Related Experiment Videos
Pulmonary scedosporium infection following lung transplantation
M Tamm1, M Malouf, A Glanville
1Cardiopulmonary Transplant Unit, St Vincent's Hospital, Sydney, Australia. mtamm@uhbs.ch
Abstract:
Infectious complications are frequent following lung transplantation. Tracheobronchial aspergillosis is the predominant fungal infection in these patients. Infections with Scedosporium apiospermium (Pseudoallescheria boydii) and Scedosporium prolificans (Scedosporium inflatum) have mainly been described in bone marrow transplant recipients and only occasionally in solid organ transplant recipients. We analysed risk factors, the clinical course and outcome of seven lung transplant recipients who developed pulmonary scedosporium infection. Scedosporium apiospermium was documented in bronchoalveolar lavage (BAL) of all seven and Scedosporium prolificans in the BAL of four of these patients. Scedosporium was detected 9-58 months after transplantation. Five of the seven patients had been treated for several months with itraconazole because of previous detection of aspergillus in BAL. All seven patients with scedosporium infection showed airway problems, including early ischemic airway stenosis in one and bronchiolitis obliterans syndrome in the other six patients. Combined treatment with itraconazole and fluconazole was not able to eradicate scedosporium. Four of the seven patients died with advanced bronchiolitis obliterans 3-35 months after the diagnosis of pulmonary scedosporium infection. Three patients are currently alive 3, 6 and 7 years after transplantation, showing persistent scedosporium infection. In conclusion, pulmonary scedosporium infection was seen in lung transplant recipients with structurally abnormal airways and under long-term therapy with itraconazole. Eradication of scedosporium proved difficult, but under combined treatment with itraconazole and fluconazole this opportunistic infection did not disseminate.
Insights
Pulmonary scedosporium infection is a rare complication in lung transplant recipients, often occurring in patients with pre-existing airway issues and prior antifungal treatment. Eradication is challenging, but combined antifungal therapy may prevent dissemination.
Area of Science:
- Medicine
- Infectious Diseases
- Transplantation
Background:
- Lung transplantation is susceptible to infectious complications, with tracheobronchial aspergillosis being common.
- Infections by Scedosporium species are rare in solid organ transplant recipients, unlike in bone marrow transplant patients.
Purpose of the Study:
- To analyze risk factors, clinical course, and outcomes of pulmonary scedosporium infection in lung transplant recipients.
- To investigate the efficacy of combined antifungal treatment in managing scedosporium infections post-lung transplant.
Main Methods:
- Retrospective analysis of seven lung transplant recipients diagnosed with pulmonary scedosporium infection.
- Identification of Scedosporium species via bronchoalveolar lavage (BAL).
- Review of patient history, including prior antifungal treatments and airway complications.
Main Results:
- Scedosporium species were detected 9-58 months post-transplantation in patients with airway problems like bronchiolitis obliterans syndrome.
- Five patients had prior itraconazole treatment for aspergillosis.
- Combined itraconazole and fluconazole treatment did not eradicate the infection, but prevented dissemination.
- Four patients died from bronchiolitis obliterans, while three remain alive with persistent infection.
Conclusions:
- Pulmonary scedosporium infection in lung transplant recipients is associated with structural airway abnormalities and prior itraconazole therapy.
- Complete eradication of scedosporium is difficult, but combined antifungal therapy can control dissemination.
- This opportunistic infection poses a significant challenge in managing lung transplant recipients.