1
|
Alsaeed M, Husain S. Infections in Heart and Lung Transplant Recipients. Infect Dis Clin North Am 2024; 38:103-120. [PMID: 38280759 DOI: 10.1016/j.idc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Infections in heart and lung transplant recipients are complex and heterogeneous. This article reviews the epidemiology, risk factors, specific clinical syndromes, and most frequent opportunistic infections in heart and/or lung transplant recipients that will be encountered in the intensive care unit and will provide a practical approach of empirical management.
Collapse
Affiliation(s)
- Mohammed Alsaeed
- Division of Infectious Diseases, Multi-Organ Transplant Program, Department of Medicine, University of Toronto, University Health Network, 585 University Avenue, 11 PMB 138, Toronto, Ontario M5G 2N2, Canada; Division of Infectious Diseases, Department of Medicine, Prince Sultan Military Medical City, Makkah Al Mukarramah Road, As Sulimaniyah, Riyadh 12233, Saudi Arabia
| | - Shahid Husain
- Division of Infectious Diseases, Multi-Organ Transplant Program, Department of Medicine, University of Toronto, University Health Network, 585 University Avenue, 11 PMB 138, Toronto, Ontario M5G 2N2, Canada.
| |
Collapse
|
2
|
Kapałka M, Kubik H, Krawiec M, Danel A, Krzyżak K, Śliwka J, Pawlak S. Invasive Pulmonary Aspergillosis After Sars-CoV-2 Infection as Limitation of Contemporary Transplantology: A Case Report. Transplant Proc 2023; 55:1880-1882. [PMID: 37365104 PMCID: PMC10239897 DOI: 10.1016/j.transproceed.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
Invasive fungal infections are uncommon in pediatric heart transplant recipients. Risk and mortality are highest in the first 6 months post-transplant, especially in patients with previous surgery and those requiring mechanical support. There is a possibility that prior SARS-CoV-2 infection may cause a more severe course of pulmonary aspergillosis, especially in immunosuppressed individuals. This report describes a female patient, eight years of age, who was admitted to the pediatric cardiac surgery department with symptoms of end-stage heart failure in urgent need of mechanical circulatory support (MCS). A left ventricular assist device (LVAD) was implanted as a bridge to transplantation. During over a year on the waiting list, LVAD was replaced twice due to the presence of fibrin on the inlet valve. While staying in the ward, the patient underwent SARS-CoV-2 infection. An orthotopic heart transplant was successfully performed after 372 days of MCS with LVAD. One month after transplantation, the girl developed severe pulmonary aspergillosis complicated by sudden cardiac arrest and implantation of venovenous extracorporeal membrane oxygenation (VV ECMO) used for 25 days. Unfortunately, a few days after weaning from VV ECMO, the patient died due to intracerebral bleeding.
Collapse
Affiliation(s)
- Michał Kapałka
- Student research group at Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Hanna Kubik
- Student research group at Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Michał Krawiec
- Student research group at Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Anna Danel
- Student research group at Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Katarzyna Krzyżak
- Student research group at Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland.
| | - Joanna Śliwka
- Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Szymon Pawlak
- Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| |
Collapse
|
3
|
Wu MY, Ali Khawaja RD, Vargas D. Heart Transplantation: Indications, Surgical Techniques, and Complications. Radiol Clin North Am 2023; 61:847-859. [PMID: 37495292 DOI: 10.1016/j.rcl.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Heart transplantation has been increasingly performed for patients with end-stage heart failure most commonly related to ischemic and non-ischemic cardiomyopathies. The major complications are procedure-related complications, infection, acute rejection, cardiac allograft vasculopathy, and malignancy. Radiologists have an important role in the evaluation of transplant candidates and early detection of postoperative complications.
Collapse
Affiliation(s)
- Markus Y Wu
- Department of Radiology, University of Colorado, 12401 East 17th Avenue, Aurora, CO 80045, USA.
