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Neoh CF, Chen SCA, Lanternier F, Tio SY, Halliday CL, Kidd SE, Kong DCM, Meyer W, Hoenigl M, Slavin MA. Scedosporiosis and lomentosporiosis: modern perspectives on these difficult-to-treat rare mold infections. Clin Microbiol Rev 2024; 37:e0000423. [PMID: 38551323 PMCID: PMC11237582 DOI: 10.1128/cmr.00004-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYAlthough Scedosporium species and Lomentospora prolificans are uncommon causes of invasive fungal diseases (IFDs), these infections are associated with high mortality and are costly to treat with a limited armamentarium of antifungal drugs. In light of recent advances, including in the area of new antifungals, the present review provides a timely and updated overview of these IFDs, with a focus on the taxonomy, clinical epidemiology, pathogenesis and host immune response, disease manifestations, diagnosis, antifungal susceptibility, and treatment. An expansion of hosts at risk for these difficult-to-treat infections has emerged over the last two decades given the increased use of, and broader population treated with, immunomodulatory and targeted molecular agents as well as wider adoption of antifungal prophylaxis. Clinical presentations differ not only between genera but also across the different Scedosporium species. L. prolificans is intrinsically resistant to most currently available antifungal agents, and the prognosis of immunocompromised patients with lomentosporiosis is poor. Development of, and improved access to, diagnostic modalities for early detection of these rare mold infections is paramount for timely targeted antifungal therapy and surgery if indicated. New antifungal agents (e.g., olorofim, fosmanogepix) with novel mechanisms of action and less cross-resistance to existing classes, availability of formulations for oral administration, and fewer drug-drug interactions are now in late-stage clinical trials, and soon, could extend options to treat scedosporiosis/lomentosporiosis. Much work remains to increase our understanding of these infections, especially in the pediatric setting. Knowledge gaps for future research are highlighted in the review.
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Affiliation(s)
- Chin Fen Neoh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
- The University of Sydney, Sydney, Australia
- Department of Infectious Diseases, Westmead Hospital, Sydney, Australia
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital universitaire Necker-Enfants malades, Paris, France
- National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology research group, Mycology Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Shio Yen Tio
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Catriona L Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
| | - Sarah E Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, Australia
- School of Biological Sciences, Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - David C M Kong
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, Melbourne, Australia
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- School of Medicine, Deakin University, Waurn Ponds, Geelong, Australia
| | - Wieland Meyer
- The University of Sydney, Sydney, Australia
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Translational Medical Mycology Research Group, ECMM Excellence Center for Clinical Mycology, Medical University of Graz, Graz, Austria
| | - Monica A Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
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2
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Palomba E, Colaneri M, Azzarà C, Fava M, Maccaro A, Renisi G, Viero G, Kaur H, Chakrabarti A, Gori A, Lombardi A, Bandera A. Epidemiology, Clinical Manifestations, and Outcome of Mucormycosis in Solid Organ Transplant Recipients: A Systematic Review of Reported Cases. Open Forum Infect Dis 2024; 11:ofae043. [PMID: 38887489 PMCID: PMC11181195 DOI: 10.1093/ofid/ofae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/25/2024] [Indexed: 06/20/2024] Open
Abstract
Mucormycosis is an emerging disease primarily affecting the immunocompromised host, but scarce evidence is available for solid organ transplant recipients (SOTRs). We systematically reviewed 183 cases occurring in SOTRs, exploring epidemiology, clinical characteristics, causative pathogens, therapeutic approaches, and outcomes. Kidney transplants accounted for half of the cases, followed by heart (18.6%), liver (16.9%), and lung (10.4%). Diagnosis showed a dichotomous distribution, with 63.7% of cases reported within 100 days of transplantation and 20.6% occurring at least 1 year after transplant. The 90-day and 1-year mortality rates were 36.3% and 63.4%, respectively. Disseminated disease had the highest mortality at both time points (75% and 93%). Treatment with >3 immunosuppressive drugs showed a significant impact on 90-day mortality (odds ratio [OR], 2.33; 95% CI, 1.02-5.66; P = .0493), as did a disseminated disease manifestation (OR, 8.23; 95% CI, 2.20-36.71; P = .0027) and the presence of diabetes (OR, 2.35; 95% CI, 1.01-5.65; P = .0497). Notably, prophylaxis was administered to 12 cases with amphotericin B. Further investigations are needed to validate these findings and to evaluate the potential implementation of prophylactic regimens in SOTRs at high risk.
