Non-Aspergillus molds

Area of Science:

• Medical Mycology
• Transplant Infectious Diseases
• Immunocompromised Host Infections

Background:

• Non-Aspergillus molds (e.g., Mucorales, Scedosporium, Lomentospora, Fusarium) are significant causes of severe morbidity and mortality in heart and lung transplant recipients.
• These fungi exhibit angioinvasion, leading to thrombosis, tissue infarction, and disseminated disease.

Purpose of the Study:

• To review the epidemiology, diagnosis, and management challenges of non-Aspergillus mold infections in transplant recipients.
• To highlight risk factors, diagnostic strategies, and current/investigational therapeutic options.

Main Methods:

• Literature review focusing on non-Aspergillus mold infections in solid organ transplant recipients.
• Analysis of risk factors, clinical presentation, diagnostic modalities, and treatment outcomes.
• Evaluation of antifungal agents, including established and investigational therapies.

Main Results:

• Infections often occur within the first year post-transplant, preceded by respiratory colonization in lung transplant recipients.
• Risk factors include advanced age, augmented immunosuppression (hypogammaglobulinemia, neutropenia, T-cell depletion), endobronchial stents, and airway ischemia.
• Diagnosis is frequently delayed, necessitating imaging and tissue sampling for culture and histopathology.

Conclusions:

• Management is challenging due to intrinsic resistance, delayed diagnosis, and drug interactions in transplant patients.
• Current treatments often involve lipid formulations of amphotericin B or azoles (voriconazole, posaconazole, isavuconazole).
• Investigational agents like fosmanogepix and olorofim show promise for future treatment strategies.