Invasive Pulmonary Aspergillosis in Heart Transplant Recipients

Abstract

Objectives: Invasive pulmonary aspergillosis is the most common invasive mycosis in heart transplant recipients. Early clinical recognition of this complication is difficult and laboratory data is not specific. Our aim was to study the characteristics of invasive pulmonary aspergillosis infections in heart transplant recipients. Materials and Methods: Between 2007 and 2013, there were 82 patients who underwent heart transplant at our institution, including 6 patients who were diagnosed with invasive pulmonary aspergillosis. Medical records of these patients were reviewed for demographic, clinical, and radiographic features, microbiology data, serum galactomannan levels, antifungal treatment, and overall outcomes. Results: The most common species causing the infection was Aspergillus fumigatus. The infection was encountered irrespective of the duration since the transplant. Bronchoalveolar lavage with positive culture for Aspergillus species and/or abnormal serum galactomannan level was suggestive of invasive pulmonary aspergillosis. Conclusions: In our opinion, empiric antifungal therapy should be commenced as soon as invasive pulmonary aspergillosis is suspected in heart transplant recipients to reduce mortality. Although the duration of antifungal therapy for invasive pulmonary aspergillosis is debatable, heart transplant recipients may require long-term therapy to avoid recurrence.

Epidemiology, risk factors and outcomes of invasive aspergillosis in solid organ transplant recipients in the Swiss Transplant Cohort Study

“…The incidence of IA in heart transplant recipients was around 7%, as previously reported . Notably, IA was a rather early post‐heart transplant complication.…”

“…The incidence of IA in heart transplant recipients was around 7%, as previously reported. 34,35 Notably, IA was a rather early post-heart transplant complication. The observed mortality rate of 25% was consistent with that recently reported in a cohort of heart transplant recipients from Spain, in which mortality was 26% in patients with early (<3 months post transplant) IA diagnosis vs 63% in patients with late IA.…”

The pathogenicity ofAspergillus fumigatus, drug resistance, and nanoparticle delivery

“…Most individuals are able to quickly eliminate the pathogen by the action of the ciliated epithelium of the upper respiratory tract and pulmonary macrophages that effectively remove conidia that reach the alveoli. Nonetheless, infections due to Aspergillus inhalation are still common in immunosuppressed patients as a result of AIDS, and treatments for cancer and organ transplants (Latgé 1999;Küpeli et al 2015;Humphrey et al 2016;Kaur et al 2017;Lipový et al 2017;Schwartz and Patterson 2018). Even though AIDS deaths overall are slowly decreasing every year, fungal infections overall account for 47% of those deaths (9% for CPA) compared with 30% for tuberculosis in 2015 (Denning 2016;Limper et al 2017).…”

Occurrence of fungi and cytotoxicity of the species: Aspergillus ochraceus, Aspergillus niger and Aspergillus flavus isolated from the air of hospital wards

“…Fewer scientific publications are devoted to toxic fungi belonging to other species such as: A. flavus or A. ochraceus [7,8]. This trend may be explained by the fact that fungi belonging to A. fumigatus species are most frequently detected in the clinical material and, moreover, they are the ones which are usually responsible for fungal infections among immunocompromised patients [9][10][11]. Nevertheless, there are the research results that prove fungi which have not been considered pathogenic so far, e.g., A. terreus, to be the cause of opportunistic infections [12], too.…”