| | - Ranish Deedar Ali Khawaja
- Department of Radiology, University of Colorado, 12401 East 17th Avenue, Aurora, CO 80045, USA. https://twitter.com/RanishKhawaja
| | - Daniel Vargas
- Department of Radiology, University of Colorado, 12401 East 17th Avenue, Aurora, CO 80045, USA. https://twitter.com/DanielVargasMD
| |
Collapse
|
4
|
Selection of Aspergillus fumigatus isolates carrying the G448S substitution in CYP51A gene after long-term treatment with voriconazole in an immunocompromised patient. Med Mycol Case Rep 2022; 36:5-9. [PMID: 35242508 PMCID: PMC8881195 DOI: 10.1016/j.mmcr.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/08/2023] Open
Abstract
We present a case of a 55-year-old man with a heart transplant who acquired Invasive Aspergillosis by Aspergillus fumigatus with the focus in the kidney. During about two years of antifungal treatment, most of the time with voriconazole, it was possible to obtain nine isolates of A. fumigatus, with the same genotypic characteristics, but with an increase in MIC for several azoles. The two last isolates presented high MICs for Voriconazole (>8 μg/mL>). Sequencing of the CYP51A gene showed G448S amino acid substitution in the same two isolates. In long-term treatments with antifungals, it would be important to regularly evaluate the susceptibility of isolated strains, as resistance to azoles has been increasingly described around the world.
Collapse
|
5
|
Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2019.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
6
|
Flores-Umanzor E, Ivey-Miranda JB, Pujol-Lopez M, Cepas-Guillen P, Fernandez-Valledor A, Caldentey G, Farrero M, García A, Sitges M, Perez-Villa F, Moreno A, Andrea R, Castel Md MA. Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing? Rev Port Cardiol 2020; 40:57-61. [PMID: 33303301 DOI: 10.1016/j.repc.2019.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 11/05/2018] [Accepted: 02/03/2019] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Infection remains a major complication among heart transplant (HT) recipients, causing approximately 20% of deaths in the first year after transplantation. In this population, Aspergillus species can have various clinical presentations including invasive pulmonary aspergillosis (IPA), which has high mortality (53-78%). AIMS To establish the characteristics of IPA infection in HT recipients and their outcomes in our setting. METHODS Of 328 heart transplantations performed in our center between 1998 and 2016, five cases of IPA were identified. Patient medical records were examined and clinical variables were extracted. RESULTS All cases were male, with a mean age of 62 years. The most common indication for HT was nonischemic dilated cardiomyopathy. Productive cough was reported as the main symptom. The imaging assessment was based on chest radiography and chest computed tomography. The most commonly reported radiological abnormality was multiple nodular opacities in both techniques. Bronchoscopy was performed in all patients and A. fumigatus was isolated in four cases on BAL culture. Treatment included amphotericin in four patients, subsequently changed to voriconazole in three patients, and posaconazole in one patient, with total treatment lasting an average of 12 months. Neutropenia was found in only one patient, renal failure was observed in two patients, and concurrent cytomegalovirus infection occurred in three patients. All patients survived after a mean follow-up of 18 months. CONCLUSIONS IPA is a potentially lethal complication after HT. An early diagnosis and prompt initiation of aggressive treatment are the cornerstone for better survival.
Collapse
Affiliation(s)
- Eduardo Flores-Umanzor
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Juan Betuel Ivey-Miranda
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Department of Cardiology, Hospital de Cardiologia, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Margarida Pujol-Lopez
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Andrea Fernandez-Valledor
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Guillen Caldentey
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Farrero
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ana García
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Sitges
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Felix Perez-Villa
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Infectious Disease Department, Hospital Clínic, IDIBAPS, Spain
| | - Rut Andrea
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María A Castel Md
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| |
Collapse
|
7
|
Nemunaitis J, Stanbery L, Senzer N. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection: let the virus be its own demise. Future Virol 2020. [PMCID: PMC7249572 DOI: 10.2217/fvl-2020-0068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There has been a collaborative global effort to construct novel therapeutic and prophylactic approaches to SARS-CoV-2 management. Although vaccine development is crucial, acute management of newly infected patients, especially those with severe acute respiratory distress syndrome, is a priority. Herein we describe the rationale and potential of repurposing a dual plasmid, Vigil (pbi-shRNAfurin-GM-CSF), now in Phase III cancer trials, for the treatment of and, in certain circumstances, enhancement of the immune response to SARS-CoV-2.