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Affiliation(s)
- Emanuele Palomba
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Marta Colaneri
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Cecilia Azzarà
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Fava
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Maccaro
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Renisi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Viero
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Institution and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Infectious Disease and Microbiology, Doodhadhari Burfani Hospital and Research Institute, Haridwar, India
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
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3
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Sharma B, Nonzom S. Mucormycosis and Its Upsurge During COVID-19 Epidemic: An Updated Review. Curr Microbiol 2023; 80:322. [PMID: 37592083 DOI: 10.1007/s00284-023-03430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 07/26/2023] [Indexed: 08/19/2023]
Abstract
Although mucormycosis may have reached an epidemic situation during the COVID-19 pandemic, the term was much more familiar even before the COVID-19 period. The year 2020 showed an outbreak of novel coronavirus (SARS-CoV-2) which affected millions of people all over the world. One of the noticeable complications observed to be associated with this disease is mucormycosis. It is an opportunistic infection caused by members of the Order Mucorales existing worldwide and has been commonly reported as a laboratory contaminant for a long time. However, nowadays due to the changes in the host environment, they have been emerging as potent opportunistic pathogens responsible for causing primary infections or coinfections with other diseases eventually resulting in morbidity and even mortality in severe cases. Although immunocompromised patients are more susceptible to this infection, few cases have been reported in immunocompetent individuals. Various risk factors which are responsible for the acquisition of mucormycosis include diabetes mellitus type 2, ketoacidosis, hematological malignancies, organ transplants, and chemotherapy recipients. Among the various etiological agents, Rhizopus is found to be the most common, and rhino-cerebral to be the most frequent clinical presentation. As far as pathogenesis is concerned, host cell invasion, thrombosis, and necrosis are the main events in the progression of this disease. The aim of the present review is to address a complete spectrum of mucormycosis and COVID-19-associated mucormycosis (CAM) in a single article. Both global and Indian scenarios of mucormycosis are taken into account while framing this review.
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Affiliation(s)
- Bharti Sharma
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India
| | - Skarma Nonzom
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India.
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4
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Dos Santos UR, Dos Santos JL. Trichoderma after crossing kingdoms: infections in human populations. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2023; 26:97-126. [PMID: 36748123 DOI: 10.1080/10937404.2023.2172498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Trichoderma is a saprophytic fungus that is used worldwide as a biocontrol and biofertilizer agent. Although considered nonpathogenic until recently, reports of human infections produced by members of the Trichoderma genus are increasing. Numerous sources of infection were proposed based upon patient data and phylogenetic analysis, including air, agriculture, and healthcare facilities, but the deficit of knowledge concerning Trichoderma infections makes patient treatment difficult. These issues are compounded by isolates that present profiles which exhibit high minimum inhibitory concentration values to available antifungal drugs. The aim of this review is to present the global distribution and sources of infections that affect both immunocompetent and immunocompromised hosts, clinical features, therapeutic strategies that are used to treat patients, as well as highlighting treatments with the best responses. In addition, the antifungal susceptibility profiles of Trichoderma isolates that have emerged in recent decades were examined and which antifungal drugs need to be further evaluated as potential candidates to treat Trichoderma infections are also indicated.
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Affiliation(s)
- Uener Ribeiro Dos Santos
- Immunobiology Laboratory, Department of Biological Science, State University of Santa Cruz, Ilhéus, BA, Brazil
| | - Jane Lima Dos Santos
- Immunobiology Laboratory, Department of Biological Science, State University of Santa Cruz, Ilhéus, BA, Brazil
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5
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Seth A, Patil SS, Axelrod D, Singh H, Sharma A, Kenwar DB, Vaiphei K, Mandwar M, Rally S, Singh S. Outcomes after lung resection in renal transplant patients with pulmonary mucormycosis. Clin Transplant 2022; 36:e14689. [PMID: 35477936 DOI: 10.1111/ctr.14689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/01/2022]
Abstract
Pulmonary mucormycosis has been associated with high mortality (reported up to 100%) in renal transplant recipients. This was a retrospective analysis of renal transplant patients with pulmonary mucormycosis between April 2014 - March 2020, who underwent surgical resection of the affected lung along with liposomal amphotericin therapy. Patients with lower respiratory illness features underwent chest X-ray, high-resolution computed tomography of the chest, and those with suspicious findings underwent analysis of bronchioloalveolar fluid and transbronchial lung biopsy. Patients with histological or microbiological evidence of mucormycosis were started on liposomal Amphotericin B. Tacrolimus and mycophenolate mofetil were stopped at the time of diagnosis. Patients were taken up for surgical resection of the affected part of the lung. Ten patients underwent combined management, while five patients were managed medically. At last follow up, seven out of ten patients (70%) who underwent combined management and two of the five patients (40%) who were managed medically, had a mean survival of 28.86 months (sd = 15.71, median = 25) and 14.17 months (sd = 12.21, median = 18), respectively, post-diagnosis of pulmonary mucormycosis. Surgical resection combined with antifungals in the perioperative period and decreased immunosuppression may improve the outcomes in renal transplant patients with pulmonary mucormycosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Abhinav Seth
- Abdominal Transplant Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, Iowa City, Iowa, USA
