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Bilgic A, Kodjikian L, Gonzalez-Cortes JH, Heuvels A, Heuvels P, Sudhalkar A, Mathis T. Postoperative Aspergillus Infection: A Case Series. Ocul Immunol Inflamm 2023; 31:1486-1489. [PMID: 35914298 DOI: 10.1080/09273948.2022.2103714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/18/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To report the clinical findings, therapy and outcomes of pauci-symptomatic Aspergillus infection in 11 eyes of 11 patients who had recently undergone uneventful cataract surgery and IOL implantation in a single operating room on the same day. METHODS Retrospective, observational study that looks at 11 patients who demonstrated Aspergillus infection after cataract surgery. All data were collected and intracameral samples sent for microscopic evaluation and culture. Additional swabs were sent from the operating room and operative consumables. RESULTS A total of 11 eyes of 11 patients were included in the analysis and were followed for at least 12 months. All patients responded completely to local and systemic voriconazole therapy. The source of infection was noted to be air-conditioning vents. Eyes with manual small incision cataract surgery (11/17) had a higher propensity for infection. CONCLUSION Pauci-symptomatic aspergillosis infection has been reported here following cataract surgery.
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Affiliation(s)
- Alper Bilgic
- Alphavision Augenarztpraxis, Bremerhaven, Germany
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Matéis, UMR-CNRS 5510, Lyon, France
| | | | - Alexandra Heuvels
- Department of Ophthalmology, Augenärzte Niederelbe, Stade & Cuxhaven, Germany
| | - Per Heuvels
- Department of Ophthalmology, Augenärzte Niederelbe, Stade & Cuxhaven, Germany
| | - Aditya Sudhalkar
- Alphavision Augenarztpraxis, Bremerhaven, Germany
- MS Sudhalkar Medical Research Foundation, Baroda, India
| | - Thibaud Mathis
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Matéis, UMR-CNRS 5510, Lyon, France
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2
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Sigera LSM, Denning DW. Invasive Aspergillosis after Renal Transplantation. J Fungi (Basel) 2023; 9:255. [PMID: 36836369 PMCID: PMC9963524 DOI: 10.3390/jof9020255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/11/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
Over 95,000 renal transplantation procedures were completed in 2021. Invasive aspergillosis (IA) affects about 1 in 250 to 1 in 43 renal transplant recipients. About 50% of cases occur in the first 6 months after transplantation; the median time of onset is nearly 3 years. Major risk factors for IA include old age, diabetes mellitus (especially if prior diabetic nephropathy), delayed graft function, acute graft rejection, chronic obstructive pulmonary disease, cytomegalovirus disease, and neutropenia. Hospital construction, demolition activities, and residential refurbishments also increase the risk. Parenchymal pulmonary infection is the most common (~75%), and bronchial, sinus, cerebral, and disseminated disease are less common. Typical pulmonary features of fever, dyspnea, cough, and hemoptysis are seen in most patients, but 20% have non-specific general features of illness. Non-specific infiltrates and pulmonary nodules are the commonest radiological features, with bilateral disease carrying a worse prognosis. Bronchoscopy for direct microscopy, fungal culture, and Aspergillus antigen are the fastest means of establishing the diagnosis; a positive serum Aspergillus antigen presages a worse outcome. Standard therapy includes voriconazole, isavuconazole, or posaconazole, with great attention necessary to assess likely drug-drug interactions. Liposomal amphotericin B and echinocandins are less effective. A reduction in or stopping immunosuppression needs careful consideration, given the overall mortality of IA in renal-transplanted patients; continuing corticosteroid after the diagnosis of IA increases mortality by 2.5 times. Surgical resection or the addition of a gamma interferon should also be considered.
