Zygomycosis in Solid Organ Transplant Recipients: A Prospective, Matched Case‐Control Study to Assess Risks for Disease and Outcome

Singh, Nina; Aguado, José María; Bonatti, Hugo; Forrest, Graeme N.; Gupta, Krishan Lal; Safdar, Nasia; John, George; Pursell, Kenneth; Muñóz, Patricia; Patel, Robin; Fortün, Jesús; Martín‐Dávila, Pilar; Philippe, B.; Philit, F.; Tabah, Alexis; Terzi, Nicolas; Châtelet, Valérie; Kusne, Shimon; Clark, Nina M.; Blumberg, Emily A.; Juliá, Marino Blanes; Humar, Abhi; Houston, Sally; Lass‐Flörl, Cornelia; Johnson, Leonard B.; Dubberke, Erik R.; Barron, Michelle A.; Lortholary, Olivier

doi:10.1086/605445

Cited by 223 publications

(215 citation statements)

References 42 publications

Supporting

Mentioning

201

Contrasting

Unclassified

Order By: Relevance

“…7,8 The major risk factors for mucormycosis are hematologic malignancy, neutropenia, pharmacologic immunosuppression, chemotherapy and corticosteroid therapy, diabetes mellitus (types 1 and 2), burns, penetrating trauma, and malnutrition. 2,3,6 Because it is rare in transplant patients, a high index of suspicion is required. The diagnosis is based on history, clinical examination, radiologic findings, and tissue biopsy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Rhinomaxillary Mucormycosis in a Renal Transplant Recipient: Case Report

Azarpira

Ashraf²,

Kazemi³

et al. 2012

Exp Clin Transplant

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

“…Induction therapy with antilymphocyte antibodies or high-dose corticosteroids for allograft rejection adds an additional defect to humoral immunity. 1,2 Zygomycosis (mucormycosis) is an invasive opportunistic fungal infection. Diabetes mellitus, immunodeficiency, neutropenia, and malignancy are the main underlying conditions.…”

Section: Introductionmentioning

confidence: 99%

Rhinomaxillary Mucormycosis in a Renal Transplant Recipient: Case Report

Azarpira

Ashraf²,

Kazemi³

et al. 2012

Exp Clin Transplant

View full text Add to dashboard Cite

“…Liver transplant recipients were more likely to have disseminated disease and develop mucormycoses earlier than did recipients of other organs. 78 These disseminated infections spread hematogenously, but are infrequently associated positive blood cultures. 79 A metastatic skin lesion may be an important clue to diagnosis as symptoms will vary based on the location and degree of angioinvasion and infarction in the infected organ.…”

Section: Mucormycosismentioning

confidence: 99%

“…80 Even with appropriate treatment, mortality rate among patients with solid organ transplants ranges from 49% to 71%. 78 …”

Section: Mucormycosismentioning

confidence: 99%

Infections After Orthotopic Liver Transplantation

Pedersen

Seetharam

2014

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management. ( J CLIN EXP HEPATOL 2014;4:347-360) I nfection after orthotopic liver transplantation (OLT) is a major cause of morbidity and mortality. Infection is estimated to occur in upto 80% of organ recipients. Bacterial infections are most frequent (70%), followed by viral (20%) and fungal infections (8%). 1,2,3 In addition to direct effects of infection and end-organ inflammation, pathogens may have a number of indirect effects that result in allograft injury, rejection and opportunistic superinfection.The risk of infection in liver transplant recipients is determined by the intensity of exposure to infectious agents and the overall level of immunosuppression. 4 In addition, conditions attendant to end-stage liver disease in the immediate perioperative period may render a recipient vulnerable to infection and include: neutropenia, deficits in mucocutaneous barrier integrity, presence of necrotic tissue, ischemia, diabetes mellitus, immunomodulating viruses, uremia, and protein-calorie malnutrition. 5 Infectious exposures come from many sources post liver transplant including: de novo (acquired acute) in the recipient, reactivation in the recipient, the donor organ, and nosocomial and time from transplant may provide clues to etiology (Figure 1). The overall level of immunosuppression is dependent upon the dose, duration, and choice of immunosuppression as well as underlying immune deficiencies. 6 Inflammatory responses to invading pathogens are often blunted by immunosuppressive therapy, and as a result, the classic signs or symptoms of infection may be absent. A high index of suspicion is need in the liver recipient, and a low threshold to perform invasive diagnostic procedures is often required. It is critical to identify clinical factors that predispose recipients to infection and much interest centers on identifying risk factors for infection after liver transplant. GENETIC POLYMORPHISMS IN THE INNATE IMMUNE SYSTEMIn addition to clinical factors that promote ...

