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Invasive fungal infections in renal transplant recipients
M R Nampoory1, Z U Khan, K V Johny
1Department of Medicine, Mubarak Al-Kabeer Hospital, Safat, Kuwait.
Abstract:
In a retrospective analysis, 18 instances of invasive fungal infections were observed in 512 (3.5%) renal transplant recipients. These included candidiasis (8), aspergillosis (5), cryptococcosis (3) and zygomycosis (2). All patients with candidiasis had Candida isolated from blood and one or more additional sites. One of them had superadded fungaemia with Torulopsis glabrata. Pulmonary disease in four and subcutaneous infection in one were encountered in the five patients with aspergillosis. Central nervous system involvement in two and cutaneous lesion in one were the findings in patients with cryptococcosis. Zygomycosis involved the lung in one and the allograft itself in the other. Prolonged fever not responding to antibacterial drugs was the most common clinical presentation. Fungal infections occurred during the first 4 months in 10 (55.5%) and 12 to 108 months in eight (44.5%) patients. Infections with cytomegalovirus and hepatitis viruses were concommitantly present in 12 (66.7%) and eight (44.5%) patients respectively. Fourteen episodes of fungal infections (77.8%) occurred in live unrelated kidney recipients who formed only 48% of our total transplant population. Nine patients were treated with systemic and/or local amphotericin B and six with amBisome. Fluconazole was administered alone in three and in combination with amphotericin B in two. Fourteen patients died but mortality was only directly attributable to fungal infection in 11. We conclude that invasive fungal infections continue to be an important cause of morbidity and mortality in renal transplant recipients. A high index of suspicion. prompt diagnosis and early institution of specific antifungal therapy are needed.
Insights
Invasive fungal infections are a significant threat to renal transplant recipients, causing substantial morbidity and mortality. Early diagnosis and prompt antifungal treatment are crucial for improving patient outcomes.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplantation
Background:
- Invasive fungal infections (IFIs) pose a serious risk to renal transplant recipients.
- These infections contribute significantly to morbidity and mortality in this vulnerable population.
Purpose of the Study:
- To analyze the incidence, types, clinical presentation, and outcomes of IFIs in renal transplant recipients.
- To identify risk factors and evaluate treatment strategies for IFIs in this patient group.
Main Methods:
- Retrospective analysis of 512 renal transplant recipients.
- Identification and categorization of 18 cases of invasive fungal infections.
- Review of clinical data, including infection types, timing, co-infections, treatment, and outcomes.
Main Results:
- 18 IFIs (3.5%) observed, including candidiasis, aspergillosis, cryptococcosis, and zygomycosis.
- Prolonged fever was the most common presentation; 77.8% of IFIs occurred in live unrelated kidney recipients.
- Concomitant cytomegalovirus and hepatitis virus infections were frequent; 11 out of 14 deaths were directly attributable to fungal infection.
Conclusions:
- Invasive fungal infections remain a critical cause of morbidity and mortality in renal transplant recipients.
- A high index of suspicion, prompt diagnosis, and early institution of specific antifungal therapy are essential.
- Targeted surveillance and management strategies are needed for high-risk subgroups, such as live unrelated kidney recipients.