Invasive fungal infections in transplant recipients

Vázquez, José Antonio; Miceli, Marisa H.; Alangaden, George

doi:10.1177/2049936113491936

Cited by 41 publications

(43 citation statements)

References 98 publications

(265 reference statements)

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“…The overall prognosis of the invasive fungal infection depends upon multiple factors, including the site of infection, the rapidity of diagnosis, and the type and intensity of immunosuppressive medication use. Advances in antifungal therapy, such as the echinocandins, voriconazole, and posaconazole, may have made an impact on the selection of antifungals due to their broader spectrum of activity, their excellent safety profile, and their ease of use in critically ill, immunosuppressed patients . Despite the development of newer antifungal agents, in our study, we did not find any statistically significant differences in patient or graft survival before versus after 2003, possibly due to the use of stronger immunosuppressive medications, more frequent treatment of antibody‐mediated rejection and selection of older candidates for transplantation after 2003.…”

Section: Discussioncontrasting

confidence: 50%

The feared five fungal infections in kidney transplant recipients: A single‐center 20‐year experience

Parajuli

Wick

Pandeya

et al. 2018

Clinical Transplantation

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Invasive fungal infections are a feared complication in kidney transplant recipients (KTRs). Here we present the University of Wisconsin experience with 5 invasive fungal infections-aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, and coccidioidomycosis-in KTRs transplanted between 01/01/1994 and 06/30/2014. During this period, there were 128 cases of fungal infections; aspergillosis was the most common (72), followed by cryptococcosis (29), histoplasmosis (14), blastomycosis (10), and coccidioidomycosis (3). The mean interval from transplant to fungal infection was 3.19 ± 3.58 years (range 5 days-15.8 years). By 6 months postinfection, there were 53 (41%) graft failures and 24 (19%) deaths. Graft failure occurred in 46%, 38%, 21%, 40%, and 67% of patients with aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, and coccidioidomycosis, respectively. Anti-thymocyte globulin (ATG) induction (HR, 1.49; 95% CI, 1.03-2.16; P = .04), diabetes (HR, 1.53; 95% CI, 1.05-2.21; P = .03), and age (HR, 1.47; 95% CI, 1.27-1.70; P ≤ .001) were associated with an increased risk for infection in univariate analysis. Multivariate adjustment retained ATG induction and older age. A large proportion of kidney transplant recipients with invasive fungal infections suffer graft failure within 3 years. Preventive, therapeutic, and monitoring strategies are needed to improve graft and patient outcomes.

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Section: Discussioncontrasting

confidence: 50%

The feared five fungal infections in kidney transplant recipients: A single‐center 20‐year experience

Parajuli

Wick

Pandeya

et al. 2018

Clinical Transplantation

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“…This condition is exacerbated especially in patients with compromised immunity. For instance, in the US as of November 2013 with 19,262 organs transplants there was a concomitant increase in the susceptibility of these immunocompromised patients to invasive fungal infections [13,14]. In order to develop better treatment strategies it is important to understand the antifungal drug-resistance mechanisms developed by fungal cells.…”

Section: Introductionmentioning

confidence: 99%

Overcoming antifungal resistance

Srinivasan

Lopez-Ribot

Ramasubramanian

2014

Drug Discovery Today: Technologies

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Fungal infections have become one of the major causes of morbidity and mortality in immunocompromised patients. Despite increased awareness and improved treatment strategies, the frequent development of resistance to the antifungal drugs used in clinical settings contributes to the increasing toll of mycoses. Although a natural phenomenon, antifungal drug resistance can compromise advances in the development of effective diagnostic techniques and novel antifungals. In this review, we will discuss the advent of cellular-microarrays, microfluidics, genomics, proteomics and other state-of-the art technologies in conquering antifungal drug resistance.

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“…Common clinical presentations are onychomycosis, keratitis, allergic disease (sinusitis and bronchopulmonary disease) for nonimmunocompromised patients and disseminated disease, as well as other severe invasive infections, in immunocompromised hosts (e.g., patients with prolonged neutropenia and T-cell immunodeficiency) (1,4,(7)(8)(9)(10)(11)(12)(13). Amphotericin B lipid formulations, voriconazole, posaconazole, and, to a lesser extent, itraconazole have been recommended or used for the treatment and prophylaxis of Fusarium infections, in addition to surgical debridement and reversal of immunosuppression (14)(15)(16)(17)(18)(19). The survival rate is low, with some reports suggesting 30% or less, for fusariosis, especially among patients with persistent neutropenia (16)(17)(18)(19)(20)(21)(22).…”

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confidence: 99%

International Evaluation of MIC Distributions and Epidemiological Cutoff Value (ECV) Definitions for Fusarium Species Identified by Molecular Methods for the CLSI Broth Microdilution Method

Espinel-Ingroff

Colombo

Córdoba

et al. 2016

Antimicrob Agents Chemother

122

103

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rThe CLSI epidemiological cutoff values (ECVs) of antifungal agents are available for various Candida spp., Aspergillus spp., and the Mucorales. However, those categorical endpoints have not been established for Fusarium spp., mostly due to the difficulties associated with collecting sufficient CLSI MICs for clinical isolates identified according to the currently recommended molecular DNA-PCR-based identification methodologies. CLSI MIC distributions were established for 53 Fusarium dimerum species complex (SC), 10 F. fujikuroi, 82 F. proliferatum, 20 F. incarnatum-F. equiseti SC, 226 F. oxysporum SC, 608 F. solani SC, and 151 F. verticillioides isolates originating in 17 laboratories (in Argentina, Australia, Brazil, Canada, Europe, Mexico, and the United States). According to the CLSI guidelines for ECV setting, ECVs encompassing >97.5% of pooled statistically modeled MIC distributions were as follows: for amphotericin B, 4 g/ml (F. verticillioides) and 8 g/ml (F. oxysporum SC and F. solani SC); for posaconazole, 2 g/ml (F. verticillioides), 8 g/ml (F. oxysporum SC), and 32 g/ml (F. solani SC); for voriconazole, 4 g/ml (F. verticillioides), 16 g/ml (F. oxysporum SC), and 32 g/ml (F. solani SC); and for itraconazole, 32 g/ml (F. oxysporum SC and F. solani SC). Insufficient data precluded ECV definition for the other species. Although these ECVs could aid in detecting nonwild-type isolates with reduced susceptibility to the agents evaluated, the relationship between molecular mechanisms of resistance (gene mutations) and MICs still needs to be investigated for Fusarium spp.

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Invasive fungal infections in transplant recipients

Cited by 41 publications

References 98 publications

The feared five fungal infections in kidney transplant recipients: A single‐center 20‐year experience

The feared five fungal infections in kidney transplant recipients: A single‐center 20‐year experience

Overcoming antifungal resistance

International Evaluation of MIC Distributions and Epidemiological Cutoff Value (ECV) Definitions for Fusarium Species Identified by Molecular Methods for the CLSI Broth Microdilution Method

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