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An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
Invasive fungal infections following liver transplantation
Rachel Hogen1, Kiran K Dhanireddy
1Division of Surgical Education, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Purpose Of Review:
The review outlines the microbiology, presentation, prophylactic strategies, resistance patterns, and consequences of invasive fungal infections (IFIs) in orthotopic liver transplantation (OLT) recipients.
Recent Findings:
There has been an increase in the proportion of non-albicans Candida causing IFIs. The biomarkers galactomannan and β-D-glucan should not be routinely used in the diagnosis of IFIs in OLT recipients due to their limited accuracy. Echinocandins have emerged as noninferior to fluconazole and other prophylactic regimens. Their broad spectrum of activity and side-effect profile are appealing; however, the development of echinocandin resistance, especially in Candida glabrata has been highlighted as one of their limitations.
Summary:
A significant decline in IFIs but an increase in IFIs caused by non-albicans Candida species has been observed in the model for end-stage liver disease era. Diagnostic tools remain limited. Studies continue to support antifungal prophylaxis individualized to recipient risk with echinocandins now established as an additional option for antifungal prophylaxis. The appropriate duration of antifungal prophylaxis remains ill-defined with some studies advocating targeted therapy based on clinical status and others more prolonged therapy beyond the historically common 4 weeks. However, prolonged therapy with echinocandins can result in resistance.
Insights
Invasive fungal infections (IFIs) in liver transplant recipients are declining but caused by more resistant non-albicans Candida. Echinocandins are effective for prophylaxis but resistance is a concern.
Area of Science:
- Medical Mycology
- Transplantation Medicine
- Infectious Diseases
Background:
- Invasive fungal infections (IFIs) pose a significant risk to orthotopic liver transplantation (OLT) recipients.
- Understanding the evolving landscape of IFIs, including causative agents and resistance patterns, is crucial for patient management.
Purpose of the Study:
- To review the microbiology, clinical presentation, prophylaxis, resistance, and outcomes of IFIs in OLT recipients.
- To provide an updated perspective on diagnostic and therapeutic strategies for IFIs in this vulnerable population.
Main Methods:
- Literature review focusing on recent studies and clinical guidelines.
- Analysis of trends in IFI epidemiology, diagnostic accuracy, and antifungal treatment efficacy.
Main Results:
- A decrease in overall IFIs, but an increase in non-albicans Candida species, has been observed.
- Biomarkers like galactomannan and β-D-glucan show limited diagnostic accuracy in OLT recipients.
- Echinocandins are effective for prophylaxis, comparable to fluconazole, but resistance, particularly in Candida glabrata, is a growing concern.
Conclusions:
- IFIs in OLT recipients have shifted towards non-albicans Candida, necessitating tailored prophylaxis strategies.
- Diagnostic tools for IFIs in OLT patients remain limited, highlighting the need for improved methods.
- Antifungal prophylaxis, including the use of echinocandins, should be individualized, with careful consideration of resistance development and optimal duration.
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