Collapse
|
8
|
Zilberberg MD, Nathanson BH, Harrington R, Spalding JR, Shorr AF. Epidemiology and Outcomes of Hospitalizations With Invasive Aspergillosis in the United States, 2009-2013. Clin Infect Dis 2019; 67:727-735. [PMID: 29718296 DOI: 10.1093/cid/ciy181] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/19/2018] [Indexed: 11/12/2022] Open
Abstract
Background Though invasive aspergillosis (IA) complicates care of up to 13% of patients with immunocompromise, little is known about its morbidity and mortality burden in the United States. Methods We analyzed the Health Care Utilization Project's data from the Agency for Healthcare Research and Quality for 2009-2013. Among subjects with high-risk conditions for IA, IA was identified via International Classification of Diseases, Ninth Revision, Clinical Modification codes 117.3, 117.9, and 484.6. We compared characteristics and outcomes between those with (IA) and without IA (non-IA). Using propensity score matching, we calculated the IA-associated excess mortality and 30-day readmission rates, length of stay, and costs. Results Of the 66634683 discharged patients meeting study inclusion criteria, 154888 (0.2%) had a diagnosis of IA. The most common high-risk conditions were major surgery (50.1%) in the non-IA and critical illness (41.0%) in the IA group. After propensity score matching, both mortality (odds ratio, 1.43; 95% confidence interval, 1.36-1.51) and 30-day readmission (1.39; 1.34-1.45) rates were higher in the IA group. IA was associated with 6.0 (95% confidence interval, 5.7-6.4) excess days in the hospital and $15542 ($13869-$17215) in excess costs per hospitalization. Conclusions Although rare even among high-risk groups, IA is associated with increased hospital mortality and 30-day readmission rates, excess duration of hospitalization, and costs. Given nearly 40000 annual admissions for IA in the United States, the aggregate IA-attributable excess costs may reach $600 million annually.
Collapse
|
9
|
Smith JD, Stowell JT, Martínez-Jiménez S, Desouches SL, Rosado-de-Christenson ML, Jain KK, Magalski A. Evaluation after Orthotopic Heart Transplant: What the Radiologist Should Know. Radiographics 2019; 39:321-343. [PMID: 30735469 DOI: 10.1148/rg.2019180141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Orthotopic heart transplant (OHT) is the treatment of choice for end-stage heart disease. As OHT use continues and postoperative survival increases, multimodality imaging evaluation of the transplanted heart will continue to increase. Although some of the imaging is performed and interpreted by cardiologists, a substantial proportion of images are read by radiologists. Because there is little to no consensus on a systematic approach to patients after OHT, radiologists must become familiar with common normal and abnormal posttreatment imaging features. Intrinsic transplant-related complications may be categorized on the basis of time elapsed since transplant into early (0-30 days), intermediate (1-12 months), and late (>12 months) stages. Although there can be some overlap between stages, it remains helpful to consider the time elapsed since surgery, because some complications are more common at certain stages. Recognition of differing OHT surgical techniques and their respective postoperative imaging features helps to avoid image misinterpretation. Expected early postoperative findings include small pneumothoraces, pleural effusions, pneumomediastinum, pneumopericardium, postoperative atelectasis, and an enlarged cardiac silhouette. Early postoperative complications also can include sternal dehiscence and various postoperative infections. The radiologist's role in the evaluation of allograft failure and rejection, endomyocardial biopsy complications, cardiac allograft vasculopathy, and posttransplant malignancy is highlighted. Because clinical manifestations of disease may be delayed in transplant recipients, radiologists often recognize postoperative complications on the basis of imaging and may be the first to suggest a specific diagnosis and thus positively affect patient outcomes. Online supplemental material is available for this article. ©RSNA, 2019.
Collapse
Affiliation(s)
- Jordan D Smith
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Justin T Stowell
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Santiago Martínez-Jiménez
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Stephane L Desouches
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Melissa L Rosado-de-Christenson
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Kaushik K Jain
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Anthony Magalski
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| |
Collapse
|
10
|
Nair VV, Narayan KV, Pulikottil SK, Kathayanat JT, Chooriyil N, Radhakrishnan R, Babu A, Nair JTK. Should all tubercular cavities be left alone? Lessons from a heart transplant. Indian J Thorac Cardiovasc Surg 2019; 35:64-67. [PMID: 33060973 DOI: 10.1007/s12055-018-0714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/04/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022] Open
Abstract
Fungal infection after solid organ transplantation poses a diagnostic and therapeutic challenge. We present the case of a 50-year-old man who underwent orthotopic heart transplantation for dilated cardiomyopathy with a history of treated pulmonary tuberculosis 10 years pre-transplant. One year post-transplantation, he was admitted with recurrent productive cough and was evaluated to have intracavitory aspergillosis of the lung. He was started on medical therapy with reduction in immunosuppression, but succumbed later with allograft rejection and multiorgan failure. Management of invasive aspergillosis in immunocompromised host is a real challenge. Management protocol should be individualised.