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Affiliation(s)
- Liyanage Shamithra Madhumali Sigera
- Division of Evolution, Genomics and Infection, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester M13 9PL, UK
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3
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Bidula S, Sexton DW, Schelenz S. Serum opsonin ficolin-A enhances host-fungal interactions and modulates cytokine expression from human monocyte-derived macrophages and neutrophils following Aspergillus fumigatus challenge. Med Microbiol Immunol 2016; 205:133-42. [PMID: 26337048 DOI: 10.1007/s00430-015-0435-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
Abstract
Invasive aspergillosis is a devastating invasive fungal disease associated with a high mortality rate in the immunocompromised, such as leukaemia patients, transplant patients and those with HIV/AIDS. The rodent serum orthologue of human L-ficolin, ficolin-A, can bind to and opsonize Aspergillus fumigatus, the pathogen that causes invasive aspergillosis, and may participate in fungal defence. Using human monocyte-derived macrophages and neutrophils isolated from healthy donors, we investigated conidial association and fungal viability by flow cytometry and microscopy. Additionally, cytokine production was measured via cytometric bead arrays. Ficolin-A opsonization was observed to significantly enhance association of conidia, while also inhibiting hyphal growth and contributing to increased fungal killing following incubation with monocyte-derived macrophages and neutrophils. Additionally, ficolin-A opsonization was capable of manifesting a decrease in IL-8, IL-1β, IL-6, IL-10 and TNF-α production from MDM and IL-1β, IL-6 and TNF-α from neutrophils 24 h post-infection. In conclusion, rodent ficolin-A is functionally comparable to human L-ficolin and is capable of modulating the innate immune response to A. fumigatus, down-regulating cytokine production and could play an important role in airway immunity.
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Affiliation(s)
- Stefan Bidula
- Biomedical Research Centre, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
- Aberdeen Fungal Group, School of Medical Sciences, Institute of Medical Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Darren W Sexton
- Biomedical Research Centre, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
- School of Pharmacy and Biomolecular Science, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Silke Schelenz
- Biomedical Research Centre, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
- Department of Microbiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
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4
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Shannon EM, Reid MJA, Chin-Hong P. Late aspergilloma of a renal allograft without need for operative management: a case report and review of the literature. Transpl Infect Dis 2016; 18:261-5. [PMID: 26751414 DOI: 10.1111/tid.12495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/13/2015] [Accepted: 11/01/2015] [Indexed: 01/16/2023]
Abstract
Aspergillus infection localized to the renal allograft is a rare and potentially life-threatening infection and typically requires a combination of operative and medical management. We report the case of a renal allograft aspergilloma in a renal transplant patient presenting 2 years post transplant, successfully managed non-surgically. To our knowledge, this is the first report of a patient presenting with an allograft aspergilloma so long after transplantation and being successfully managed with antifungal therapy alone.
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Affiliation(s)
- E M Shannon
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - M J A Reid
- Division of Infectious Disease, Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - P Chin-Hong
- Division of Infectious Disease, Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, California, USA
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5
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Bidula S, Sexton DW, Yates M, Abdolrasouli A, Shah A, Wallis R, Reed A, Armstrong-James D, Schelenz S. H-ficolin binds Aspergillus fumigatus leading to activation of the lectin complement pathway and modulation of lung epithelial immune responses. Immunology 2015; 146:281-91. [PMID: 26133042 DOI: 10.1111/imm.12501] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 01/07/2023] Open
Abstract
Aspergillus fumigatus is an opportunistic fungal pathogen that typically infects the lungs of immunocompromised patients leading to a high mortality. H-Ficolin, an innate immune opsonin, is produced by type II alveolar epithelial cells and could participate in lung defences against infections. Here, we used the human type II alveolar epithelial cell line, A549, to determine the involvement of H-ficolin in fungal defence. Additionally, we investigated the presence of H-ficolin in bronchoalveolar lavage fluid from transplant patients during pneumonia. H-Ficolin exhibited demonstrable binding to A. fumigatus conidia via l-fucose, d-mannose and N-acetylglucosamine residues in a calcium- and pH-dependent manner. Moreover, recognition led to lectin complement pathway activation and enhanced fungal association with A549 cells. Following recognition, H-ficolin opsonization manifested an increase in interleukin-8 production from A549 cells, which involved activation of the intracellular signalling pathways mitogen-activated protein kinase MAPK kinase 1/2, p38 MAPK and c-Jun N-terminal kinase. Finally, H-ficolin concentrations were significantly higher in bronchoalveolar lavage fluid of patients with lung infections compared with control subjects (n = 16; P = 0·00726). Receiver operating characteristics curve analysis further highlighted the potential of H-ficolin as a diagnostic marker for lung infection (area under the curve = 0·77; P < 0·0001). Hence, H-ficolin participates in A. fumigatus defence through the activation of the lectin complement pathway, enhanced fungus-host interactions and modulated immune responses.
