Pulmonary Fungal Infections in Kidney Transplant Recipients: An 8-Year Study

Sharifipour, Farideh; Rezaeetalab, Fariba; Naghibi, Massih

doi:10.1016/j.transproceed.2009.02.072

Cited by 29 publications

(23 citation statements)

References 7 publications

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“…Aspergillus species were the second most common cause of pneumonia in our study (16% of the episodes); the incidence of aspergillus pneumonia was higher than that (5%) described in other European studies (8). The most important risk factors for fungal infection in other studies were steroids, acute rejection episodes associated with high steroid dosages, broad spectrum antibiotic treatment and long intensive care unit stays (17). In our study, fungal pneumonia was significantly associated with a higher frequency of antibiotic usage in the last three months than were pneumonias caused by other agents.…”

Section: Discussioncontrasting

confidence: 56%

Epidemiology and Clinical and Radiographic Characteristics of Pneumonia in Kidney Transplant Recipients; 24-Year Experience

Dizdar¹,

Akalın²

2017

Turk Neph Dial Transpl

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OBJECTIVE: Pneumonia increases morbidity and mortality in kidney transplant (KT) recipients. This study aimed to investigate characteristics of pneumonias in KT recipients by focusing on clinical and radiographic findings and diagnostic methods over a long study period. MATERIAL and METHODS:The medical records of kidney transplant recipients who had a diagnosis of pneumonia from 1988 to 2011 were reviewed retrospectively. RESULTS:Among 406 consecutive KT recipients, 20% had pneumonia during the study period and total 111 episodes of pneumonia developed in these patients. Fifty-six percent of the pneumonias were community acquired and 44% nosocomial. Bacterial infections were the most common cause (20%) and 13 (12%) of the episodes were polymicrobial. Antibiotic usage in the last three months was significantly more common in fungal pneumonia episodes than others. Bronchoscopy had the highest final overall diagnostic yield.CONCLUSION: Community-acquired pneumonia was more common, but it showed a more benign clinical course. Bacterial pneumonia was the most common cause, but polymicrobial infection was present in a significant number of KT recipients. Fungi can invade KT recipients, in particular, patients in the interval of 1-6 month after transplantation and patients who have used antibiotics in the last three months.KEy wORDS: Pneumonia, Kidney transplantation, Radiography, Physical examination, Nosocomial Öz AMAÇ: Pnömoni böbrek nakil hastalarında morbidite ve mortaliteyi artırır. Çalışmada böbrek nakil hastalarında uzun bir zaman diliminde klinik ve radyografik bulgular ve tanısal yöntemlere odaklanarak pnömonilerin özellikleri incelendi. GEREÇ ve yÖNTEMLER:Retrospektif olarak 1988 ile 2011 yılları arasında pnömoni tanısı almış böbrek nakil hastalarının bilgileri incelendi. BULGULAR:Çalışma süresi içerisinde böbrek nakli yapılmış 406 hastanın %20'sinde pnömoni gelişti. Toplam pnömoni atak sayısı 111 idi. Pnömoni ataklarının %56'sı toplum, %44'ü nazokomial kökenli idi. Bakteriyel enfeksiyonlar en sık nedendi (%20) ve atakların 13'ü (%12) polimikrobiyaldi. Son üç ay içinde antibiyotik kullanımı fungal pnömonilerde daha sıktı. Bronkoskopi en yüksek tanı koydurucu yöntemdi. SONUÇ:Böbrek nakli hastalarında toplum kökenli pnömoniler daha sıktır ve daha iyi bir seyre sahiptir. Bakteriyel pnömoniler en sık neden olmasına rağmen polimikrobiyal enfeksiyonlarda oldukça sıktır. Fungal pnömoniler özellikle nakilden sonraki 1-6 aylık dönemde sıktır ve son üç ay içinde antibiyotik kullanan hastalarda daha sık görülür.