| | - Shivakumar S Patil
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
| | - David Axelrod
- Abdominal Transplant Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, Iowa City, Iowa, USA
| | - Harkant Singh
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Research and Education, Sector-12, Chandigarh, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
| | - Deepesh Benjamin Kenwar
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
| | - Kim Vaiphei
- Department of Pathology, Postgraduate Institute of Medical Research and Education, Research Block A, Sector-12, Chandigarh, India
| | - Milind Mandwar
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
| | - Sahil Rally
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
| | - Sarbpreet Singh
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
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6
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Trichodermosis: Human Infections Caused by Trichoderma Species. Fungal Biol 2022. [DOI: 10.1007/978-3-030-91650-3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Muthu V, Agarwal R, Dhooria S, Sehgal IS, Prasad KT, Aggarwal AN, Chakrabarti A. Has the mortality from pulmonary mucormycosis changed over time? A systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:538-549. [PMID: 33418022 DOI: 10.1016/j.cmi.2020.12.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/25/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Pulmonary mucormycosis (PM) is increasingly being reported in immunocompromised patients and has a high mortality. Our aim was to assess the mortality of PM and its trend over time. We also evaluated the role of combined medical-surgical therapy in PM. METHODS We performed a systematic review of Pubmed, Embase, and Cochrane central databases. Studies were eligible if they described at least five confirmed cases of PM and reported mortality. We also assessed the effect of combined medical-surgical therapy versus medical treatment alone on PM mortality. We used a random-effects model to estimate the pooled mortality of PM and compared it across three time periods. The factors influencing mortality were assessed using meta-regression. We evaluated the risk difference (RD) of death in the following: subjects undergoing combined medical-surgical therapy versus medical therapy alone, subjects with isolated PM versus disseminated disease, and PM in diabetes mellitus (DM) versus non-DM as a risk factor. RESULTS We included 79 studies (1544 subjects). The pooled mortality of PM was 57.1% (95% confidence interval [CI] 51.7-62.6%). Mortality improved significantly over time (72.1% versus 58.3% versus 49.8% for studies before 2000, 2000-2009, and 2010-2020, respectively, p 0.00001). This improved survival was confirmed in meta-regression after adjusting for the study design, the country's income level, and the sample size. Combined medical-surgical therapy was associated with a significantly lower RD (95%CI) of death: -0.32 (-0.49 to -0.16). The disseminated disease had a higher risk of death than isolated PM, but DM was not associated with a higher risk of death than other risk factors. CONCLUSIONS While PM is still associated with high mortality, we noted improved survival over time. Combined medical-surgical therapy improved survival compared to medical treatment alone.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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8
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Thatipelli S, Santoiemma P, Echenique IA, Green R, Ison MG, Ladner D, Kanwar YS, Stosor V. Donor-derived renal allograft mucormycosis in a combined liver and kidney transplantation: Case report and review of the literature. Transpl Infect Dis 2020; 23:e13534. [PMID: 33251715 DOI: 10.1111/tid.13534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/13/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Abstract
Mucormycosis infrequently may present with isolated renal involvement. Among solid organ transplant recipients, renal allograft mucormycosis has been most often associated with medical tourism or transplantation outside of the western world. We report a case of an HIV/HCV co-infected woman who underwent simultaneous liver and kidney transplantation with a Public Health Service increased risk donor organ. 16 days after transplant, she developed massive hematuria and was found to have renal allograft Rhizopus spp. involvement, we surmise to have been from donor-derived infection. Therapy included nephrectomy, debridement, liposomal amphotericin B, and posaconazole with survival. We reviewed PubMed indexed, English-language cases of isolated renal mucormycosis in general, in HIV/AIDS, and from donor-derived renal allograft infections.
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Affiliation(s)
- Sneha Thatipelli
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phillip Santoiemma
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Richard Green
- Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Northwestern University Transplant Outcomes Research Collaboration, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniela Ladner
- Northwestern University Transplant Outcomes Research Collaboration, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yashpal S Kanwar
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Northwestern University Transplant Outcomes Research Collaboration, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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9
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Zhang H, Wang K, Chen H, Sun L, Wang Z, Fei S, Tan R, Gu M. The Double-Edged Sword of Immunosuppressive Therapy in Kidney Transplantation: A Rare Case Report of Pulmonary Mucormycosis Post-Transplant and Literature Review. Front Med (Lausanne) 2020; 7:500. [PMID: 33072770 PMCID: PMC7538690 DOI: 10.3389/fmed.2020.00500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022] Open
Abstract
Immunosuppressive therapy is improving the graft survival of kidney transplant recipients and increasing the potential risk of infection. Pulmonary mucormycosis is a rare post-operative infection complication characterized with rapid deterioration and high mortality. In this case, a 33-year-old patient underwent a kidney transplantation with regular immunosuppressive therapy. Soon, 38 days post-transplant, pulmonary patchy shadows can be seen in the radiological examination and rounded into a large cavity formation with splenic rupture 25 days later. The diagnosis of mucormycosis was confirmed by lung biopsy and spleen histopathology. This case is a reminder that early diagnosis is imperative, meanwhile, rational antifungal therapy, timely elimination of immunosuppressants, and alternatively, abandoning the graft should be prudently assessed in the treatment of mucormycosis.
