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High mortality in systemic fungal infections following renal transplantation in third-world countries
1Department of Nephrology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Abstract:
Amongst 310 recipients of live related renal transplants, systemic fungal infections were observed in 19 patients (6.1%). These included cryptococcosis in eight (42%), candidiasis in seven (37%), mucormycosis in two (11%), aspergillosis in one (5.5%), and a mixed cryptococcal and Aspergillus infection in one patient (5.5%). Infections occurred within 12 months of transplantation in seven patients and after 13-37 months in the remaining patients. Prolonged fever not responding to antibiotics was the most common presentation. Central nervous system was involved in all patients with cryptococcosis, while Candida infection primarily involved the urinary tract. Both patients with mucormycosis exhibited signs and symptoms of florid rhinocerebral disease and a rapid downhill course. Pulmonary manifestations were the most prominent features of patients with aspergillosis. Parenteral amphotericin B with or without 5-fluorocytosine was started in all, but three patients could receive the therapy only for 1-3 weeks. Three patients with cryptococcosis developed amphotericin-related complications and were changed to oral fluconazole. Seven patients recovered and 12 (63%) died. None of the patients had cytomegalovirus infection preceding the onset of fungal disease. The high frequency of fungal infections amongst our allograft recipients could not be ascribed to over immunosuppression, since 16 patients (84%) were only on maintenance doses of immunosuppressive drugs and in 13 (68.4%) graft function was normal at the time of diagnosis. The high frequency of fungal infections in our patients was most probably related to the poor hygienic and sanitary conditions which continue to be prevalent in the tropical environment of third-world countries. Delays in the diagnosis and late institution of therapy result in a high mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Systemic fungal infections occurred in 6.1% of renal transplant recipients. Poor hygiene in tropical environments likely contributed to high infection rates and mortality, despite adequate graft function.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplantation Immunology
Background:
- Systemic fungal infections pose a significant threat to renal transplant recipients.
- Understanding the epidemiology and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence, types, clinical manifestations, and outcomes of systemic fungal infections in live-related renal transplant recipients.
- To identify potential contributing factors and assess the impact on graft and patient survival.
Main Methods:
- Retrospective analysis of 310 live-related renal transplant recipients.
- Identification and classification of fungal infections based on clinical presentation and microbiological data.
- Review of treatment regimens, complications, and patient outcomes.
Main Results:
- 19 patients (6.1%) developed systemic fungal infections, including cryptococcosis, candidiasis, mucormycosis, and aspergillosis.
- Infections presented with prolonged fever; specific organ involvement varied by fungal type (CNS for Cryptococcus, urinary tract for Candida, rhinocerebral for mucormycosis, pulmonary for Aspergillus).
- Mortality rate was high (63%), with delays in diagnosis and treatment contributing to poor outcomes. Poor hygiene in tropical environments was implicated as a likely factor.
Conclusions:
- Systemic fungal infections are a serious complication in renal transplant recipients, associated with high mortality.
- Environmental factors, such as poor hygiene in tropical regions, may play a significant role.
- Prompt diagnosis and timely, aggressive treatment are essential to improve survival rates.