Background: The clinical significance and risk of progression to invasive disease of the non-Aspergillus molds from the bronchoalveolar lavage (BAL) of lung transplant (LTx) recipients are not known.
Methods: We reviewed the medical records from March 1996 to March 2006 of all LTx recipients whose BAL culture grew non-Aspergillus mold. The clinical characteristics, administration of prophylaxis, and outcomes were recorded.
Results: Eighty-five non-Aspergillus molds were isolated from the BAL of 75 patients. Of these LTx recipients, 14.5% had a BAL with non-Aspergillus mold. Emphysema was the most common underlying diagnosis for transplantation (41.3%) and the most common isolate was Cladosporium. Isolation of a non-Aspergillus mold occurred at a median of 415 days after LTx. Prophylaxis with an anti-mold agent was noted in 44.7% (38 of 85) of the isolates. Median follow-up was 765 days. There were no cases of proven invasive fungal infection up to 1 year after isolation of the mold; and only 1 case of probable zygomycosis.
Conclusions: Isolation of non-Aspergillus molds in the BAL of LTx recipients may not be associated with the development of invasive disease, irrespective of anti-fungal prophylaxis. These results suggest that initiation of targeted anti-fungal prophylaxis after isolation of non-Aspergillus molds from BAL may not be warranted.