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Murine Corneal Transplantation: A Model to Study the Most Common Form of Solid Organ Transplantation
Published on: November 17, 2014
Rhino-orbital-cerebral zygomycosis in solid organ transplant recipients
Hsin-Yun Sun1, Graeme Forrest, Krishan L Gupta
1Division of Infectious Diseases, Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Background:
Rhino-orbital-cerebral disease is a significant manifestation of zygomycosis in solid organ transplant (SOT) recipients. However, its characteristics and outcome are not well addressed.
Methods:
SOT recipients with zygomycosis as per the European Organization for Research and Treatment in Cancer and the Mycoses Study Group criteria in a cohort study at our centers published previously and those identified with a PubMed search from the 1950s to November 2009 were studied. Patients with mycosis involving the sinuses, orbits, or central nervous system (CNS) were included.
Results:
Patients comprised a total of 90 SOT recipients with rhino-orbital-cerebral zygomycosis, including 13 in our cohort and 77 in the literature. CNS disease occurred in 57% (51 of 90). Overall mortality was 52.3% (46 of 88), and the mortality in patients with CNS disease was 73.5% (36 of 49). In logistic regression analysis, older age (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.04-1.21, P=0.002) was associated with a higher mortality rate, whereas lipid formulations of amphotericin B compared with amphotericin B deoxycholate (OR 0.09, 95% CI 0.02-0.50, P=0.006) and surgery (OR 0.12, 95% CI 0.01-0.94, P=0.043) were independently associated with an improved survival even when controlled for CNS involvement and the era of diagnosis of disease.
Conclusions:
Rhino-orbital-cerebral zygomycosis, particularly CNS disease, is associated with substantial mortality rate in SOT recipients. Older age is a significant risk factor for mortality, whereas lipid formulations of amphotericin B and surgery improved outcomes.
Insights
Rhino-orbital-cerebral zygomycosis in solid organ transplant recipients has a high mortality rate, especially with central nervous system involvement. Lipid formulations of amphotericin B and surgery improve survival, while older age increases risk.
Area of Science:
- Mycology
- Infectious Diseases
- Transplant Medicine
Background:
- Rhino-orbital-cerebral zygomycosis is a severe fungal infection in solid organ transplant (SOT) recipients.
- Limited data exists on the specific characteristics and outcomes of this condition in SOT patients.
Purpose of the Study:
- To characterize rhino-orbital-cerebral zygomycosis in SOT recipients.
- To identify factors associated with mortality and survival in these patients.
Main Methods:
- A cohort study of SOT recipients with zygomycosis was conducted.
- Literature review identified additional cases from 1950s to 2009.
- Patients with sinus, orbital, or central nervous system (CNS) involvement were included.
Main Results:
- 90 SOT recipients had rhino-orbital-cerebral zygomycosis; 57% had CNS disease.
- Overall mortality was 52.3%, rising to 73.5% with CNS involvement.
- Older age increased mortality risk, while lipid amphotericin B and surgery improved survival.
Conclusions:
- Rhino-orbital-cerebral zygomycosis, especially with CNS disease, carries a high mortality rate in SOT recipients.
- Older age is a significant risk factor for mortality.
- Lipid formulations of amphotericin B and surgical intervention are associated with better outcomes.
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