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Fungal infections in solid organ transplant recipients
1Harvard Medical School, Boston, Massachusetts, USA.
Abstract:
Invasive fungal infections occur in 5% to 45% of solid organ transplant recipients, and are a major cause of morbidity and mortality in the immunocompromised population. The net depression of host defenses and environmental factors, such as preoperative exposures to endemic mycoses or nosocomial and specific surgery-associated exposures, affect the development of invasive infection. Most fungal infections in solid organ transplant recipients occur within the first 2 months after transplantation. The most common pathogens in the majority of solid organ transplant recipients are Candida spp, followed by Aspergillus sp. Diagnosis is best made by a high index of suspicion and aggressive acquisition of specimens for culture; serologic tests are useful for infections due to Cryptococcus neoformans and Histoplasma capsulatum. Amphotericin B is the drug of choice for life-threatening infections. The triazoles, fluconazole and itraconazole, may be effective alternatives for less serious infections due to susceptible organisms. Prophylactic and preemptive treatment strategies require further study.
Insights
Invasive fungal infections are common in solid organ transplant recipients, leading to significant illness and death. Early diagnosis and appropriate antifungal treatment are crucial for managing these serious infections.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Mycology
Background:
- Invasive fungal infections (IFIs) affect 5-45% of solid organ transplant (SOT) recipients, contributing to substantial morbidity and mortality.
- Impaired host defenses and environmental exposures (endemic mycoses, nosocomial, surgery-associated) precipitate IFIs.
- The majority of IFIs in SOT recipients manifest within the first two months post-transplant.
Purpose of the Study:
- To review the epidemiology, diagnosis, and management of invasive fungal infections in solid organ transplant recipients.
- To highlight common fungal pathogens and diagnostic modalities.
- To discuss current treatment strategies and areas for future research.
Main Methods:
- Literature review of invasive fungal infections in solid organ transplant recipients.
- Analysis of common pathogens, diagnostic approaches, and therapeutic options.
- Synthesis of information on risk factors and timing of infection.
Main Results:
- Candida spp. are the most frequent pathogens, followed by Aspergillus spp.
- Diagnosis relies on clinical suspicion and specimen cultures; serology aids in specific fungal infections.
- Amphotericin B is recommended for life-threatening infections, with triazoles as alternatives for less severe cases.
Conclusions:
- Invasive fungal infections pose a significant threat to solid organ transplant recipients.
- Prompt diagnosis and targeted antifungal therapy are essential for improving outcomes.
- Further investigation into prophylactic and preemptive treatment strategies is warranted.