Mucormycosis in renal transplant recipients: review of 174 reported cases

Abstract

BackgroundMucormycosis is a highly lethal fungal infection especially in immunocompromised individuals.MethodsIn order to review the epidemiology, diagnosis, and treatment of mucormycosis in renal transplant recipients we searched publications of mucormycosis cases in renal transplant recipients in PUBMED database up to December 2015.ResultsA total of 174 cases in renal transplant recipients were included in this review. Most of the cases (76%) were male. Major underlying diseases were diabetes mellitus (43.1%). Rhinocerebral was the most common site of infection (33.3%). Rhizopus species was the most frequent fungus (59.1%) in patients with pathogen identified to species level. The mortality rates of disseminated mucormycosis (76.0%) and graft renal (55.6%) were higher than infection in other sites. The overall survival in patients received surgical debridement combined with amphotericin B/posaconazole (70.2%) was higher than those who received antifungal therapy alone (32.4%), surgery alone (36.4%) or without therapy (0%) (p < 0.001). The overall survivals in patients receiving posaconazole and lipid amphoterincin B were higher than that receiving deoxycholate formulation (92.3% and 73.4% vs 47.4%).ConclusionsMucormycosis is a severe infection in renal transplant recipients. Surgical debridement combined with antifungals, especially liposomal amphotericin B and posaconazole, can significantly improve patient’s overall survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2381-1) contains supplementary material, which is available to authorized users.

Transplant tourism following the declaration of Istanbul: Poor outcomes and nephrologist dilemma

“…However, two tourists in our cohort developed Mucormycosis. In the literature, 20 cases of renal graft Mucormycosis have been reported, however with a very high mortality rate reaching up to 55% . In our experience, we speculate that inadequate surgical settings and poor sanitation were the main causes of this serious complication.…”

Transplant tourism complicated by life-threatening New Delhi metallo-β-lactamase-1 infection

“…18 In renal transplant patients, combined surgical debridement and antifungal therapy is critical for successful treatment. 19 Even with optimal management, mortality rates were 30%, which increased to 56% when the kidney graft was infected and 76% when there was dissemination (infection at 2 or more sites). We found no evidence of dissemination in our patient, he was managed with aggressive local debridement and prolonged antifungal therapy, and he has continued to do well.…”

Isolated cutaneous mucormycosis in a pediatric renal transplant recipient

“…Mucormycosis is a rare life‐threatening fungal infection characterized by angioinvasion and dissemination that most often presents in immune‐compromised patients, such as those with hematological malignancies, poorly controlled diabetes mellitus, or recipients of hematopoietic stem cell or solid organ transplantation . Here, we present a case of isolated cutaneous mucormycosis associated with an infiltrated intravenous catheter in a pediatric renal transplant recipient.…”

“…In renal transplant recipients, mucormycosis constitutes only a small proportion of invasive fungal infections, estimated at 0.2%‐1.2%; however, it is associated with high mortality in these patients. A recent review of 174 cases of mucormycosis in adult renal transplant recipients documents a mortality rate of 23% in cutaneous‐limited disease and 76% in disseminated disease . This high mortality risk is compounded by the fact that mucormycosis presents initially non‐specifically, progresses rapidly, and can affect multiple organ systems, posing a difficult diagnostic challenge.…”