Invasive pulmonary Aspergillosis in organ transplants--Focus on lung transplants

Respir Investig. 2016 Mar;54(2):76-84. doi: 10.1016/j.resinv.2015.08.005. Epub 2015 Nov 10.

Abstract

Infections with filamentous fungi are common in transplant recipients. The risk for aspergillosis and other invasive pulmonary mycosis (IPM) is high in patients undergoing stem cell and lung transplantations. The mortality rates range from 20% to 60% and depend on a number of risk factors. The typical manifestations of IPM are lung infiltrates, consolidations, and fungal tracheobronchitis. The most common infectious agent is Aspergillus fumigatus. Infections caused by non-Aspergillus molds are more frequent for various reasons. The species distribution of non-Aspergillus molds varies in different locations. Furthermore, infections caused by Mucor and Penicillium are increasing, as are infections caused by species resistant to azoles and amphotericin B. Most centers use antifungal prophylaxis with inhaled amphotericin B or oral azoles. Early diagnosis and therapy is crucial. Reliable information on the local microbiological spectrum is a prerequisite for the effective treatment of molds with primary or secondary resistance to antimycotic drugs.

Keywords: Aspergillosis; Immunosuppression; Lung transplantation; Mold infection; Solid organ transplantation.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Administration, Inhalation
  • Amphotericin B / administration & dosage
  • Antibiotic Prophylaxis
  • Antifungal Agents / administration & dosage
  • Aspergillus fumigatus
  • Drug Resistance, Fungal
  • Early Diagnosis
  • Female
  • Humans
  • Immunocompromised Host
  • Invasive Pulmonary Aspergillosis / diagnosis
  • Invasive Pulmonary Aspergillosis / etiology*
  • Invasive Pulmonary Aspergillosis / microbiology
  • Invasive Pulmonary Aspergillosis / prevention & control
  • Lung Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Risk
  • Risk Factors
  • Stem Cell Transplantation / adverse effects

Substances

  • Antifungal Agents
  • Amphotericin B