Collapse
Affiliation(s)
| | | | | | | | - Nidheesh Chooriyil
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, India
| | - Ratish Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, India
| | - Akash Babu
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, India
| | | |
Collapse
|
11
|
Collateral Development of Invasive Pulmonary Aspergillosis (IPA) in Chronic Obstructive Pulmonary Disease (COPD) Patients. Fungal Biol 2019. [DOI: 10.1007/978-3-030-18586-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
12
|
Infections in Heart, Lung, and Heart-Lung Transplantation. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7121494 DOI: 10.1007/978-1-4939-9034-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Half a century has passed since the first orthotopic heart transplant took place. Surgical innovations allowed for heart, lung, and heart-lung transplantation to save lives of patients with incurable chronic cardiopulmonary conditions. The complexity of the surgical interventions, chronic host health conditions, and antirejection immunosuppressive medications makes infectious complications common. Infections have remained one of the main barriers for successful transplantation and a source of significant morbidity and mortality. Recognition of infections and its management in this setting require outstanding clinical skills since transplant recipients may not exhibit classic signs or symptoms of disease, and laboratory work has some pitfalls. The prevention, identification, and management of infectious diseases complications in this population are a priority to undertake to improve the medical outcomes of transplantation. Herein, we reviewed the historical aspects, epidemiology, and prophylaxis of infections in heart, lung, and heart-lung transplantation. We also discuss the most prevalent organisms affecting the host and the organ systems involved.
Collapse
|
13
|
Abstract
Infections in heart and lung transplant recipients are complex and heterogeneous. This article reviews the epidemiology, risk factors, specific clinical syndromes, and most frequent opportunistic infections in heart and/or lung transplant recipients that will be encountered in the intensive care unit and will provide a practical approach of empirical management.
Collapse
Affiliation(s)
- Mohammed Alsaeed
- Division of Infectious Diseases, Multi-Organ Transplant Program, Department of Medicine, University of Toronto, University Health Network, 585 University Avenue, 11 PMB 138, Toronto, Ontario M5G 2N2, Canada; Division of Infectious Diseases, Department of Medicine, Prince Sultan Military Medical City, Makkah Al Mukarramah Road, As Sulimaniyah, Riyadh 12233, Saudi Arabia
| | - Shahid Husain
- Division of Infectious Diseases, Multi-Organ Transplant Program, Department of Medicine, University of Toronto, University Health Network, 585 University Avenue, 11 PMB 138, Toronto, Ontario M5G 2N2, Canada.
| |
Collapse
|
14
|
Cook JC, Cook A, Tran RH, Chang PP, Rodgers JE. A case-control study of the risk factors for developing aspergillosis following cardiac transplant. Clin Transplant 2018; 32:e13367. [DOI: 10.1111/ctr.13367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/12/2018] [Accepted: 07/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer C. Cook
- Department of Pharmacy; Duke University Hospital; Durham North Carolina
| | - Abigail Cook
- Loyola Medicine; Loyola University Health System; Maywood Illinois
| | - Richard H. Tran
- Pharmaceutical Product Development; Morrisville North Carolina
| | - Patricia P. Chang
- UNC School of Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Jo E. Rodgers
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| |
Collapse
|
15
|
Ullmann AJ, Aguado JM, Arikan-Akdagli S, Denning DW, Groll AH, Lagrou K, Lass-Flörl C, Lewis RE, Munoz P, Verweij PE, Warris A, Ader F, Akova M, Arendrup MC, Barnes RA, Beigelman-Aubry C, Blot S, Bouza E, Brüggemann RJM, Buchheidt D, Cadranel J, Castagnola E, Chakrabarti A, Cuenca-Estrella M, Dimopoulos G, Fortun J, Gangneux JP, Garbino J, Heinz WJ, Herbrecht R, Heussel CP, Kibbler CC, Klimko N, Kullberg BJ, Lange C, Lehrnbecher T, Löffler J, Lortholary O, Maertens J, Marchetti O, Meis JF, Pagano L, Ribaud P, Richardson M, Roilides E, Ruhnke M, Sanguinetti M, Sheppard DC, Sinkó J, Skiada A, Vehreschild MJGT, Viscoli C, Cornely OA. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 2018; 24 Suppl 1:e1-e38. [PMID: 29544767 DOI: 10.1016/j.cmi.2018.01.002] [Citation(s) in RCA: 800] [Impact Index Per Article: 133.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 02/06/2023]
Abstract
The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of aspergillosis. Of the numerous recommendations, a few are summarized here. Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended. For diagnosis, direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programmes. Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported. Combinations of antifungals as primary treatment options are not recommended. Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended. Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy. Secondary prophylaxis is strongly recommended in high-risk patients. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.
