Non-Aspergillus Fungal Pneumonia in Transplant Recipients

Respiratory Tract Infections: Sinusitis, Bronchitis, and Pneumonia

Solid organ and hematopoietic stem cell transplant recipients are at increased risk of upper and lower respiratory tract infections. While these infections are frequently encountered in the general population, the spectrum of their clinical presentation including morbidity and mortality is increased in patients undergoing transplantation procedures. Impaired innate and adaptive immunity, potential anatomical abnormalities resulting from extensive surgical procedures, presences of indwelling medical devices, and increased healthcare exposure put transplant recipients at particularly high risk for respiratory tract disease. Infections of the respiratory tract can be divided into those affecting the paranasal sinuses, the upper airways such as bronchitis and tracheobronchitis, and the lower airways like pneumonia. Each of these clinical syndromes can further be classified based on their chronicity, acute vs. chronic; their setting, community vs. nosocomial; and the etiology such as bacteria, viruses, fungi, and rarely parasites. It is also important to realize that such immunologically vulnerable patients are at risk for polymicrobial infection that may present concurrently or in a sequential, consecutive fashion. This chapter reviews the common respiratory tract infections affecting transplant recipients with particular attention directed toward epidemiological risk factors, clinical presentations, diagnostic strategies, and common pathogens. Specific causes of opportunistic pneumonias are also reviewed.

Successful treatment of Talaromyces amestolkiae pulmonary infection with voriconazole in an acute lymphoblastic leukemia patient

Infections due to Talaromyces spp. are uncommon, but they have been reported previously as causative agents of disease in immunocompromised patients. The prognosis of hemato-oncological patients with an invasive fungal infection is generally poor and the identification of the causative agent is usually not achieved or in some cases the isolated agent is taken as a contaminant and not treated, which contributes to their bad outcome. We report a case of Talaromyces amestolkiae pulmonary infection in an acute lymphoblastic leukemia patient, which was successfully treated with voriconazole, and discuss the importance of molecular identification and treatment of non-traditionally pathogenic fungi in this specific subset of patients.

Invasive Candida infections in solid organ transplant recipient children

Solid organ transplantation (SOT) is now an accepted therapy for many end-stage organ disorders and fungal infections are the principal cause of infection-related mortality in SOT recipients. Among invasive fungal infections, Candida species are the most common pathogens identified, associated with high mortality rates. The epidemiology and clinical manifestations of Candida infections vary with the type of organ transplantation. This article reviews invasive Candida infections in pediatric SOT recipients.