Aspergillus Infection in Lung Transplant Recipients With Cystic Fibrosisa

Helmi, Mohamed; Love, Robert B.; Welter, Debbie; Cornwell, Richard; Meyer, Keith C.

doi:10.1378/chest.123.3.800

Cited by 125 publications

(20 citation statements)

References 21 publications

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“…For instance, potential mechanisms of age related immune dysfunction include reduced numbers of naïve T cells, dysfunctional memory cells, and increased susceptibility to immunosuppression (30). Pre-transplant Aspergillus colonization and Cystic Fibrosis have been previously described as risk factors for invasive Aspergillosis after lung transplantation (31, 32). The absence of association in our study is likely the consequence of our use of targeted prophylaxis with 6-months of antifungal therapy for all patients with pre-transplant Aspergillus colonization.…”

Section: Discussionmentioning

confidence: 99%

Aspergillus Colonization of the Lung Allograft Is a Risk Factor for Bronchiolitis Obliterans Syndrome

Weigt

Elashoff

Huang

et al. 2009

American Journal of Transplantation

184

169

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Multiple infections have been linked with the development of bronchiolitis obliterans syndrome (BOS) post-lung transplantation. Lung allograft airway colonization by Aspergillus species is common among lung transplant recipients. We hypothesized that Aspergillus colonization may promote the development of BOS and may decrease survival post-lung transplantation. We reviewed all lung transplant recipients transplanted in our center between 1/2000 and 6/2006. Bronchoscopy was performed according to a surveillance protocol and when clinically indicated. Aspergillus colonization was defined as a positive culture from bronchoalveolar lavage or two sputum cultures positive for the same Aspergillus species, in the absence of invasive pulmonary Aspergillosis. We found that Aspergillus colonization was strongly associated with BOS and BOS related mortality in Cox regression analyses. Aspergillus colonization typically preceded the development of BOS by a median of 261 days (95% CI 87 to 520). Furthermore, in a multivariate Cox regression model, Aspergillus colonization was a distinct risk factor for BOS, independent of acute rejection. These data suggest a potential causative role for Aspergillus colonization in the development of BOS post-lung transplantation and raise the possibility that strategies aimed to prevent Aspergillus colonization may help delay or reduce the incidence of BOS.

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Section: Discussionmentioning

confidence: 99%

Aspergillus Colonization of the Lung Allograft Is a Risk Factor for Bronchiolitis Obliterans Syndrome

Weigt

Elashoff

Huang

et al. 2009

American Journal of Transplantation

184

169

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“…They are common colonizers of the airways in immunocompromised hosts and the primary cause of invasive mycosis. They have been isolated from up to 57% of patients with cystic fibrosis [1, 10, 17, 26, 33, 35]. In lung transplant recipients, the incidence of infection ranges from 3 to 22%, and the incidence of isolated tracheobronchitis is 5% [29, 44].…”

Section: Discussionmentioning

confidence: 99%

“…Posttransplant antifungal prophylactic or preemptive therapies are used in many transplant centers, especially in patients with cystic fibrosis where Aspergillus is a common colonizer [110]. If the suture material from prior surgery is present in the EB tree, it should be removed with scissors or burned with a neodymium:yttrium aluminum garnet (Nd-YAG) laser [35]. In this literature review, 54 (45%) of the lung transplant recipients with EB aspergillosis, required bronchoplasty for stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Reviewing the English literature, we recognized that the most common agents causing EBFI are Aspergillus spp. [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45], Coccidioides immitis [46] , agents of zygomycosis [6,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73], Candida spp. [6, 34,74,75,76], Cryptococcus neoformans [77,78,79,80,81,82,83,84,85,86,87,88], and Histoplasma capsulatum [89,…”

Section: Introductionmentioning

confidence: 99%

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Endobronchial Fungal Disease: An Under-Recognized Entity

Karnak

Avery²,

Gildea

et al. 2006

Respiration

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Most fungi enter the human body via inhalation; however, endobronchial fungal infection (EBFI) seems to be a rare manifestation compared to pulmonary or systemic disease. This presentation seems to be related to environmental factors as well as to the host status. With the increasing popularity of flexible bronchoscopy, it is being recognized with a higher frequency. Bronchoscopic findings in EBFI vary from mild mucosal inflammation to central airway obstruction. We searched English literature related to the topic and found 228 total cases of EBFI: Aspergillus species (121), Coccidioides immitis (38), Zygomycetes (31), Candida species (14) Cryptococcus neoformans (13), and Histoplasma capsulatum (11). We have also included a single case of endobronchial Pseudallescheria boydii infection in a lung transplant recipient that has not been reported previously. Most patients were immunocompromised, exhibited systemic manifestations of the primary infection, and responded to appropriate therapy. EBFI should be included in the differential diagnosis of any form of airway lesions in immunocompromised patients, especially among residents from the endemic areas.

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“…This was shown by Helmi et al in patients with cystic fibrosis (CF). ITBA developed only in patients with persistent preoperative airway colonization with A. fumigatus while none of the patients who had not been colonized prior to surgery developed any form of invasive aspergillosis [51]. The authors noted that antifungal prophylaxis did not prevent the development of ITBA, and amphotericin B therapy (with or without endobronchial debridement of necrotic tissue) was required to clear the infection in all patients [51].…”

Section: Trachobronchial Aspergillosismentioning

confidence: 99%

Tracheobronchial Manifestations ofAspergillusInfections

Krenke

Grabczak

2011

The Scientific World JOURNAL

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Human lungs are constantly exposed to a large number of Aspergillus spores which are present in ambient air. These spores are usually harmless to immunocompetent subjects but can produce a symptomatic disease in patients with impaired antifungal defense. In a small percentage of patients, the trachea and bronchi may be the main or even the sole site of Aspergillus infection. The clinical entities that may develop in tracheobronchial location include saprophytic, allergic and invasive diseases. Although this review is focused on invasive Aspergillus tracheobronchial infections, some aspects of allergic and saprophytic tracheobronchial diseases are also discussed in order to present the whole spectrum of tracheobronchial aspergillosis. To be consistent with clinical practice, an approach basing on specific conditions predisposing to invasive Aspergillus tracheobronchial infections is used to present the differences in the clinical course and prognosis of these infections. Thus, invasive or potentially invasive Aspergillus airway diseases are discussed separately in three groups of patients: (1) lung transplant recipients, (2) highly immunocompromised patients with hematologic malignancies and/or patients undergoing hematopoietic stem cell transplantation, and (3) the remaining, less severely immunocompromised patients or even immunocompetent subjects.

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Aspergillus Infection in Lung Transplant Recipients With Cystic Fibrosisa

Cited by 125 publications

References 21 publications

Aspergillus Colonization of the Lung Allograft Is a Risk Factor for Bronchiolitis Obliterans Syndrome

Aspergillus Colonization of the Lung Allograft Is a Risk Factor for Bronchiolitis Obliterans Syndrome

Endobronchial Fungal Disease: An Under-Recognized Entity

Tracheobronchial Manifestations ofAspergillusInfections

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