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Affiliation(s)
- Hengcheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Transplantation Research Center, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ke Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Chen
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Sun
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zijie Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuang Fei
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruoyun Tan
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Gu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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10
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Wand O, Unterman A, Izhakian S, Fridel L, Kramer MR. Mucormycosis in lung transplant recipients: A systematic review of the literature and a case series. Clin Transplant 2020; 34:e13774. [PMID: 31860739 DOI: 10.1111/ctr.13774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mucormycosis is a rare infection in lung transplant recipients (LTR). Our objective was to better define the clinical presentation and optimal management of this frequently lethal infection. METHODS A systematic review of the literature was performed to identify all published cases of mucormycosis in LTR using PubMed/MEDLINE. These cases were analyzed together with a new case series from our clinic. RESULTS Literature search yielded 44 articles matching the inclusion criteria, describing 121 cases. Six additional cases were identified from our clinic. Data regarding infection site and outcome were available for a total of 53 patients. The lungs were the most common site of infection (62%), followed by rhinocerebral and disseminated disease. Most cases (78%) developed in the first post-transplant year, with over 40% of them in the first month. Additional risk factors for mucormycosis were identified in over half of the patients. Surgical debridement was uncommon in pulmonary infection (9%). Posaconazole therapy was used in 35% of cases, mostly in combination with amphotericin B. Overall mortality was 32% but varied according to site of infection. CONCLUSION Mucormycosis in LTRs tends to be an early post-surgical infection, associated with additional risk factors and intensified immunosuppressive states, and most often affects the lungs, where surgical debridement is rarely feasible. Posaconazole as first-line therapy should be further explored.
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Affiliation(s)
- Ori Wand
- Pulmonary Institute, Rabin Medical Center, Petach Tiqwa, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Pulmonary Division, Meir Medical Center, Kfar-Sava, Israel
| | - Avraham Unterman
- Pulmonary Institute, Rabin Medical Center, Petach Tiqwa, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Yale University School of Medicine, New Haven, CT, USA
| | - Shimon Izhakian
- Pulmonary Institute, Rabin Medical Center, Petach Tiqwa, Israel
| | - Ludmila Fridel
- Pathology Institute, Rabin Medical Center, Petach Tiqwa, Israel
| | - Mordechai R Kramer
- Pulmonary Institute, Rabin Medical Center, Petach Tiqwa, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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11
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BAL fluid analysis in the identification of infectious agents in patients with hematological malignancies and pulmonary infiltrates. Folia Microbiol (Praha) 2019; 65:109-120. [PMID: 31073843 PMCID: PMC7090732 DOI: 10.1007/s12223-019-00712-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/25/2019] [Indexed: 11/02/2022]
Abstract
The present study aims to evaluate the diagnostic yield of bronchoalveolar lavage (BAL) fluid in patients with hematological malignancies and describe the most common pathogens detected in BAL fluid (BALF.) An analysis of 480 BALF samples was performed in patients with hematological malignancies over a period of 7 years. The results of culture methods, PCR, and immunoenzymatic sandwich microplate assays for Aspergillus galactomannan (GM) in BALF were analyzed. Further, the diagnostic thresholds for Aspergillus GM and Pneumocystis jiroveci were also calculated. Microbiological findings were present in 87% of BALF samples. Possible infectious pathogens were detected in 55% of cases; 32% were classified as colonizing. No significant difference in diagnostic yield or pathogen spectrum was found between non-neutropenic and neutropenic patients. There was one significant difference in BALF findings among intensive care units (ICU) versus non-ICU patients for Aspergillus spp. (22% versus 9%, p = 0.03). The most common pathogens were Aspergillus spp. (n = 86, 33% of BAL with causative pathogens) and Streptococcus pneumoniae (n = 46, 18%); polymicrobial etiology was documented in 20% of cases. A quantitative PCR value of > 1860 cp/mL for Pneumocystis jirovecii was set as a diagnostic threshold for pneumocystis pneumonia. The absorbance index of GM in BALF of 0.5 was set as a diagnostic threshold for aspergillosis. The examination of BAL fluid revealed the presence of pathogen in more than 50% of cases and is, therefore, highly useful in this regard when concerning pulmonary infiltrates.
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12
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Shoham S, Dominguez EA. Emerging fungal infections in solid organ transplant recipients: Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13525. [PMID: 30859651 DOI: 10.1111/ctr.13525] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
These updated AST-IDCOP guidelines review the epidemiology, diagnosis, and management of emerging fungi after organ transplantation. Infections due to numerous generally innocuous fungi are increasingly recognized in solid organ transplant (SOT) recipients, comprising about 7%-10% of fungal infections in this setting. Such infections are collectively referred to as emerging fungal infections and include Mucormycetes, Fusarium, Scedosporium, and dematiaceous fungi among others. The causative organisms are diverse in their pathophysiology, uncommon in the clinical setting, have evolving nomenclature, and are often resistant to multiple commonly used antifungal agents. In recent years significant advances have been made in understanding of the epidemiology of these emerging fungal infections, with improved diagnosis and expanded treatment options. Still, treatment guidelines are generally informed by and limited to experience from cohorts of patients with hematological malignancies and/or solid and stem cell transplants. While multicenter randomized controlled trials are not feasible for these uncommon infections in SOT recipients, collaborative prospective studies can be valuable in providing information on the epidemiology, clinical manifestations, treatment strategies, and outcomes associated with the more commonly encountered infections.
