplant recipients is low with the more common infections being invasive candidiasis, aspergillosis and cryptococosis. Zygomycosis comprises of only 0.2%-1.2% of infections in renal transplant recipients with current recommendations advising against routine prophylaxis. Case: The patient was a 60-year-old male with a history of renal transplant 25 years ago on immunosuppressants, chronic transplant glomerulopathy, squamous cell carcinoma post penectomy and bilateral orchiectomy 2 years ago, controlled diabetes and hypertension who presented with pain in the perineal region for 4 days. On exam he was discovered to be afebrile and had a scrotal skin fold with urethral opening from his previous surgery and 2.5 cm induration and tenderness in the left gluteal fold. He was treated with 5 days of Unasyn. A biopsy was taken to rule out recurrence of squamous cell carcinoma and he was discharged home. The patient returned with worsening perineal pain within 3 days. On exam he had progressive induration with erythema, swelling and tenderness in the perineum. An initial white blood cell count of 15.8 increased to 25.8 and blood cultures remained negative. The computed tomography scan showed diffuse edema in the perineum without any evidence of abscesses. Immunosuppression was held and broad spectrum antibiotics were started. His renal failure progressively worsened eventually requiring continuous renal replacement therapy, intensive care transfer and vasopressor support. The biopsy revealed intermingled fibrous tissue with focal necrosis and no evidence of malignant cells. A repeat incision and debridement (I&D) culture showed growth consistent with mucor. He was started on liposomal amphotericin B and taken to the OR for multiple debridements. Unfortunately he progressed to multisystem organ failure and died after transitioning to comfort care. Conclusions: Invasive fungal infections remain one of the life threatening differentials for cellulitis like skin lesions, especially for patients not responding to antibiotics and those who are immunocompromised. Early cultures and histopathology of lesions should be done for diagnosis and to avoid delays in treatment.

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