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Affiliation(s)
- Stefan Bidula
- Biomedical Research Centre, Norwich Medical School, University of East Anglia, Norwich, UK.,Aberdeen Fungal Group, School of Medical Sciences, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Darren W Sexton
- Biomedical Research Centre, Norwich Medical School, University of East Anglia, Norwich, UK.,School of Pharmacy and Biomolecular Science, Liverpool John Moores University, Liverpool, UK
| | - Matthew Yates
- Biomedical Research Centre, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alireza Abdolrasouli
- Section of Infectious Diseases and Immunity, Imperial College London, London, UK
| | - Anand Shah
- Section of Infectious Diseases and Immunity, Imperial College London, London, UK
| | - Russell Wallis
- Departments of Infection, Immunity and Inflammation and Biochemistry, University of Leicester, Leicester, UK
| | - Anna Reed
- Department of Lung Transplantation, Harefield Hospital, Middlesex, UK
| | | | - Silke Schelenz
- Biomedical Research Centre, Norwich Medical School, University of East Anglia, Norwich, UK.,Department of Microbiology, Royal Brompton Hospital, London, UK
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6
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Bidula S, Sexton DW, Abdolrasouli A, Shah A, Reed A, Armstrong-James D, Schelenz S. The serum opsonin L-ficolin is detected in lungs of human transplant recipients following fungal infections and modulates inflammation and killing of Aspergillus fumigatus. J Infect Dis 2015; 212:234-46. [PMID: 25612732 DOI: 10.1093/infdis/jiv027] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 01/08/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) is a life-threatening systemic fungal infection in immunocompromised individuals that is caused by Aspergillus fumigatus. The human serum opsonin, L-ficolin, has been observed to recognize A. fumigatus and could participate in fungal defense. METHODS Using lung epithelial cells, primary human monocyte-derived macrophages (MDMs), and neutrophils from healthy donors, we assessed phagocytosis and killing of L-ficolin-opsonized live A. fumigatus conidia by flow cytometry and microscopy. Additionally, cytokines were measured by cytometric bead array, and L-ficolin was measured in bronchoalveolar lavage (BAL) fluid from lung transplant recipients by enzyme-linked immunosorbent assay. RESULTS L-ficolin opsonization increased conidial uptake and enhanced killing of A. fumigatus by MDMs and neutrophils. Opsonization was also shown to manifest an increase in interleukin 8 release from A549 lung epithelial cells but decreased interleukin 1β, interleukin 6, interleukin 8, interleukin 10, and tumor necrosis factor α release from MDMs and neutrophils 24 hours after infection. The concentration of L-ficolin in BAL fluid from patients with fungal infection was significantly higher than that for control subjects (P = .00087), and receiving operating characteristic curve analysis highlighted the diagnostic potential of L-ficolin for lung infection (area under the curve, 0.842; P < .0001). CONCLUSIONS L-ficolin modulates the immune response to A. fumigatus. Additionally, for the first time, L-ficolin has been demonstrated to be present in human lungs.
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Affiliation(s)
- Stefan Bidula
- Biomedical Research Centre, Norwich Medical School, University of East Anglia, Norwich
| | - Darren W Sexton
- Biomedical Research Centre, Norwich Medical School, University of East Anglia, Norwich
| | | | - Anand Shah
- Section of Infectious Diseases and Immunity, Imperial College London
| | - Anna Reed
- Department of Lung Transplantation, Harefield Hospital, Middlesex, United Kingdom
| | | | - Silke Schelenz
- Biomedical Research Centre, Norwich Medical School, University of East Anglia, Norwich Department of Microbiology, Royal Brompton Hospital, London
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7
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Ivastinovic D, El-Shabrawi Y, Ardjomand N. Endogenous endophthalmitis after carotid endarterectomy due to exudative macular degeneration. Wien Klin Wochenschr 2014; 127:146-8. [PMID: 25409946 DOI: 10.1007/s00508-014-0642-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022]
Abstract
A 78-year-old male patient with unilateral exudative macular degeneration developed endogenous endophthalmitis 11 days after carotid endarterectomy. The endophthalmitis could not be treated by intravitreal application of antibiotics. The patient underwent vitrectomy and systemic application of vancomycin. Six days later, the eye was quiet and the patient was discharged with a visual acuity of 0.9 logMAR.Patients with exudative macular degeneration have a higher risk for developing endogenous endophthalmitis after vascular surgery of the carotid arteries and prolonged postoperative application of systemic antibiotics might be considered in these patients.
