Saprophytic Fungal Infections and Complications Involving the Bronchial Anastomosis Following Human Lung Transplantation

Endobronchial Fungal Disease: An Under-Recognized Entity

“…Among 121 patients (both transplant recipients and other cases) retrieved from the literature, 1 patient had A. fumigatus and A. flavus [25], 2 had A. nidulans [8, 20], 4 had A. niger [1, 9, 12, 28] and4 had A. flavus [5, 15, 21, 28]. In 34 patients no species were identified [2,5,6,7, 16, 17, 27, 31, 34, 42] while the rest (63%) had A. fumigatus. …”

“…Direct exposure of the transplanted organ to the environment, impairment in local host defenses (i.e. mucociliary clearance and cough reflex), disruption of lymphatic drainage, ischemic airway injury, altered alveolar phagocytic function and overall greater requirement of immunosuppression can cause airway disease and colonization by Aspergillus [12, 28, 29, 34]. Patients treated with resectional surgery could also develop bronchial stump aspergillosis, resulting from the colonization of the suture material.…”

“…Fourteen cases of EB involvement exist in the literature [6, 34,74,75,76]. Eight subjects (57%) were lung transplant recipients.…”

“…[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 [89,90,91,92...…”

Medical complications of lung transplantation

“…Although usually responsive to oral itraconazole or to inhaled or intravenous amphotericin, airway infections have rarely progressed to invasive pneumonia or have resulted in fatal erosion into the adjacent pulmonary artery [20,23,24]. An increased risk of subsequent bronchial stenosis or bronchomalacia has also been reported [25], but it is unclear whether this is a consequence of the infection or of an underlying ischaemic injury to the bronchus that predisposed to infection.…”