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Affiliation(s)
- Shmuel Shoham
- Transplant and Oncology Infectious Diseases Program, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward A Dominguez
- Organ Transplant Infectious Disease, Methodist Transplant Specialists, Dallas, Texas
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A Rare Case of Pulmonary Coinfection by Lichtheimia ramosa and Aspergillus fumigatus in a Patient With Delayed Graft Function After Renal Transplantation. Transplant Proc 2019; 51:551-555. [PMID: 30879588 DOI: 10.1016/j.transproceed.2018.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/09/2018] [Indexed: 11/21/2022]
Abstract
Pulmonary coinfection with Mucor and Aspergillus species has not been reported in organ transplant recipients. Here, we report a rare case of pulmonary coinfection with invasive fungal species in a renal transplant recipient with delayed graft function. The patient was first treated with a regime containing voriconazole, but the infection only worsened. Then, bronchoalveolar lavage fluid culture and internal transcribed spacer region sequencing were performed, and simultaneous pulmonary infection by Lichtheimia ramosa and Aspergillus fumigatus was clearly diagnosed. Susceptibility testing determined that the fungi were sensitive to amphotericin B and posaconazole. Therefore, a therapeutic regime containing posaconazole and amphotericin B liposome, which are less toxic to the kidney, was planned and resulted in resolution of the infectious symptoms. The present case demonstrates the importance of identifying fungal pathogens early and definitively, determining the effective anti-fungal medications, and administering the properly planned therapeutic regime in a timely manner to treat cases of coinfection in transplant recipients.
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Gastric Mucormycosis in a Renal Transplant Patient Treated with Isavuconazole Monotherapy. Case Rep Transplant 2019; 2019:9839780. [PMID: 31007963 PMCID: PMC6441519 DOI: 10.1155/2019/9839780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/20/2019] [Indexed: 12/27/2022] Open
Abstract
Gastrointestinal mucormycosis is a rare infection in solid organ transplant recipients. Our patient, a 79-year-old male, presented with severe dysphagia and odynophagia about 2 weeks after receiving a renal transplant. An upper gastrointestinal (UGI) endoscopy revealed esophagitis and gastric ulceration, the cultures from which grew Rhizopus species. A usual treatment strategy should include Amphotericin B as monotherapy or in combination with Posaconazole or Isavuconazole for such infections. Our patient was treated with Isavuconazole monotherapy, in an effort to minimize renal toxicity from Amphotericin B to the new allograft. Unique to our case was a successful clinical response and resolution of UGI lesions with Isavuconazole monotherapy. Due to the vagueness of presenting symptoms, such infections can be easily missed in an immunocompromised patient which can have tragic outcomes. Prompt diagnosis and modulation of immunosuppression are essential to decrease mortality and morbidity. Isavuconazole is a novel agent and can be used as a monotherapy for such infections, especially in renal transplant recipients.
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Thomas S, Pawar B, Fernandes D, Nayar S, George P, Cherian S. An Unusual Case of Pulmonary Mucormycosis. Transplant Proc 2018; 50:3943-3945. [PMID: 30503525 DOI: 10.1016/j.transproceed.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/01/2018] [Indexed: 01/15/2023]
Abstract
Invasive fungal infections in solid organ transplant recipients are associated with significant morbidity and mortality. Of these fungal infections, mucormycosis presents as an aggressive, frequently fatal angioinvasive infection. Immunocompromised hosts and diabetes are important risk factors. These infections are frequently difficult to diagnose. A high index of suspicion in the appropriate setting and early, aggressive treatment with the newer antifungal agents have altered the previously grave prognosis. We present the first reported case of cavitating pulmonary mucormycosis in a renal transplant recipient caused by an unusual species of Mucorales. The patient was treated with a combination of lobectomy and antifungal treatment comprising of amphotericin B and posaconazole. He remains free of disease recurrence on monotherapy with posaconazole.
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Affiliation(s)
- S Thomas
- Alice Springs Hospital, Northern Territory, Australia.
| | - B Pawar
- Alice Springs Hospital, Northern Territory, Australia
| | - D Fernandes
- Alice Springs Hospital, Northern Territory, Australia
| | - S Nayar
- Alice Springs Hospital, Northern Territory, Australia
| | - P George
- Alice Springs Hospital, Northern Territory, Australia
| | - S Cherian
- Alice Springs Hospital, Northern Territory, Australia
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Ferrándiz-Pulido C, Martin-Gomez MT, Repiso T, Juárez-Dobjanschi C, Ferrer B, López-Lerma I, Aparicio G, González-Cruz C, Moreso F, Roman A, García-Patos V. Cutaneous infections by dematiaceous opportunistic fungi: Diagnosis and management in 11 solid organ transplant recipients. Mycoses 2018; 62:121-127. [DOI: 10.1111/myc.12853] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Trinidad Repiso
- Department of Dermatology; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | | | - Berta Ferrer
- Department of Pathology; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - Ingrid López-Lerma
- Department of Dermatology; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - Gloria Aparicio
- Department of Dermatology; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | | | - Francesc Moreso
- Department of Nephology; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - Antonio Roman
- Department of Neumology; Hospital Universitari Vall d'Hebron; Barcelona Spain
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Deigendesch N, Costa Nunez J, Stenzel W. Parasitic and fungal infections. HANDBOOK OF CLINICAL NEUROLOGY 2018; 145:245-262. [PMID: 28987173 DOI: 10.1016/b978-0-12-802395-2.00018-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Parasitic infections of the central nervous system (CNS) comprise a plethora of infectious agents leading to a multitude of different disease courses and thus diagnostic and therapeutic challenges. The prevalence of different pathogens is basically dependent on geographic and ethnic backgrounds, its infectious route frequently involving a third party, such as flies or domestic animals. The present review focuses on cerebral malaria due to Plasmodium falciparum infection, and Toxoplasma gondii encephalitis. Fungi produce a large variety of inflammatory conditions of the CNS with a variegated spectrum of signs and symptoms, which may involve the meninges and the brain parenchyma, where they produce cerebritis or abscesses and granulomatous lesions, respectively. Fungal CNS lesions are increasingly prevalent and diagnostically relevant due to increasing numbers of human immunodeficiency virus-positive patients, increasing numbers of patients reaching old age suffering from malignant tumors or decreased immunity, and finally the increasing use of established and new immunosuppressive treatments, which increase the susceptibility of patients to develop invasive mycoses. Fungi appear with characteristic morphotypes comprising hyphae, yeasts, and pseudohyphae. The mode by which fungi penetrate into the CNS, and the host/immune requirements are incompletely understood and remain a challenge for research.
