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Fungal infections in renal transplant recipients
Abstract:
Infection continues to be a major source of morbidity and the major source of mortality in renal transplant recipients who are susceptible to opportunistic infections. We recently reviewed all renal transplant recipients who had fungi cultured during a three year period. C. albicans and T. glabrata were cultured most frequently. Deep fungal infections occurred in many patients and were frequently observed late in the course of bacterial and viral infections. Ten patients had fungemia, and primary fungal pneumonia occurred in eight patients. Three patients had fungal infection of the central nervous system. Three of eight patients with fungal pneumonia and eight of ten patients with fungemia died as a result of their fungus infections. These patients frequently had poor renal function and were receiving high steroid doses or had recently been treated for kidney rejection. One patient with fungal pneumonia and six patients with fungemia had the fungus cultured from a superficial site. Several patients developed fungal infections late in the course of viral or bacterial infections. Amphotericin-B and 5-fluorocytosine remain the mainstays of antifungal therapy.
Insights
Fungal infections, particularly Candida albicans and Talaromyces glabrata, pose significant mortality risks in renal transplant recipients. Prompt diagnosis and treatment are crucial for managing these opportunistic infections.
Area of Science:
- Nephrology
- Infectious Diseases
- Mycology
Background:
- Renal transplant recipients are highly susceptible to opportunistic fungal infections.
- Fungal infections contribute significantly to morbidity and mortality in this immunocompromised population.
Purpose of the Study:
- To review the incidence, types, and outcomes of fungal infections in renal transplant recipients over a three-year period.
- To identify risk factors and common pathogens associated with deep fungal infections.
Main Methods:
- Retrospective review of all renal transplant recipients with cultured fungi over three years.
- Analysis of clinical data, including infection sites, types, treatments, and outcomes.
Main Results:
- Candida albicans and Talaromyces glabrata were the most frequently cultured fungi.
- Deep fungal infections, including fungemia (10 patients) and fungal pneumonia (8 patients), were common, often occurring late in bacterial or viral infections.
- Mortality was high, with 80% of fungemia cases and 37.5% of fungal pneumonia cases proving fatal.
- Poor renal function, high-dose steroids, and recent kidney rejection treatment were associated risk factors.
Conclusions:
- Fungal infections represent a critical threat to renal transplant recipients, necessitating vigilant monitoring and management.
- Amphotericin-B and 5-fluorocytosine remain primary antifungal therapies.
- Early detection and intervention are vital to improve outcomes in transplant patients with fungal infections.