Opportunistic Mycelial Fungal Infections in Organ Transplant Recipients: Emerging Importance of Non-Aspergillus Mycelial Fungi

Abstract

To determine the spectrum and impact of mycelial fungal infections, particularly those due to non-Aspergillus molds, 53 liver and heart transplant recipients with invasive mycelial infections were prospectively identified in a multicenter study. Invasive mycelial infections were due to Aspergillus species in 69.8% of patients, to non-Aspergillus hyalohyphomycetes in 9.4%, to phaeohyphomycetes in 9.4%, to zygomycetes in 5.7%, and to other causes in 5.7%. Infections due to mycelial fungi other than Aspergillus species were significantly more likely to be associated with disseminated (P=.005) and central nervous system (P=.07) infection than were those due to Aspergillus species. Overall mortality at 90 days was 54.7%. The associated mortality rate was 100% for zygomycosis, 80% for non-Aspergillus hyalohyphomycosis, 54% for aspergillosis, and 20% for phaeohyphomycosis. Thus, non-Aspergillus molds have emerged as significant pathogens in organ transplant recipients. These molds are more likely to be associated with disseminated infections and to be associated with poorer outcomes than is aspergillosis.

Fungal Infections in Transplant and Oncology Patients

“…Pathogens included Aspergillus species in 70%, nonAspergillus hyalohyphomycetes in 9%, phaeohyphomycetes in 9%, Zygomycetes in 6%, and other or unidentified moulds in 6% of patients. Dissemination was significantly more likely with infection due to a non-Aspergillus mould compared with Aspergillus [17].…”

“…In immunocompromised hosts, Aspergillus most commonly presents as invasive pulmonary aspergillosis, often with subsequent dissemination [16][17][18]. In lung transplant recipients, Aspergillus may also cause tracheobronchitis and bronchial anastomotic infection.…”

Common fungal isolates from routine clinical specimens: a two years’ studyfrom a tertiary care hospital in South India

“…and Zygomycetes are becoming increasingly common. 2,3 Although C. albicans is the most prevalent species involved in causing fungal infections, the incidence of infections due to non-albicans species is increasing 4 particularly in patients treated in the intensive care unit (ICU) and is associated with significant morbidity and mort alit y. Epidemiologic studies have identified int ravenous cat heters, broad spectrum antibiotics, mucosal colonization, neutropenia, previous surgical procedures, total parenteral nutrition, extremes of age, and concomitant bacteraemia as significant risk factors for fungal infections. [5][6][7] Early diagnosis is challenging due to delays in, and low sensitivity of confirmatory blood cultures, or difficulty in discriminating colonization/ contamination from invasion in samples like sputum.…”

Pseudallescheria boydii infection after liver retransplantation

“…2 ReLT for acute and chronic graft failure can produce a good outcome; however, early mortality associated with devastating infections such as aspergillosis must be accepted. 3 Antifungal prophylaxis has been suggested to prevent mold infections.…”

“…7,8 Recently, a shift toward more uncommon pathogens has been observed. 2 Mold infections are predominantly diagnosed among defined highrisk groups such as patients with fulminant liver failure or renal failure and patients who have undergone reLT. P. boydii, also known as Scedosporium apiospermum, has been previously described in liver, kidney, heart, and lung recipients.…”