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Affiliation(s)
- Nikolaus Deigendesch
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jean Costa Nunez
- Department of Pathology, Universidade Federal de Santa Catarina, Florianopolis, Brazil
| | - Werner Stenzel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Al Hammadi A, Ostrosky-Zeichner L. Epidemiology and Management of Candidiasis in Solid Organ Transplant Recipients. CURRENT FUNGAL INFECTION REPORTS 2016. [DOI: 10.1007/s12281-016-0269-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Geltner C, Lass-Flörl C. Invasive pulmonary Aspergillosis in organ transplants--Focus on lung transplants. Respir Investig 2016; 54:76-84. [PMID: 26879476 DOI: 10.1016/j.resinv.2015.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/10/2015] [Accepted: 08/13/2015] [Indexed: 06/05/2023]
Abstract
Infections with filamentous fungi are common in transplant recipients. The risk for aspergillosis and other invasive pulmonary mycosis (IPM) is high in patients undergoing stem cell and lung transplantations. The mortality rates range from 20% to 60% and depend on a number of risk factors. The typical manifestations of IPM are lung infiltrates, consolidations, and fungal tracheobronchitis. The most common infectious agent is Aspergillus fumigatus. Infections caused by non-Aspergillus molds are more frequent for various reasons. The species distribution of non-Aspergillus molds varies in different locations. Furthermore, infections caused by Mucor and Penicillium are increasing, as are infections caused by species resistant to azoles and amphotericin B. Most centers use antifungal prophylaxis with inhaled amphotericin B or oral azoles. Early diagnosis and therapy is crucial. Reliable information on the local microbiological spectrum is a prerequisite for the effective treatment of molds with primary or secondary resistance to antimycotic drugs.
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Affiliation(s)
- Christian Geltner
- Department of Pulmonology, Academic Hospital Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, A-9020 Klagenfurt, Austria.
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
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Fungal infections in intestinal and multivisceral transplant recipients. Curr Opin Organ Transplant 2015; 20:295-302. [DOI: 10.1097/mot.0000000000000188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Vazquez R, Vazquez-Guillamet M, Suarez J, Mooney J, Montoya J, Dhillon G. Invasive mold infections in lung and heart-lung transplant recipients: Stanford University experience. Transpl Infect Dis 2015; 17:259-66. [DOI: 10.1111/tid.12362] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/20/2014] [Accepted: 01/19/2015] [Indexed: 01/01/2023]
Affiliation(s)
- R. Vazquez
- Department of Medicine; University of New Mexico; Albuquerque New Mexico USA
| | | | - J. Suarez
- Universidad de la Sabana; Bogota Colombia
| | - J. Mooney
- Department of Medicine; Stanford University School of Medicine; Stanford California USA
| | - J.G. Montoya
- Department of Medicine; Stanford University School of Medicine; Stanford California USA
| | - G.S. Dhillon
- Department of Medicine; Stanford University School of Medicine; Stanford California USA
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Invasive Fungal Infections in Pediatric Solid Organ Transplant Patients: Epidemiology and Management. CURRENT FUNGAL INFECTION REPORTS 2015. [DOI: 10.1007/s12281-015-0217-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Chrenkova V, Kolarik M, Hubacek P, Kolarik J, Simonek J, Lischke R, Drevinek P. Possible Tyromyces fissilis (Basidiomycota, Polyporales) co-infection in a lung transplant recipient. Folia Microbiol (Praha) 2014; 60:33-5. [PMID: 25064474 DOI: 10.1007/s12223-014-0336-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/02/2014] [Indexed: 11/29/2022]
Abstract
Invasive fungal diseases are severe complication of the lung transplant patients' follow-up as they are increasing the risk of rejection. We report a patient who developed possible Tyromyces fissilis co-infection during graft rejection episode 2 years after bilateral lung transplantation for cystic fibrosis. The fungus was detected using conventional culture methods as a filamentous basidiomycete and further placed to T. fissilis species based on internal transcribed spacer (ITS) rDNA sequences. The patient was treated according to the susceptibility testing results by voriconazole in combination with the anti-rejection therapy and recovered completely within few weeks. This is, to our knowledge, the first published case report of T. fissilis as a possible causative agent of an infection/rejection episode in a lung transplant recipient.
