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Non-Aspergillus molds.

Emily M Eichenberger1, Maria Alejandra Mendoza2, John W Baddley3

  • 1Emory University School of Medicine, Atlanta, Georgia.

JHLT Open
|December 1, 2025
PubMed
Summary
This summary is machine-generated.

Non-Aspergillus molds pose serious risks for heart and lung transplant patients, causing severe illness and death. Early diagnosis and novel antifungal therapies are crucial for managing these challenging infections.

Keywords:
FusariumLomentosporaMucorScedosporiumheart transplantinvasive fungal infectionlung transplant

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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.