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Fungal complications of transplantation: diagnosis, treatment and prevention
1PHLS Mycology Reference Laboratory, Public Health Laboratory, Bristol, UK.
Abstract:
Invasive fungal infection remains a major problem in transplant recipients. The commonest causes of infection are Candida, and Aspergillus spp., although a growing number of other organisms (including species of Fusarium and Trichosporon) have been reported to cause infection in neutropenic bone marrow transplant recipients. The clinical manifestations of these infections are described and methods of diagnosis are discussed. As in other groups of immunocompromised patients, the diagnosis is often difficult to establish, but transplant recipients who are given empirical treatment with amphotericin B have increased rates of survival. The roles of lipid-associated forms of amphotericin B and of the triazole compounds, itraconazole and fluconazole, in the treatment and prevention of fungal infection are discussed.
Insights
Invasive fungal infections are a significant risk for transplant recipients, often caused by Candida and Aspergillus species. Early diagnosis and empirical treatment with amphotericin B improve survival rates in these immunocompromised patients.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
Background:
- Invasive fungal infections (IFIs) pose a major threat to transplant recipients.
- Candida and Aspergillus species are the most frequent causative agents of IFIs.
- Emerging fungal pathogens like Fusarium and Trichosporon are increasingly reported in neutropenic bone marrow transplant recipients.
Purpose of the Study:
- To describe the clinical manifestations of IFIs in transplant recipients.
- To discuss diagnostic methods for IFIs in this population.
- To review treatment and prevention strategies for IFIs.
Main Methods:
- Review of clinical manifestations of IFIs.
- Discussion of diagnostic challenges and approaches.
- Analysis of therapeutic options, including empirical treatment.
Main Results:
- Diagnosis of IFIs in transplant recipients is often challenging.
- Empirical treatment with amphotericin B is associated with improved survival rates.
- Lipid-associated amphotericin B and triazoles (itraconazole, fluconazole) play key roles in management.
Conclusions:
- IFIs are a critical concern in transplant recipients, requiring prompt recognition and management.
- Timely empirical antifungal therapy, particularly with amphotericin B, is crucial for improving patient outcomes.
- Advanced antifungal agents offer effective options for treatment and prophylaxis.