Emerging Fungal Infections in Solid Organ Transplant Recipients

Abstract

The most important emerging and rare fungal pathogens in solid organ transplant recipients are the Zygomycetes, Scedosporium, Fusarium and the dark molds. Factors impacting 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 (e.g. sampling of bronchoalveolar lavage fluid) and changes in patients’ interactions with the environment. Early diagnosis, differentiation between colonization and infection and institution of appropriate therapy is vital when contending with these fungi. Moreover, effective treatment often requires a multi-disciplinary approach. 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.

Clinical and Morphologic Findings in Disseminated Scedosporium Apiospermum Infections in Immunocompromised Patients

“…In vitro studies have shown a synergistic eff ect of these two antifungals (10). When feasible, this treatment should be combined with surgical debridement (11,12). Th e use of voriconazole in cases that involve central nervous system (CNS) infection is particularly important, as it has increased CNS penetration compared to amphotericin B, echinocandins, itraconazole, or posaconazole (8).…”

Spectrum of Superficial and Deep Fungal Isolates in Northern Pakistan

“…Fusarium spp, Scedosporium spp and dematiaceous fungi are emerging pathogens in solid organ transplant recipients. [23] Fusarium spp, Scedosporium apiospermum are important cause of and fungal keratitis after trauma and corticosteroid use. [24] Scytalidium dimidiatum is a dematiaceous mould and can cause opportunistic infections.…”

Pathogenesis and host defence against Mucorales: the role of cytokines and interaction with antifungal drugs

“…A number of risk factors are known to be associated with invasive mucormycosis, including haematologic malignancies and transplantation, iron overload, diabetes and ketoacidosis, birth prematurity and possibly prior exposure to certain Aspergillus‐ active antifungal agents [i.e. voriconazole (VRC) and caspofungin (CAS)] . In the haematology patients, the cumulative incidence of mucormycosis in Europe and the United States has been increasing during the last decade, recording high mortality rates and suboptimal outcomes with currently available therapy …”