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Affiliation(s)
- Domagoj Ivastinovic
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
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8
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Abstract
In susceptible patients, invasive aspergillosis has a high incidence and a mortality of up to 80%. The diagnosis of this condition is difficult, especially in the early stages of the disease and, as a consequence, antifungal therapy, despite its expense and toxicity, is often initiated empirically. Until recently, there were very few effective antifungal agents for established invasive aspergillosis, but the introduction of two new drugs, voriconazole and caspofungin, has increased the treatment options. These newer antifungal therapies, combined with improved early diagnosis due to the introduction of newer microbiologic techniques, offer the hope that there will be a significant improvement in the substantial morbidity and mortality associated with invasive aspergillosis over the next 5 years.
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Affiliation(s)
- S R Doffman
- Barts & the London NHS Trust, West Smithfield, London, EC1A 7BE, UK.
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9
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Gratieri T, Gelfuso GM, Lopez RFV, Souto EB. Current efforts and the potential of nanomedicine in treating fungal keratitis. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.10.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Cheng HH, Ding Y, Wu M, Tang CC, Zhang RJ, Lin XF, Xu JT. Endogenous aspergillus endophthalmitis after kidney transplantation. Int J Ophthalmol 2011; 4:567-71. [PMID: 22553722 DOI: 10.3980/j.issn.2222-3959.2011.05.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 09/23/2011] [Indexed: 11/02/2022] Open
Abstract
Endogenous aspergillus endophthalmitis(EAE) after kidney transplant is a rare but important clinical problem due to potentially devastating consequences. Early diagnosis of EAE, timely removal of affected vitreous by vitrectomy, proper anti-fungal treatment, all contributed to the successful control of the disease. Therapeutic success of EAE in post-transplant patients depends largely on prompt diagnosis. Definite diagnosis of EAE is based on positive culture results of vitreous specimen, while fundoscopy and B scan ultrasound may aid early diagnosis. In terms of anti-fungal medicine, amphotericin B has long been the first choice, but its systemic applicaiton has severe adverse reactions, especially for patients with impaired renal function. Herein, we report the treatment modality of EAE after kidney transplant with vitrectomy, systemic administration of micafungin plus voriconazole, topical application of fluconazol and amphotercin B.
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Affiliation(s)
- Huan-Huan Cheng
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China
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11
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Vergoulidou M, Krause L, Foerster MH, Thiel E, Schwartz S. Endogenous filamentous fungal endophthalmitis--single-centre survey in patients with acute leukaemia or postallogeneic stem cell transplantation and review of the literature. Mycoses 2011; 54:e704-11. [PMID: 21605192 DOI: 10.1111/j.1439-0507.2010.02004.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endogenous endophthalmitis caused by filamentous fungi has been infrequently described and its prognosis in immunocompromised patients is largely unknown. Patients were identified through a single-centre database containing patients with endophthalmitis. Cases published since 2002 were reviewed. Clinical and treatment features as well as outcomes were analysed. Six patients were identified from the database. Underlying conditions were haematological malignancies (HM) and/or allogeneic haematopoietic stem cell transplantation (HSCT). Three patients underwent vitrectomy. None of the patients survived and the median time from first evidence of endophthalmitis until death was 33 days. The median time from first evidence of an invasive fungal infection to endophthalmitis was only 5 days. Fifty-six patients were identified from the literature. The majority of these patients underwent vitrectomy (27) or enucleation (10) and received intraocular antifungal therapy (28). Only 13 (23%) of 56 patients experienced an improved vision. The survival rate was 52% in all 56 patients but was significantly less in patients with HM or post-HSCT when compared with all others (26% vs. 70%, respectively; P = 0.003). Endogenous endophthalmitis caused by filamentous fungi is frequently associated with a permanent decrease or loss of vision. This type of fungal infection carries a particular poor prognosis in patients with profound immunosuppression, requiring improved treatment strategies.