Collapse
Affiliation(s)
- A J Ullmann
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J M Aguado
- Infectious Diseases Unit, University Hospital Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - S Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - D W Denning
- The National Aspergillosis Centre, Wythenshawe Hospital, Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, ECMM Excellence Centre of Medical Mycology, Manchester, UK; The University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; European Confederation of Medical Mycology (ECMM)
| | - A H Groll
- Department of Paediatric Haematology/Oncology, Centre for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - K Lagrou
- Department of Microbiology and Immunology, ECMM Excellence Centre of Medical Mycology, University Hospital Leuven, Leuven, Belgium; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - C Lass-Flörl
- Institute of Hygiene, Microbiology and Social Medicine, ECMM Excellence Centre of Medical Mycology, Medical University Innsbruck, Innsbruck, Austria; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R E Lewis
- Infectious Diseases Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; ESCMID Fungal Infection Study Group (EFISG)
| | - P Munoz
- Department of Medical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - P E Verweij
- Department of Medical Microbiology, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - A Warris
- MRC Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - F Ader
- Department of Infectious Diseases, Hospices Civils de Lyon, Lyon, France; Inserm 1111, French International Centre for Infectious Diseases Research (CIRI), Université Claude Bernard Lyon 1, Lyon, France; European Respiratory Society (ERS)
| | - M Akova
- Department of Medicine, Section of Infectious Diseases, Hacettepe University Medical School, Ankara, Turkey; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M C Arendrup
- Department Microbiological Surveillance and Research, Statens Serum Institute, Copenhagen, Denmark; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R A Barnes
- Department of Medical Microbiology and Infectious Diseases, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK; European Confederation of Medical Mycology (ECMM)
| | - C Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; European Respiratory Society (ERS)
| | - S Blot
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia; European Respiratory Society (ERS)
| | - E Bouza
- Department of Medical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R J M Brüggemann
- Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG)
| | - D Buchheidt
- Medical Clinic III, University Hospital Mannheim, Mannheim, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Cadranel
- Department of Pneumology, University Hospital of Tenon and Sorbonne, University of Paris, Paris, France; European Respiratory Society (ERS)
| | - E Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini Children's Hospital, Genoa, Italy; ESCMID Fungal Infection Study Group (EFISG)
| | - A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India; European Confederation of Medical Mycology (ECMM)
| | - M Cuenca-Estrella
- Instituto de Salud Carlos III, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - G Dimopoulos
- Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece; European Respiratory Society (ERS)
| | - J Fortun
- Infectious Diseases Service, Ramón y Cajal Hospital, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J-P Gangneux
- Univ Rennes, CHU Rennes, Inserm, Irset (Institut de Recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Garbino
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - W J Heinz
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R Herbrecht
- Department of Haematology and Oncology, University Hospital of Strasbourg, Strasbourg, France; ESCMID Fungal Infection Study Group (EFISG)
| | - C P Heussel
- Diagnostic and Interventional Radiology, Thoracic Clinic, University Hospital Heidelberg, Heidelberg, Germany; European Confederation of Medical Mycology (ECMM)
| | - C C Kibbler
- Centre for Medical Microbiology, University College London, London, UK; European Confederation of Medical Mycology (ECMM)
| | - N Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, St Petersburg, Russia; European Confederation of Medical Mycology (ECMM)
| | - B J Kullberg
- Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - C Lange
- International Health and Infectious Diseases, University of Lübeck, Lübeck, Germany; Clinical Infectious Diseases, Research Centre Borstel, Leibniz Center for Medicine & Biosciences, Borstel, Germany; German Centre for Infection Research (DZIF), Tuberculosis Unit, Hamburg-Lübeck-Borstel-Riems Site, Lübeck, Germany; European Respiratory Society (ERS)
| | - T Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; European Confederation of Medical Mycology (ECMM)
| | - J Löffler
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O Lortholary
- Department of Infectious and Tropical Diseases, Children's Hospital, University of Paris, Paris, France; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Maertens
