Primary Pulmonary Involvement of Fusarium solani in a Lung Transplant Recipient

Arney, Keane L.; Tiernan, Rosemary; Judson, Marc A.

doi:10.1378/chest.112.4.1128

Cited by 35 publications

(18 citation statements)

References 10 publications

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“…9,35,41 The mean age of infection was 44.3 years (range, 18–62 yr) (Table 3). The reasons for lung transplantation included advanced bullous emphysema in 1 patient, emphysema due to alpha-1 antitrypsin deficiency and tobacco use in 1 patient, and cystic fibrosis in the remaining patient.…”

Section: Resultsmentioning

confidence: 99%

Fusarium Infection in Lung Transplant Patients

et al. 2011

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Fusarium is a fungal pathogen of immunosuppressed lung transplant patients associated with a high mortality in those with severe and persistent neutropenia. The principle portal of entry for Fusarium species is the airways, and lung involvement almost always occurs among lung transplant patients with disseminated infection. In these patients, the immunoprotective mechanisms of the transplanted lungs are impaired, and they are, therefore, more vulnerable to Fusarium infection. As a result, fusariosis occurs in up to 32% of lung transplant patients. We studied fusariosis in 6 patients following lung transplantation who were treated at Massachusetts General Hospital during an 8-year period and reviewed 3 published cases in the literature. Cases were identified by the microbiology laboratory and through discharge summaries. Patients presented with dyspnea, fever, nonproductive cough, hemoptysis, and headache. Blood tests showed elevated white blood cell counts with granulocytosis and elevated inflammatory markers. Cultures of Fusarium were isolated from bronchoalveolar lavage, blood, and sputum specimens. Treatments included amphotericin B, liposomal amphotericin B, caspofungin, voriconazole, and posaconazole, either alone or in combination. Lung involvement occurred in all patients with disseminated disease and it was associated with a poor outcome. The mortality rate in this group of patients was high (67%), and of those who survived, 1 patient was treated with a combination of amphotericin B and voriconazole, 1 patient with amphotericin B, and 1 patient with posaconazole. Recommended empirical treatment includes voriconazole, amphotericin B or liposomal amphotericin B first-line, and posaconazole for refractory disease. High-dose amphotericin B is recommended for treatment of most cases of fusariosis. The echinocandins (for example, caspofungin, micafungin, anidulafungin) are generally avoided because Fusarium species have intrinsic resistance to them. Treatment should ideally be based on the Fusarium isolate, susceptibility testing, and host-specific factors. Prognosis of fusariosis in the immunocompromised is directly related to a patient’s immune status. Prevention of Fusarium infection is recommended with aerosolized amphotericin B deoxycholate, which also has activity against other important fungi.

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Section: Resultsmentioning

confidence: 99%

Fusarium Infection in Lung Transplant Patients

et al. 2011

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“…1,3,17 Lipid formulations of amphotericin B have less potential for nephrotoxicity and are thus an alternative for 1st-line therapy of fusariosis. 5,18 Voriconazole has demonstrated efficacy in 6 (40%) of 16 cases of fusariosis. 19 Similarly, in an early interim report from a clinical trial that evaluated posaconazole in treating refractory invasive fungal infection, positive outcomes were observed in patients with fusariosis.…”

Section: Discussionmentioning

confidence: 99%

“…1 Fusarium species are now emerging as opportunistic fungal pathogens in these patient populations, as indicated by an increasing number of reports of Fusarium infection in the literature. [2][3][4][5] One major US hematopoietic stem-cell transplantation center reported that Fusarium species are responsible for a majority of infections caused by non-Aspergillus filamentous fungi. 6 Since 1975, when the 1st case of Fusarium solani infection was reported in a child with acute leukemia, Ͼ100 additional cases have been reported; common sites of infection are the skin, blood, and lung.…”

mentioning

confidence: 99%

Successful treatment of Fusarium proliferatum pneumonia with posaconazole in a lung transplant recipient

Herbrecht

Kessler

Kravanja

et al. 2004

The Journal of Heart and Lung Transplantation

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“…Fusarium species infections have been rarely reported after solid‐organ transplantation,18, 25–31 apparently with a better outcome with respect to BMT recipients (7 of 8 cases described in the scientific literature eradicated the infection, and only 1 patient died).…”

Section: Discussionmentioning

confidence: 99%

Systemic fungemia and hepatic localizations ofFusarium solani in a liver transplanted patient: An emerging fungal agent

et al. 2006

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The incidence of invasive fungal infection is increasing especially in the field of transplantation, affecting as many as 50% of bone marrow transplant (BMT) patients with neutropenia and 5-20% of solid-organ transplant (SOT) recipients. Fusarium species are soil saprophytes and plant pathogens. They may cause superficial mycoses or important opportunistic infections in patients with bone marrow suppression and neutropenia, they have been rarely described in solid organ recipients, and up to now there have been no reports of such infection in isolated liver transplanted patients. We describe a case of disseminated Fusarium solani infection with hepatic localization in a liver transplanted patient that resolved with the administration of amphotericin B. Our observation confirms that Fusarium spp. are emerging pathogens that may most frequently affect not only BMT patients and patients with hematological malignancies, but also SOT patients. They may cause both localized and disseminated infection. In conclusion, Fusarium spp. etiology should be considered in the context of infectious diseases following liver transplantation.

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Primary Pulmonary Involvement of Fusarium solani in a Lung Transplant Recipient

Cited by 35 publications

References 10 publications

Fusarium Infection in Lung Transplant Patients

Fusarium Infection in Lung Transplant Patients

Successful treatment of Fusarium proliferatum pneumonia with posaconazole in a lung transplant recipient

Systemic fungemia and hepatic localizations ofFusarium solani in a liver transplanted patient: An emerging fungal agent

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