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Affiliation(s)
- Vanda Chrenkova
- Department of Medical Microbiology 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, 15006, Prague 5, Czech Republic,
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Abstract
The most important emerging and rare fungal pathogens in solid organ transplant recipients are the Zygomycetes, Scedosporium, Fusarium, and the dark molds. Factors affecting the emergence of these fungi include the combination of intensive immunosuppressive regimens with increasingly widespread use of long-term azole antifungal therapy; employment of aggressive diagnostic approaches (eg, sampling of bronchoalveolar lavage fluid); and changes in patients' interactions with the environment. This article reviews the epidemiology, microbiology, and clinical impact of emerging fungal infections in solid organ transplant recipients, and provides up-to-date recommendations on their treatment.
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Affiliation(s)
- Shmuel Shoham
- Transplant and Oncology Infectious Diseases Program, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Huprikar S, Shoham S. Emerging fungal infections in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:262-71. [PMID: 23465019 DOI: 10.1111/ajt.12118] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- S Huprikar
- Transplant Infectious Diseases Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Webb B, Blair J, Kusne S, Scott R, Steidley D, Arabia F, Vikram H. Concurrent Pulmonary Aspergillus fumigatus and Mucor Infection in a Cardiac Transplant Recipient: A Case Report. Transplant Proc 2013; 45:792-7. [DOI: 10.1016/j.transproceed.2012.03.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 03/06/2012] [Indexed: 10/27/2022]
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Zhao L, Wang CX, Zhang L, Tu XA, Wang W, Chen Y, Liu LS. Mucormycosis Extending From the Surgical Wound to the Transplanted Kidney: Case Report and Literature Review. EXP CLIN TRANSPLANT 2012; 10:403-5. [DOI: 10.6002/ect.2011.0107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sun HY, Singh N. Mucormycosis: its contemporary face and management strategies. THE LANCET. INFECTIOUS DISEASES 2011; 11:301-11. [PMID: 21453871 DOI: 10.1016/s1473-3099(10)70316-9] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Several countries have seen rising frequencies of mucormycosis among patients with haematological disorders, malignancies, or diabetes mellitus, and among transplant recipients. Growing numbers of immunocompromised hosts, widespread use of antifungal agents inactive against mucormycosis, or other unidentified factors, could be contributing to this situation. The predominant clinical manifestations of mucormycosis vary from host to host. Additionally, risk factors specific to different subgroups have been identified, such as leukaemia, allogeneic haemopoietic stem-cell transplant, voriconazole prophylaxis, diabetes, and malnutrition. We summarise the current state of knowledge of characteristics and risk factors and discuss topical developments in therapeutic methods and strategies in the management of mucormycosis.
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Affiliation(s)
- Hsin-Yun Sun
- Infectious Diseases Section, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
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Fortún J, Carratalá J, Gavaldá J, Lizasoain M, Salavert M, de la Cámara R, Borges M, Cervera C, Garnacho J, Lassaleta Á, Lumbreras C, Sanz MÁ, Ramos JT, Torre-Cisneros J, Aguado JM, Cuenca-Estrella M. [Guidelines for the treatment of invasive fungal disease by Aspergillus spp. and other fungi issued by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). 2011 Update]. Enferm Infecc Microbiol Clin 2011; 29:435-54. [PMID: 21474210 DOI: 10.1016/j.eimc.2011.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 01/20/2011] [Accepted: 01/24/2011] [Indexed: 01/17/2023]
Abstract
The guidelines on the treatment of invasive fungal disease by Aspergillus spp. and other fungi issued by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) are presented. These recommendations are focused on four clinical categories: oncology-haematology patients, solid organ transplant recipients, patients admitted to intensive care units, and children. An extensive review is made of therapeutical advances and scientific evidence in these settings. These guidelines have been prepared according the SEIMC consensus rules by a working group composed of specialists in infectious diseases, clinical microbiology, critical care medicine, paediatrics and oncology-haematology. Specific recommendations on the prevention of fungal infections in these patients are included.
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Affiliation(s)
- Jesús Fortún
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Carneiro HA, Coleman JJ, Restrepo A, Mylonakis E. Fusarium infection in lung transplant patients: report of 6 cases and review of the literature. Medicine (Baltimore) 2011; 90:69-80. [PMID: 21200188 PMCID: PMC3750960 DOI: 10.1097/md.0b013e318207612d] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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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Affiliation(s)
- Herman A Carneiro
- From Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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35
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Banet N, Gordon C, Willis M, Gilligan P, Thorne L. Unexpected Death in a Heart Transplant Recipient. Lab Med 2011. [DOI: 10.1309/lml5d5ewmzzgyech] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
Solid organ transplantation is emerging as a lifesaving procedure for increasing numbers of patients, and invasive fungal infections are a significant cause of mortality and morbidity for patients undergoing such procedures. Risks for developing these infections are continuing to evolve, leading to shifts in the epidemiology of invasive mycoses occurring after transplantation. Targeting preventive efforts to select solid organ transplantation groups at highest risk for invasive fungal infections is critical to optimizing prophylaxis strategies. The epidemiology of posttransplantation fungal infections, antifungal drug interactions and side effects, and new diagnostic capabilities should be considered when choosing an approach to antifungal prophylaxis for this population.
