Mortality risk factors in patients with zygomycosis: a retrospective and multicentre study of 25 cases

Mucormycosis (zygomycosis) of renal allograft

“…Only 9 patients received a kidney from related donors; the remaining 15 received the transplanted kidney from unrelated donors, including 5 from deceased donors, (2 from the same donor; cases 13 and 14). Live unrelated renal transplantation in 10 patients was done in India [ 17 ], Egypt [ 2 ] and Pakistan [ 3 ]. All patients had received routine immunosuppression in the post-transplant period including prednisolone, cyclosporine, tacrolimus, azathioprine or mycophenolate in varying combinations as shown in Table 1 .…”

“…Mucormycosis is most commonly acquired during the nadir of immunosuppression between 1 and 6 months post transplantation [ 2 ]. Increased immunosuppression for the treatment of rejection is associated with an enhanced incidence of fungal infection [ 2 , 13 ].…”

“…Renal transplant recipients are prone to developing opportunistic infections due to their immunosuppressed state [ 1 – 3 ]. Among these, the Zygomycetes class of filamentous fungi causes the most devastating disease following renal transplantation [ 1 , 2 ]. The pathogenic fungi of this class belong to the order Mucorales, and the family Mucoraceae [ 4 ].…”

Mucormycosis of the Transplanted Kidney With Renal Papillary Necrosis

“…11 Renal transplant recipients have been reported to develop this infection often in developing countries, especially in those persons who undergo live-unrelated "commercial" transplant. 12 Occurrence of mucormycosis in renal transplant is related to many factors including heightened immunosuppression in the initial posttransplant period with induction protocols and antirejection therapy like pulse steroids, antilymphocyte antibodies, and interleukin-2 receptor antagonists, intraoperative or postoperative surgical complications, "transmission" from infected donors, and the presence of immunomodulating viruses such as cytomegalovirus and hepatitis C. 13,14 Involvement of the renal allograft may occur in disseminated diseases, with isolated graft involvement. 15 Being angioinvasive, the Mucorales invade the blood vessels, causing vascular thrombosis and associated ischemic necrosis of the kidney.…”

“…Fungal hyphae also may invade the glomeruli, the tubules, and the parenchyma, aside from the renal vessels. 13 The cortical and modularly necrosis results in irreversible kidney damage and renal failure. Clinical presentation of these patients includes pain and tenderness over the graft site, fever, a progressive decline in renal function, leukocytosis, hematuria, enlarged kidney on ultrasonography with typical radiologic features on contrast-enhanced computerized tomography.…”