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Affiliation(s)
- Maria Vergoulidou
- Department of Hematology and Oncology, Charité-Campus Benjamin Franklin, Berlin, Germany
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12
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Schwartz S, Reisman A, Troke PF. The efficacy of voriconazole in the treatment of 192 fungal central nervous system infections: a retrospective analysis. Infection 2011; 39:201-10. [PMID: 21512792 DOI: 10.1007/s15010-011-0108-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 03/29/2011] [Indexed: 10/18/2022]
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13
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Endogenous endophthalmitis associated with intravenous drug abuse: seven-year experience at a tertiary referral center. Retina 2011; 30:1721-5. [PMID: 20829741 DOI: 10.1097/iae.0b013e3181dd6db6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Intravenous drug use (IVDU) is a known risk factor for endogenous endophthalmitis. Endogenous fungal endophthalmitis (EFE) is emerging as a common problem among this community. We describe the management and visual outcomes of acute IVDU-associated EFE. METHODS A prospective consecutive case series of 19 patients presenting with presumed acute IVDU-associated EFE from 2001 to 2007 to the Royal Victorian Eye and Ear Hospital was included. All data were collected in a standardized manner. Outcome measures included visual acuity, microbial profiles, and vitrectomy rate. RESULTS Nineteen cases of IVDU-associated EFE were identified. Eight of these (42%) were men, and the mean age was 32.7 years (SD ± 8.0 years). Presenting visual acuity ranged from 6/6 to perception of light, with 58% having a visual acuity of 6/48 or less at presentation. Thirteen (68.4%) were culture positive with all cultures identifying Candida species, and 52.7% underwent vitrectomy. Fifty percent of subjects overall achieved a final visual acuity of 6/18 or better. Men demonstrated improved visual acuity when compared with women (P = 0.04). Age had no effect on final acuity. CONCLUSION Intravenous drug use is a significant risk factor for developing EFE. Good visual outcomes can be achieved with early treatment, often with intravitreal therapy alone.
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14
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Ballonzoli L, Bourcier T. [Ocular side effects of steroids and other immunosuppressive agents]. Therapie 2010; 65:115-20. [PMID: 20478243 DOI: 10.2515/therapie/2010002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 01/02/2010] [Indexed: 11/20/2022]
Abstract
The increasing use of immunosuppressive (IS) drugs in transplants or in systemic diseases, implies a long period of treatment and to be aware of possible side effects. These drugs can be used alone or in combination with steroids. This review deals with the issue of ocular side effects of the most used IS drugs, including steroids. Data were collected from Medline using Pubmed software. We first describe specific complication of each drug and then conclude on major common toxicity represented by opportunistic infections and induced cancers.
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15
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Hashemi S, Shishegar M, Nikeghbalian S, Salahi H, Bahador A, Kazemi K, Dehghani M, Kakaei F, Gholami S, Janghorban P, Malek-Hosseini S. Endogenous Aspergillus Endophthalmitis Occurring After Liver Transplantation: A Case Report. Transplant Proc 2009; 41:2933-5. [DOI: 10.1016/j.transproceed.2009.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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17
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Del Pozo JL, van de Beek D, Daly RC, Pulido JS, McGregor CGA, Patel R. Incidence and clinical characteristics of ocular infections after heart transplantation: a retrospective cohort study. Clin Transplant 2009; 23:484-9. [PMID: 19573087 DOI: 10.1111/j.1399-0012.2009.01026.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ocular infections associated with organ transplantation are well documented following renal and liver transplantation; however, few studies have reported ocular infections following heart transplant. METHODS We retrospectively studied patients who underwent heart transplantation in the Mayo Clinic Cardiac Transplant Program from January 1st 1988 through June 30th 2006. RESULTS We report the frequency and type of ocular infections among 313 heart transplant recipients. There were eight patients (2.5%) diagnosed with ocular infections including three cases of ophthalmic zoster, one case of cytomegalovirus retinitis, one case of Aspergillus fumigatus endophthalmitis, one case of Haemophilus influenzae conjunctivitis, one case of blepharitis, and one case of preseptal orbital cellulitis. CONCLUSIONS Ocular infections are rare after heart transplantation and usually present within the first year post-transplantation. The majority can be regarded as opportunistic infections which may be indicative of infections at other body sites. Ocular infections after heart transplantation may be associated with significant morbidity and visual loss if not promptly diagnosed.
