Fungal infections in solid organ recipients

Fungal infections are a major cause of morbidity and mortality after organ transplantation. The incidence of these infections has increased considerably over the last decade.

The aim of this study was to evaluate the incidence of fungal infections, to identify the most common fungal pathogens, and to determine the associated risk factors in solid organ recipients.

One hundred twenty renal and 50 liver recipients were transplanted at the organ transplant unit of Nemazi Hospital in Shiraz, Iran, from September 2004 to August 2005 and were followed for fungal infections for at least 6 months. On admission to the hospital, all patients were evaluated for fungal colonization by mouth, vagina, urine, and rectal swabs cultured in Sabouraud Dextrose Agar. Samples of sputum, bronchoalveolar lavage, urine, cerebrospinal fluid (CSF), pleural tap, and tissue biopsy were evaluated by direct microscopic examination and were cultured for any clinical signs of fungal infections.

Fifty-four kidney recipients (45%) had Candida colonization in different sites of their bodies. Fungal infections presented in 13 of 120 recipients (10.8%). Five recipients had invasive fungal infections (3 had fungal pneumonitis and 2 had severe esophagitis), and 8 patients had cutaneous and mucocutaneous infections. All of the recipients with invasive fungal infections were colonized with Candida, and 2 of them died. Forty-two (84%) liver recipients had Candida colonization in different sites of their bodies. Fungal infections presented in 6 liver recipients. In 4 patients, invasive fungal infections occurred (2 fungal pneumonitis, 1 meningitis, and 1 severe esophagitis), 2 patients showed mucocutaneous infections. Three recipients with invasive fungal infections had Candida colonization. The mean time to diagnosis was 70 days after transplantation. The most common etiologic agent for fungal infections was Candida albicans.

Renal and liver recipients with Candida colonization are at high risk for fungal infections and therefore, control of fungal colonization in liver and renal transplant candidates would reduce the risk of invasive fungal infections after transplantation.