Diagnosis and Treatment of Fungal Infections in Lung Transplant Recipients

Abstract

Fungal infections are a significant source of morbidity in the lung transplant population via direct allograft damage and predisposing patients to the development of chronic lung allograft dysfunction. Prompt diagnosis and treatment are imperative to limit allograft damage. This review article discusses incidence, risk factors, and symptoms with a specific focus on diagnostic and treatment strategies in the lung transplant population for fungal infections caused by Aspergillus, Candida, Coccidioides, Histoplasma, Blastomyces, Scedosporium/Lomentospora, Fusarium, and Pneumocystis jirovecii. Evidence for the use of newer triazole and inhaled antifungals to treat isolated pulmonary fungal infections in lung transplant recipients is also discussed.

The epidemiology of invasive fungal infections in transplant recipients

“…Other molds, such as Mucorales, Scedosporium/Lomentospora spp., Fusarium spp., Scopulariopsis/Microascus , Paecilomyces spp. have been described as emerging causes of IFIs [ 30 , 31 ]. However, many other fungi may complicate the management of SOT recipients, including dimorphic fungi [ 32 , 33 ].…”

Culture-independent diagnostic approaches for invasive aspergillosis in solid organ transplant recipients

“…The study noted a false positive rate of 12%, which could be attributed to procedural factors (e.g., environmental contamination with Aspergillus species, cross-reaction with sequences from other fungal species such as Penicillium species) or clinical factors such as respiratory tract colonization with Aspergillus species [ 57 ]. The primary limitations of Aspergillus PCR testing include the difficulty in differentiating between colonization and active infection, the lack of a standardized PCR methodology, and the inability to identify Aspergillus subspecies [ 58 ]. With recent advances in the standardization of laboratory procedures [ 59 ], various commercial PCR assays such as AsperGenius (target gene: 28S rDNA, PathoNostics) and MycAssay Aspergillus (target gene: 18S rDNA, Myconostica), have been developed and become available [ 60 ].…”