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Affiliation(s)
- Jose L Del Pozo
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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18
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Fatal case of invasive aspergillosis and cytomegalovirus coinfection after kidney transplantation inside the Eurotransplant Senior Program. J Mycol Med 2009. [DOI: 10.1016/j.mycmed.2008.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Cheung CY, Wu TC, Chan YH, Lee KC, Chan HW, Chau KF, Li CS. Coexisting Cutaneous Aspergillosis and Pulmonary Tuberculosis in a Renal Transplant Recipient. Int J Organ Transplant Med 2008. [DOI: 10.1016/s1561-5413(08)60025-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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20
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Guerin M, Orazakai A, Cross KS, Beatty S. Endogenous endophthalmitis following ipsilateral carotid endarterectomy. Ir J Med Sci 2008; 177:73-4. [PMID: 18274818 DOI: 10.1007/s11845-008-0114-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2007] [Accepted: 01/08/2008] [Indexed: 11/26/2022]
Abstract
We report a case involving a 75-year-old lady who presented to our department of ophthalmology complaining of a 1 day history of ocular pain and reduced vision in the right eye, associated with rigors and diarrhoea. This patient, who had undergone a right carotid endarterectomy (CEA) 4 days previously, was subsequently confirmed to have developed endogenous endophthalmitis. To our knowledge, endogenous endopthalmitis has not previously been described as a postoperative complication of CEA, and should be considered in patients presenting with ocular complaints after this type of surgery.
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Affiliation(s)
- M Guerin
- Department of Ophthalmology, Waterford Regional Hospital, Waterford, Ireland.
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21
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Gabardi S, Kubiak DW, Chandraker AK, Tullius SG. Invasive fungal infections and antifungal therapies in solid organ transplant recipients. Transpl Int 2007; 20:993-1015. [PMID: 17617181 DOI: 10.1111/j.1432-2277.2007.00511.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This manuscript will review the risk factors, prevalence, clinical presentation, and management of invasive fungal infections (IFIs) in solid organ transplant (SOT) recipients. Primary literature was obtained via MEDLINE (1966-April 2007) and EMBASE. Abstracts were obtained from scientific meetings or pharmaceutical manufacturers and included in the analysis. All studies and abstracts evaluating IFIs and/or antifungal therapies, with a primary focus on solid organ transplantation, were considered for inclusion. English-language literature was selected for inclusion, but was limited to those consisting of human subjects. Infectious complications following SOT are common. IFIs are associated with high morbidity and mortality rates in this patient population. Determining the best course of therapy is difficult due to the limited availability of data in SOT recipients. Well-designed clinical studies are infrequent and much of the available information is often based on case-reports or retrospective analyses. Transplant practitioners must remain aware of their therapeutic options and the advantages and disadvantages associated with the available treatment alternatives.
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Affiliation(s)
- Steven Gabardi
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, USA.
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22
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Veroux M, Corona D, Gagliano M, Sorbello M, Macarone M, Cutuli M, Giuffrida G, Morello G, Paratore A, Veroux P. Voriconazole in the Treatment of Invasive Aspergillosis in Kidney Transplant Recipients. Transplant Proc 2007; 39:1838-40. [PMID: 17692627 DOI: 10.1016/j.transproceed.2007.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aspergillosis and other invasive mold infections are severe complications in immunosuppressed patients, and in renal transplant patients it is the most common cause of systemic fungal disease with an incidence ranging from 0.4% to 2.4% with a high mortality of 56% to 100%. We present our experience with voriconazole in a population of kidney transplant recipients with invasive aspergillosis. PATIENTS AND METHODS From January 2002 to December 2005, 245 kidney transplantations were performed. RESULTS Four patients (1.6%) presented with clinical and laboratory findings of invasive aspergillosis. Three patients presented with pulmonary aspergillosis, while one patient presented with pulmonary and ocular aspergillosis. All patients underwent a therapy with voriconazole 200 mg twice a day, in combination with caspofungin in one patient. All patients are alive, with no clinical recurrence of aspergillosis at a median follow-up of 13 months. One patient lost her graft due to discontinuation of immunosuppression. CONCLUSIONS Voriconazole is a potent and well-tolerated antifungal drug that is extremely efficacious in the treatment of invasive aspergillosis in kidney transplant recipients. A careful monitoring of immunosuppressive drugs should be considered to avoid nephrotoxicity.
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Affiliation(s)
- M Veroux
- Department of Surgery, Transplantation and Advanced Technologies, Organ Transplant Unit, University Hospital of Catania, Catania, Italy.
