Epidemiology and Management of Candidiasis in Solid Organ Transplant Recipients

Prevention and Treatment of Yeast and Endemic Fungal Infections

“…IC is less common, while mold infections due to aspergillosis, mucormycosis, scedosporiosis, or other molds predominate [3]. By late stage when 80% of SOT recipients are maintained on minimal chronic immunosuppression, the risk of IFIs declines [2]. The predominant fungal pathogens in this interval are Cryptococcus and endemic fungi, but mold infections such as aspergillosis and mucormycosis are possible and may occur at any time posttransplantation [3,17].…”

“…Host factors include underlying immune defects; extrinsic factors such as loss of integrity of mucocutaneous barriers and surgical complications; dose, duration, and sequence of immunosuppressive therapy; and environmental exposures to specific pathogens (Table 13.2) [23,24]. Other risk factors that are specific to the type of organ transplant include the type of anastomosis or drainage, intensity of immunosuppression especially in the immediate posttransplantation period, and postoperative complications (anastomotic leak, ischemia, thrombosis, fluid collection, and the presence of foreign bodies) (Table 13.3) [2,[23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”

“…Candidemia is the most common form of IC in SOT recipients (64%), followed by urinary tract infections (11%) and peritonitis (9%) [3,11]. Candidemia may occur due to translocation across damaged intestinal barriers or from central venous catheters (CVC) [2,44]. Intra-abdominal infections are particularly common among liver, pancreas, and small bowel transplant recipients [3].…”

“…Solid organ transplantation (SOT) for the treatment of end-organ disease has increased over the last three decades. While novel immunosuppressive regimens have improved allograft survival and function, combined with surgical complications, these predispose transplant recipients to infectious complications [1,2]. Invasive fungal infections (IFIs) are particularly concerning in this population due to the associated high morbidity and mortality [1].…”

“…The most common IFIs in SOT recipients are candidiasis, aspergillosis, cryptococcosis, and those caused by endemic fungi such as Blastomyces, Coccidioides, and Histoplasma [3]. The incidence of IFIs varies according to type of organ transplant, and the risk of infection changes over time based on host state of immunosuppression and many fungal factors (e.g., virulence and resistance of fungi) [2,4]. In this chapter, we review epidemiology, clinical presentation, diagnosis, and treatment of fungal infections due to yeast and endemic fungi in SOT recipients.…”