Opportunistic deep cutaneous mycoses in solid organ transplant recipients

Area of Science:

• Medical Mycology
• Transplant Infectious Diseases

Background:

• Invasive fungal infections (IFIs) are a leading cause of death in organ transplant recipients.
• Risk factors include immunosuppression intensity, organ type (lung, liver), age, surgical complexity, and environmental exposure.
• Superficial fungal infections are caused by Candida, Dermatophytes, and Malassezia, while invasive mycoses involve agents like Aspergillus, Cryptococcus, and Zygomycetes.

Purpose of the Study:

• To review the epidemiology, risk factors, clinical manifestations, and treatment of fungal infections in organ transplant recipients.
• To highlight the importance of recognizing cutaneous manifestations of fungal infections.
• To emphasize the need for prompt diagnosis and effective therapeutic strategies.

Main Methods:

• Literature review of invasive and superficial fungal infections in organ transplant recipients.
• Analysis of risk factors, common etiological agents, and clinical presentations.
• Discussion of diagnostic approaches, including biopsy for histology and culture.
• Evaluation of current therapeutic options.

Main Results:

• Despite advances, IFIs remain a major threat to organ transplant recipients.
• Cutaneous manifestations can signal systemic fungal dissemination or direct inoculation.
• Common etiological agents include Aspergillus, Cryptococcus, Zygomycetes, Scedosporium, and Pseudallescheria.
• Diagnostic challenges exist due to non-specific cutaneous signs, necessitating high clinical suspicion and timely biopsy.
• Liposomal amphotericin B and novel triazoles demonstrate therapeutic efficacy.

Conclusions:

• Fungal infections, both superficial and invasive, represent a significant clinical challenge in organ transplantation.
• Prompt diagnosis through biopsy and appropriate antifungal therapy are essential for improving outcomes.
• Continued vigilance and research are needed to combat the morbidity and mortality associated with IFIs in this vulnerable population.