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23
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Morand K, Bartoletti AC, Bochot A, Barratt G, Brandely ML, Chast F. Liposomal amphotericin B eye drops to treat fungal keratitis: physico-chemical and formulation stability. Int J Pharm 2007; 344:150-3. [PMID: 17669608 DOI: 10.1016/j.ijpharm.2007.04.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 04/25/2007] [Indexed: 10/23/2022]
Abstract
Local fungal infections with Candida, Fusarium, Curvularia and Aspergillus can lead to serious ulceration of the cornea and must be treated rapidly. The current treatment consists of 0.15% (w/v) amphotericin B eye drops prepared from Fungizone, containing deoxycholate, irritant for the cornea, which reduces patient compliance. Eye drops based on liposomal amphotericin B (AmBisome would be a convenient alternative; however, according to the manufacturer's instructions, AmBisome can only be kept refrigerated for 1 week after reconstitution. A longer shelf-life at ambient temperature would be preferable for a preparation made in a hospital pharmacy and delivered to patients. Thus, the possibility of storing an ophthalmic preparation of 0.5% (w/v) liposomal amphotericin B after reconstitution was investigated. After 6 months at room temperature or at +2-8 degrees C, the hydrodynamic diameter measured by quasi-elastic light scattering remained constant at 108 +/- 30 nm with a polydispersity index lower than 0.15. Amphotericin B content, checked by a validated HPLC method, was maintained between 94 and 107%. Amphotericin B and soy phosphatidylcholine proportions remained constant, indicating that the liposomes remained intact and retained the drug. These results show the feasibility of an ophthalmic preparation based on liposomal amphotericin B developed in hospital pharmacies.
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Affiliation(s)
- K Morand
- Service de Pharmacie, Hôpital Hôtel-Dieu, 1 Place du Parvis Notre Dame, 75181 Paris, France
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24
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Muñoz P, Guinea J, Bouza E. Update on invasive aspergillosis: clinical and diagnostic aspects. Clin Microbiol Infect 2006. [DOI: 10.1111/j.1469-0691.2006.01603.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Kramer M, Kramer MR, Blau H, Bishara J, Axer-Siegel R, Weinberger D. Intravitreal Voriconazole for the Treatment of Endogenous Aspergillus Endophthalmitis. Ophthalmology 2006; 113:1184-6. [PMID: 16713628 DOI: 10.1016/j.ophtha.2006.01.059] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Revised: 01/28/2006] [Accepted: 01/31/2006] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe the first use of intravitreal voriconazole in a human eye for the treatment of Aspergillus endophthalmitis. DESIGN Interventional case report. PATIENT A 22-year-old woman receiving immunosuppressive agents 5 weeks after lung transplantation who presented with blurred vision and redness in the right eye. INTERVENTIONS Intravitreal injection of voriconazole (100 microg/0.1 ml) with pars plana vitrectomy, given after isolation of A. terreus in the vitreous sample. Previous treatment modalities, including vitrectomy with repeated intravitreal amphotericin B and systemic voriconazole, failed to prevent deterioration. MAIN OUTCOME MEASURES Visual acuity (VA) and ocular inflammation. RESULTS Significant improvement was observed in VA (to 6/15) and in ocular inflammatory reaction. The patient recovered with no evidence of systemic fungal infection. CONCLUSION Intravitreal voriconazole may be used as an adjunct to systemic treatment in patients with Aspergillus endophthalmitis. Further clinical studies are needed to determine how often this approach can safely treat this condition.
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Affiliation(s)
- Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel.
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26
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Bétis F, Lassalle S, Gastaud P, Hofman P. Granulomatous endophthalmitis caused by Aspergillus fumigatus mimicking intraocular carcinoma metastasis. Pathology 2006; 38:71-2. [PMID: 16484013 DOI: 10.1080/00313020500466537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Siu YP, Leung KT, Tong MKH, Kwok YL, Wong PK, Kwan TH. Fatal case of Aspergillus coinfection in a renal transplant recipient suffering from cytomegalovirus pneumonitis (Case Report). Nephrology (Carlton) 2005; 10:619-22. [PMID: 16354248 DOI: 10.1111/j.1440-1797.2005.00459.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cytomegalovirus (CMV) disease is common in postrenal transplant recipients, and may predispose the patients to secondary bacterial or fungal infections. However, simultaneous coinfection is rare and often makes diagnosis difficult. We report a case of CMV pneumonitis in a renal transplant recipient presenting with elevated CMV pp65 antigen level and abnormal chest radiograph. Despite potent and broad-spectrum antimicrobial therapy, his condition deteriorated rapidly - he soon went into respiratory failure, septic shock and died several days later. Transbronchial biopsy and bronchoalveolar lavage obtained before the patient's death showed evidence of invasive pulmonary aspergillosis with concomitant CMV pneumonitis. High index of suspicion and early and empirical initiation of antifungal therapy may be necessary for successful management of fulminant pneumonia in solid organ transplant recipients.
