Mycoses in the transplanted patient

Oral health complications after a heart transplant: a review

Background Heart transplants have become a successful treatment for some cardiovascular diseases. To prevent rejection of the transplanted heart, patients have to take immunosuppressive medication.Aims The aims of this study were to identify and review oral health complications after heart transplantation.Methods The electronic database PubMed was searched for relevant articles. The search yielded 332 papers, of which 24 matched the criteria for this review.Results Gingival hyperplasia was observed in 8.3-67% of the patients. Heart transplant patients who received professional periodontal treatment starting six months after transplantation showed significantly better scores on the Gingival Index (GI) and gingival hyperplasia. In comparison to a control group, heart transplant patients did not differ significantly in the DMF(T) index. The incidence of fungal infection in patients receiving a heart transplant varied between 10% and 25%. Heart transplant patients had a 4.3 times higher chance of developing oral cancer.Conclusion Patients who underwent a heart transplant and subsequently used immunosuppressive medicines appear to have a higher risk of gingival hyperplasia, periodontal conditions, the presence of Candida species and oral malignancies, in comparison to healthy individuals. The association between heart transplants and dental caries was unclear. It is recommended that heart transplant patients receive frequent oral examination and professional dental cleaning.

Presence of Candida spp. in the oral cavity of heart transplantation patients

Candida spp. can lead to infections or even fungal sepsis particularly among immunocompromized individuals.

Human albumin promotes germination, hyphal growth and antifungal resistance by Aspergillus fumigatus

Invasive aspergillosis is one of the most common deep-seated fungal infections among patients with an impaired immune system. Albumin is a serum protein commonly administered to critical patients. Our objective was to evaluate the in vitro effect of human albumin upon germination and hyphal growth of Aspergillus species, especially the most pathogenic, Aspergillus fumigatus, as well as its influence on antifungal drug activity. Human albumin induced, at normal serum concentrations (2-4%), a significant promotion of conidial germination by A. fumigatus, but not by Aspergillus flavus and Aspergillus niger. However, mycelium growth following germination was enhanced in all Aspergillus species. Minimal inhibitory concentrations (MIC) of all strains tested to amphotericin B and itraconazole increased in the presence of physiological concentrations of human albumin. Voriconazole activity was not, however, significantly affected by the presence of the protein. Conidial germination represents a crucial initial step in the progression to invasive disease, involving metabolic pathways that may differ considerably among Aspergillus species. Our results support the concept that human albumin may promote a faster onset and enhanced dissemination of invasive aspergillosis.