show abstract

“…Específicamente, en un estudio que incluyó 50 casos de mucormicosis, se identificó que en el grupo de receptores de trasplante hepático era particularmente frecuente la infección diseminada, y se logró determinar como factores de riesgo la presencia de insuficiencia renal, diabetes mellitus y uso previo de voriconazol o caspofungina 37 .…”

Section: Trasplante De óRganos Sólidosunclassified

Profilaxis antifúngica en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos

Rabagliati¹,

Santolaya²

2012

Rev. chil. infectol.

View full text Add to dashboard Cite

Prophylaxis against fungal infections in solid organ and hematopoietic stem cells transplantationInvasive fungal infections are an important cause of morbidity and mortality in SOT and HSCT recipients. The main species involved are Candida spp. and Aspergillus spp, less frequently Cryptococcus spp., causal agents of mucormycosis and Fusarium spp. Usually occur within the first six months post-transplant, but they do it later, especially during episodes of rejection, which maintains the state of immune system involvement. Prophylaxis recommendations are specific to each type of transplant. In liver transplantation use of fluconazole is recommended only in selected cases by high risk factor for invasive fungal infections (A1). If the patient has a high risk of aspergillosis, there are some suggestions for adults population to use amphotericin B-deoxycholate, liposomal amphotericin B or caspofungin (C2) without being validated none of these recommendations in pediatric population. In adult lung transplant patients where the risk of aspergillosis is higher than in other locations, we recommend universal prophylaxis with itraconazole 200 mg/day, nebulised liposomal amphotericin B or voriconazole (C2), no validated recommendations for pediatrics. In HSCT, universal prophylaxis is recommended only in allogeneic and autologous selected cases. The most accepted indication is fluconazole (A1), and posaconazole (A1) or micafungin (A1) in selected cases with high risk of aspergillosis.Key words: Fungus, Candida, Aspergillus, yeasts, moulds, prophylaxis, amphotericin, fl uconazole, voriconaamphotericin, fluconazole, voriconazole, posaconazole, caspofungin, micafungin, transplants, solid organ transplantation, hematopoietic stem cells transplantation.Palabras clave: Hongos, Candida, Aspergillus, levaduras, hongos filamentosos, profilaxis, anfotericina, fluconazol, voriconazol, posaconazol, caspofungina, micafungina, trasplante, trasplante de órganos sólidos, trasplante de precursores hematopoyéticos. IntroducciónL as infecciones fúngicas constituyen una importante causa de morbilidad en los pacientes receptores de trasplantes de órganos sólidos (TOS) y trasplante de precursores hematopoyéticos (TPH) 1 , generando desafíos diagnósticos y terapéuticos, elevación de los costos de manejo y elevada mortalidad 2,3 . En los receptores de trasplantes, la enfermedad fúngica invasora (EFI) es provocada tanto por hongos levaduriformes como filamentosos, destacando Candida spp. y Aspergillus spp. 2-4 , menos frecuentemente Cryptococcus spp., agentes causales de mucormicosis 5,6 y Fusarium spp. 7 , infecciones por hongos endémicos como Histoplasma capsulatum, Coccidioides immitis, Paracoccidioides brasiliensis, y con menor cuantía dematiáceos como Cladosporium, Cladophialophora, Scopulariopsis, Alternaria, Curvularia y Bipolaris spp 8 .Existen diferencias en la frecuencia de EFI entre los distintos tipos de TOS y TPH; no obstante, algunas características son comunes: en ambos grupos la mayoría de las EFI son producidas por Candida spp. o ...

show abstract

Zygomycosis in Solid Organ Transplant Recipients: A Prospective, Matched Case‐Control Study to Assess Risks for Disease and Outcome

Abstract: The risks identified for zygomycosis and for disseminated disease, including those that were previously unrecognized, have implications for further elucidating the biologic basis and for optimizing outcomes in SOT recipients with zygomycosis.

Cited by 223 publications

References 42 publications

Rhinomaxillary Mucormycosis in a Renal Transplant Recipient: Case Report

Rhinomaxillary Mucormycosis in a Renal Transplant Recipient: Case Report

Infections After Orthotopic Liver Transplantation

Profilaxis antifúngica en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos

Contact Info

Product

Resources

About