Paecilomyces variotii in a pediatric patient with lung transplantation

Area of Science:

• Medical Mycology
• Transplant Infectious Diseases
• Pediatric Pulmonology

Background:

• Aspergillus is the most common filamentous fungus in lung transplant (Tx) patients' airways.
• Airway colonization by Aspergillus increases the risk of invasive fungal infections in this vulnerable population.
• Other filamentous fungi can also pose significant threats post-transplantation.

Observation:

• Paecilomyces variotii was isolated from the airways of a pediatric patient with cystic fibrosis (CF) after bilateral living-donor lobar lung Tx.
• This marks the first reported isolation of P. variotii in the pediatric lung Tx population.
• The presence of Paecilomyces highlights the diversity of fungal pathogens encountered in lung transplant recipients.

Findings:

• Paecilomyces variotii demonstrates variable in vitro susceptibility to current antifungal medications.
• This variability presents challenges in selecting effective antifungal therapy for lung transplant patients.
• The study underscores the need for vigilant monitoring and tailored treatment strategies for fungal infections.

Implications:

• Early identification and characterization of fungal species like P. variotii are crucial for effective management.
• The findings necessitate further research into the antifungal susceptibility patterns of emerging fungal pathogens in immunocompromised hosts.
• This case emphasizes the importance of considering a broader spectrum of filamentous fungi in post-lung transplant care, especially in pediatric CF patients.