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Affiliation(s)
- Yui-Pong Siu
- Department of Medicine, Tuen Mun Hospital, Hong Kong, China
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28
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Ribeiro SCC, Santana ANC, Arriagada GH, Martins JEC, Takagaki TY. A novel cause of invasive pulmonary infection in an immunocompetent patient: Aspergillus candidus. J Infect 2005; 51:e195-7. [PMID: 16291268 DOI: 10.1016/j.jinf.2005.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 02/18/2005] [Indexed: 11/26/2022]
Abstract
Aspergillus candidus, a common contaminant of grain dust, may represent an important respiratory hazard to grain workers, considering its immunomodulating capability by producing p-terphenyl metabolites and terprenins, potent cytotoxic substances. However, there are only three cases of A. candidus infection in the English literature, one fatal solitary brain mass and two onychomycosis. We describe the first case of invasive pulmonary infection and skin abscesses due to A. candidus, determination of minimal inhibitory concentration for anti-fungals, and the successful treatment with liposomal amphotericin B and itraconazole. Possible mechanisms involved in the dissemination of infection in an immunocompetent host are discussed.
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Affiliation(s)
- S C C Ribeiro
- Pulmonary Division, University of São Paulo Medical School, São Paulo, SP, Brazil
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29
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Leibovitch I, Lai T, Raymond G, Zadeh R, Nathan F, Selva D. Endogenous endophthalmitis: a 13-year review at a tertiary hospital in South Australia. ACTA ACUST UNITED AC 2005; 37:184-9. [PMID: 15849050 DOI: 10.1080/00365540410020965] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This retrospective report presents a series of patients with endogenous endophthalmitis treated over a 13-y period in a tertiary care centre in South Australia. 16 eyes of 13 patients (8 M, 5 F) with a mean age 62 y were included. Systemic predisposing risk factors were mainly diabetes mellitus (30.7%), chronic obstructive airway disease (23.1%) and end-stage renal disease (15.4%). Isolated organisms included fungal species in 11 eyes (7 eyes with Candida albicans and 4 with Aspergillus fumigatus), Gram-positive isolates in 4 eyes, and Pseudomonas aeruginosa in 1 eyes. Presenting visual acuity was 20/200 or lower in 8 patients (61.5%). Final visual improvement of more than 2 lines was noted in 5 patients, it was stable or worse in 6 patients and in 2 patients the eye was either enucleated or eviscerated. Systemic aspergillosis resulted in death of both patients. In conclusion, the clinical course and microbiological profile of pathogens in patients with endogenous endophthalmitis in our series are similar to other recent western reports. Candida species are the leading isolates, with an overall poor visual prognosis, especially in Aspergillus infections. Close monitoring of immune-compromised patients with systemic infections may enable early diagnosis and treatment and improve prognosis.
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Affiliation(s)
- Igal Leibovitch
- Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, South Australia.
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30
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Abstract
Aspergillus infections are occurring with an increasing frequency in transplant recipients. Notable changes in the epidemiologic characteristics of this infection have occurred; these include a change in risk factors and later onset of infection. Management of invasive aspergillosis continues to be challenging, and the mortality rate, despite the use of newer antifungal agents, remains unacceptably high. Performing molecular studies to discern new targets for antifungal activity, identifying signaling pathways that may be amenable to immunologic interventions, assessing combination regimens of antifungal agents or combining antifungal agents with modulation of the host defense mechanisms, and devising diagnostic assays that can rapidly and reliably diagnose infections represent areas for future investigations that may lead to further improvement in outcomes.
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Affiliation(s)
- Nina Singh
- University of Pittsburgh Medical Center, VA Medical Center, Infectious Disease Section, University Dr. C, Pittsburgh, PA 15240, USA. nis5+@pitt.edu
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