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Section: Discussioncontrasting

confidence: 56%

Epidemiology and Clinical and Radiographic Characteristics of Pneumonia in Kidney Transplant Recipients; 24-Year Experience

Dizdar¹,

Akalın²

2017

Turk Neph Dial Transpl

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“…Improvements in patient selection, management, surgical techniques and immunosuppressive regimens, as well as reduction of environmental exposure may also be responsible for the low incidence. The following variables have been assessed as risk factors for IPA [10][11][12][13][14][15][16]:…”

Section: Discussionmentioning

confidence: 99%

Radiological and clinical findings of 25 patients with invasive pulmonary aspergillosis: retrospective analysis of 2150 liver transplantation cases

Qin

Yuan²,

Dong³

et al. 2012

The British Journal of Radiology

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Objective: The purpose of this study was to evaluate the radiological and clinical findings of invasive pulmonary aspergillosis (IPA) after liver transplantation. Methods: This study included 25 consecutive liver transplant recipients with histologically confirmed IPA after liver transplantation. Radiological examinations performed for diagnosis were available in all patients. Clinical findings and changes in clinical response and radiological findings after treatment were also evaluated. Results: 3 main radiological findings were identified: nodules, 64% (16/25); masses, 36% (9/25); and consolidations in a patchy pattern, 20% (5/25). A tree-in-bud pattern was found in 12% (3/25) of patients. In 8 (32%) of 25 patients, we found a combination of 2 or more of these signs: 5 (20%) patients presented with concurrent nodules accompanied by patchy consolidations and/or tree-in-bud, and 3 (12%) patients showed masses accompanied by large consolidations. A halo sign was observed in 20 (80%) of 25 patients. Hypodense sign and cavitary lesions were encountered in 17 (68%) of 25 patients. Follow-up radiological findings after treatment showed improvement in 18 patients, no change in 4 patients and progression in 3 patients. There were three aspergillosis-associated deaths during the follow-up period. The onset time of IPA was a median of 31 days after transplantation. The most common symptom at diagnosis was fever (n=15). None of the 25 patients had leukopaenia at the time of the diagnosis of IPA. Conclusions: The most common radiological findings of IPA after liver transplantation are multiple nodules with or without halo sign, masses and consolidations, which usually appear about 1 month after transplantation.

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“…and Candida or mucoraceous genera have been described and pose important diagnostic dilemmas. To be able to identify dual infections, it is crucial to have alternative diagnostic testing of tissues such as immunohistochemistry, in situ hybridization, or PCR, which at this time are available only for research use (70,147). In addition, in invasive pulmonary aspergillosis, cultures are positive in only 50% of bronchoalveolar lavage fluid specimens (148), and organisms recovered from BAL fluid samples may reflect colonization rather than the actual pathogen.…”

Section: Diseases Where Hyphae Are Usually Seen In Tissuementioning

confidence: 99%

“…Poor staining of hyphae with GMS should suggest mucormycosis. To be able to specifically identify Mucorales in tissues or to detect dual infections by Mucorales genera and other fungi, it is important to use immunohistochemistry, in situ hybridization, or PCR (70,147).…”

Section: Mucormycosis (Zygomycosis) (I) Epidemiologicmentioning

confidence: 99%

Histopathologic Diagnosis of Fungal Infections in the 21st Century

2011

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SUMMARY Fungal infections are becoming more frequent because of expansion of at-risk populations and the use of treatment modalities that permit longer survival of these patients. Because histopathologic examination of tissues detects fungal invasion of tissues and vessels as well as the host reaction to the fungus, it is and will remain an important tool to define the diagnostic significance of positive culture isolates or results from PCR testing. However, there are very few instances where the morphological characteristics of fungi are specific. Therefore, histopathologic diagnosis should be primarily descriptive of the fungus and should include the presence or absence of tissue invasion and the host reaction to the infection. The pathology report should also include a comment stating the most frequent fungi associated with that morphology as well as other possible fungi and parasites that should be considered in the differential diagnosis. Alternate techniques have been used to determine the specific agent present in the histopathologic specimen, including immunohistochemistry, in situ hybridization, and PCR. In addition, techniques such as laser microdissection will be useful to detect the now more frequently recognized dual fungal infections and the local environment in which this phenomenon occurs.

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Pulmonary Fungal Infections in Kidney Transplant Recipients: An 8-Year Study

Cited by 29 publications

References 7 publications

Epidemiology and Clinical and Radiographic Characteristics of Pneumonia in Kidney Transplant Recipients; 24-Year Experience

Epidemiology and Clinical and Radiographic Characteristics of Pneumonia in Kidney Transplant Recipients; 24-Year Experience

Radiological and clinical findings of 25 patients with invasive pulmonary aspergillosis: retrospective analysis of 2150 liver transplantation cases

Histopathologic Diagnosis of Fungal Infections in the 21st Century

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