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Chitsaz S, Bagheri J, Mandegar MH, Rayatzadeh H, Razavi J, Azadi L. Extensive sino-orbital zygomycosis after heart transplantation: a case report. Transplant Proc 2010; 41:2927-9. [PMID: 19765477 DOI: 10.1016/j.transproceed.2009.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Zygomycosis is an opportunistic fungal infection mainly affecting patients with diabetes mellitus, immunodeficiency, and malignancies. The majority of cases in which it has been reported as a posttransplantation complication have been after renal or liver transplantation. There are few instances of rhino-sinusitis and orbital mucormycosis complicating heart transplantation. CASE REPORT A 38-year-old diabetic man who had undergone heart transplantation returned to the transplantation follow-up clinic 20 days after a successful operation with unilateral periorbital swelling, nasal discharge, and multiple cranial nerve dysfunctions. Multidisciplinary investigations resulted in detection of mucormycosis in the paranasal sinuses and the orbital space, as well as a thrombosis of the cavernous sinus. Surgical ablation of the infected parts, along with antifungal treatment and adjustment of immunosuppressive maintenance, restricted extension of the craniofacial involvement. Allograft function remained undisturbed. CONCLUSION Early detection of opportunistic infections in transplant recipients plays a big role in preventing dissemination. Fungal infections, including zygomycosis, should be considered for recipients, especially those with risk factors, such as diabetes, who present with local unusual manifestations. Sinonasal and orbital mucormycosis, if diagnosed in timely fashion, can be managed to reduce mortality. Although devastation of one-side facial and ophthalmic structures was inevitable in this case, the overall outcome was acceptable.
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Affiliation(s)
- S Chitsaz
- Department of Cardiac Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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38
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Kubak BM, Huprikar SS. Emerging & rare fungal infections in solid organ transplant recipients. Am J Transplant 2009; 9 Suppl 4:S208-26. [PMID: 20070683 DOI: 10.1111/j.1600-6143.2009.02913.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- B M Kubak
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA. Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
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40
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Neurohr C, Huppmann P, Zimmermann G, Leuchte H, Baumgartner R, Hatz R, Frey L, Uberfuhr P, Bittmann I, Behr J, Reichart B. Tacrolimus and mycophenolate mofetil as first line immunosuppression after lung transplantation. Transpl Int 2009; 22:635-43. [PMID: 19207186 DOI: 10.1111/j.1432-2277.2009.00843.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The optimal maintenance therapy after lung transplantation remains to be established. The aim of this study was to analyse the impact of tacrolimus and mycophenolate mofetil (MMF) as first line immunosuppression on long-term survival and Bronchiolitis Obliterans Syndrome (BOS). From January 1996 through December 2006, all 155 recipients receiving tacrolimus and MMF as maintenance immunosuppression were included in this study. Tacrolimus and MMF was discontinued in 36 patients (23.2%). The overall survival rates were 91.6% at 6 months, 86.4% at 1 year, 74.9% at 3 years, 60.3% at 5 years and 32.4% at 10 years. The overall freedom from acute rejection was 74.6%, 63.2% and 59.4% at 1, 3, and 5 years respectively. The overall BOS-free survival was 95.6% at 1 year, 88.4% at 3 years, 69.5% at 5 years and 30.5% at 10 years. The development of BOS > or = 1 was associated with a significantly increased risk of death and reduced long-term survival. The combination of tacrolimus and MMF offers safe and reliable maintenance immunosuppression after lung transplantation. However, substantial improvements of long-term survival and freedom from BOS might only be achieved by a change in organ allocation policies and patient management beyond differential immunosuppressive protocols.
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Affiliation(s)
- Claus Neurohr
- Department of Int. Medicine I, Division of Pulmonary Diseases, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
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Cuenca-Estrella M, Bernal-Martinez L, Isla G, Gomez-Lopez A, Alcazar-Fuoli L, Buitrago M. Incidence of zygomycosis in transplant recipients. Clin Microbiol Infect 2009; 15 Suppl 5:37-40. [DOI: 10.1111/j.1469-0691.2009.02978.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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42
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Meis J, Chakrabarti A. Changing epidemiology of an emerging infection: zygomycosis. Clin Microbiol Infect 2009; 15 Suppl 5:10-4. [DOI: 10.1111/j.1469-0691.2009.02973.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bonatti H, Pruett T, Brandacher G, Hagspiel K, Housseini A, Sifri C, Sawyer R. Pneumonia in Solid Organ Recipients: Spectrum of Pathogens in 217 Episodes. Transplant Proc 2009; 41:371-4. [DOI: 10.1016/j.transproceed.2008.10.045] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 10/06/2008] [Indexed: 12/21/2022]
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