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[Aspergillosis in pulmonary transplantation]
A de Pablo1, P Ussetti, M Cruz Carreño
1Servicio de Neumología, Clínica Puerta de Hierro, Madrid.
Background:
Fungal infections are a frequent cause of morbidity an mortality in transplant recipients. Aspergillus spp. is an ubiquitous fungus capable of producing diverse clinical entities with varying severity.
Objective:
To study the incidence and severity of Aspergillus spp. infections in lung transplantation, analysing the different clinical presentations and response to antifungal drugs.
Methods:
A review was made of the clinical histories of all patients undergoing lung transplantation who developed positive Aspergillus spp. cultures in our centre between June 1991 and December 1996.
Results:
Eleven of 49 transplanted patients (22%) developed Aspergillus spp. infections. Four patients presented invasive aspergillosis forms and 7 tracheobronchitis. In spite of antifungal treatment 3 patients (30%) died of invasive aspergillosis as a direct consequence of the infection. Of the 7 patients with tracheobronchitis, 2 were ulcerative and 1 pseudomembranous, all responded to antifungal treatment. Three patients (10.3%) developed Aspergillus spp. infections despite prophylaxis with itraconazole.
Conclusion:
Invasive aspergillosis in the immediate posttransplant period was mortal despite treatment. As opposed, aspergillar tracheobronchitis have been overcome using combined treatments of liposomal or lipidic amphotericin, itraconazole and nebulised amphotericin.
Insights
Fungal infections like aspergillosis pose risks to lung transplant recipients. Invasive aspergillosis is often fatal, while tracheobronchitis is treatable with antifungal therapies.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
- Pulmonology
Background:
- Fungal infections, particularly Aspergillus spp., are significant causes of illness and death in transplant recipients.
- Aspergillus spp. are common fungi that can cause a range of infections with varying severity.
Purpose of the Study:
- To investigate the incidence and severity of Aspergillus spp. infections following lung transplantation.
- To analyze clinical presentations and responses to antifungal drugs for Aspergillus infections in lung transplant patients.
Main Methods:
- A retrospective review of clinical histories was conducted.
- Patients included underwent lung transplantation and developed positive Aspergillus spp. cultures between June 1991 and December 1996.
Main Results:
- 22% (11 of 49) of lung transplant patients developed Aspergillus spp. infections.
- Invasive aspergillosis occurred in 4 patients, resulting in a 30% mortality rate despite treatment.
- Aspergillar tracheobronchitis occurred in 7 patients, with all cases responding to antifungal treatment.
Conclusions:
- Invasive aspergillosis in the early post-transplant period is frequently fatal, even with treatment.
- Aspergillar tracheobronchitis can be successfully managed with combination antifungal therapies, including liposomal amphotericin, itraconazole, and nebulized amphotericin.