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Pre-emptive therapy with azoles in lung transplant patients. Geneva Lung Transplantation Group
J Hamacher1, A Spiliopoulos, A M Kurt
1Pulmonary Division, University Hospital, Geneva, Switzerland.
Abstract:
Pulmonary fungal infection is diagnosed in up to 15-25% of lung transplant recipients and frequently bears a fatal outcome. This prospective uncontrolled study addresses the efficacy and safety of pre-emptive azole therapy against fungal infection in these patients. Fluconazole or itraconazole have been systematically used according to reported fungus sensitivity after the discovery of fungi in lower respiratory tract samples. Patients were treated until the bronchial suture was normal and the cultures of the following bronchoscopy remained negative. Fungi were found post-transplantation in the lower respiratory tract specimens of 26 out of 31 (84%) patients, predominantly Candida albicans (20 patients) and Aspergillus fumigatus (16 patients). Mycelia characteristic of Candida spp. or Aspergillus spp. were found in necrotic tissue at the bronchial suture of nine patients. The mean duration of the 38 treatments was 3.6+/-2.6 months (range, 0.5-12 months). After a median follow-up of 16 (range, 0-48) months, two cases of extended ulcerative and pseudo membranous Aspergillus fumigatus bronchitis were observed and healed under itraconazole treatment. In conclusion, pre-emptive azole therapy may be effective and well-tolerated in lung transplant patients where fungi are found in the airways or pleura.
Insights
Pre-emptive azole therapy effectively treats pulmonary fungal infections in lung transplant recipients. This approach demonstrated good tolerance and positive outcomes in patients with airway or pleural fungi.
Area of Science:
- Medical Mycology
- Transplantation Medicine
- Infectious Diseases
Background:
- Pulmonary fungal infections affect 15-25% of lung transplant recipients, often leading to fatal outcomes.
- Early detection and treatment are crucial for managing fungal infections post-transplantation.
Purpose of the Study:
- To evaluate the efficacy and safety of pre-emptive azole therapy for fungal infections in lung transplant patients.
- To assess the outcomes of fluconazole or itraconazole treatment based on fungal sensitivity.
Main Methods:
- Prospective, uncontrolled study involving lung transplant recipients.
- Systematic use of fluconazole or itraconazole based on identified fungal species in lower respiratory tract samples.
- Treatment continued until bronchial suture normalization and negative cultures post-bronchoscopy.
Main Results:
- Fungi detected in 84% (26/31) of patients post-transplantation, with Candida albicans and Aspergillus fumigatus being predominant.
- Nine patients showed fungal mycelia at the bronchial suture site.
- Two cases of Aspergillus fumigatus bronchitis healed successfully with itraconazole treatment during follow-up.
Conclusions:
- Pre-emptive azole therapy appears effective and well-tolerated in lung transplant patients with airway or pleural fungal presence.
- This therapeutic strategy may reduce the incidence and severity of pulmonary fungal infections in this high-risk population.