- Department of Haematology, ECMM Excellence Centre of Medical Mycology, University Hospital Leuven, Leuven, Belgium; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Department of Medicine, Ensemble Hospitalier de la Côte, Morges, Switzerland; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - L Pagano
- Department of Haematology, Universita Cattolica del Sacro Cuore, Roma, Italy; European Confederation of Medical Mycology (ECMM)
| | - P Ribaud
- Quality Unit, Pôle Prébloc, Saint-Louis and Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M Richardson
- The National Aspergillosis Centre, Wythenshawe Hospital, Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, ECMM Excellence Centre of Medical Mycology, Manchester, UK; The University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - E Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M Ruhnke
- Department of Haematology and Oncology, Paracelsus Hospital, Osnabrück, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M Sanguinetti
- Institute of Microbiology, Fondazione Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Rome, Italy; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - D C Sheppard
- Division of Infectious Diseases, Department of Medicine, Microbiology and Immunology, McGill University, Montreal, Canada; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Sinkó
- Department of Haematology and Stem Cell Transplantation, Szent István and Szent László Hospital, Budapest, Hungary; ESCMID Fungal Infection Study Group (EFISG)
| | - A Skiada
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M J G T Vehreschild
- Department I of Internal Medicine, ECMM Excellence Centre of Medical Mycology, University Hospital of Cologne, Cologne, Germany; Centre for Integrated Oncology, Cologne-Bonn, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; European Confederation of Medical Mycology (ECMM)
| | - C Viscoli
- Ospedale Policlinico San Martino and University of Genova (DISSAL), Genova, Italy; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O A Cornely
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany; Clinical Trials Center Cologne, University Hospital of Cologne, Cologne, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM); ESCMID European Study Group for Infections in Compromised Hosts (ESGICH).
| |
Collapse
|
16
|
Lohrmann GM, Vucicevic D, Lawrence R, Steidley DE, Scott RL, Kusne S, Blair JE. Single-center experience of antifungal prophylaxis for coccidioidomycosis in heart transplant recipients within an endemic area. Transpl Infect Dis 2017; 19. [PMID: 28695649 DOI: 10.1111/tid.12744] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/27/2017] [Accepted: 04/19/2017] [Indexed: 11/29/2022]
Abstract
In endemic regions, coccidioidomycosis causes substantial morbidity and mortality for patients receiving solid organ transplants. We aimed to demonstrate the effect of antifungal coccidioidal prophylaxis in heart transplant (HT) recipients. We retrospectively reviewed the electronic health records of all patients who received HTs between October 19, 2005, and December 13, 2014. We collected information regarding antifungal regimens and determined whether patients subsequently developed infections. Our 174-person cohort all received antifungal prophylaxis for at least 6 months (mean follow-up, 53.8 months). One proven and one probable coccidioidal infection (each, 0.6%) occurred during the study period. The incidence of coccidioidomycosis was 0.6% at 1 year and 2.3% at 5 years. No cases of proven coccidioidomycosis occurred within 2 years after transplantation. No patients developed disseminated disease, and no sentinel events were attributed to coccidioidomycosis. Both fluconazole and voriconazole were well tolerated. In the absence of intolerance or contraindication, we suggest continuing a universal antifungal prophylactic regimen with fluconazole for at least 6-12 months in HT recipients residing in a coccidioidomycosis-endemic area.
Collapse
Affiliation(s)
- Graham M Lohrmann
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Darko Vucicevic
- Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Romy Lawrence
- Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - D Eric Steidley
- Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Robert L Scott
- Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Shimon Kusne
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
| |
Collapse
|
17
|
Godet C, Couturaud F, Ragot S, Laurent F, Brun AL, Bergeron A, Cadranel J. [Allergic bronchopulmonary aspergillosis: Evaluation of a maintenance therapy with nebulized Ambisome ®]. Rev Mal Respir 2017; 34:581-587. [PMID: 28552257 DOI: 10.1016/j.rmr.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/25/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Allergic bronchopulmonary aspergillosis (ABPA) affects 3-13% of patients with asthma. Its natural history includes possibly life-threatening exacerbations and evolution towards fixed obstructive ventilatory disorders or even irreversible lung fibrosis lesions. ABPA prognosis is directly associated with exacerbation control and the main objective of the treatment is to decrease their frequency and duration. Recommendations regarding dosage and duration of treatment are not very precise. The currently used combination of itraconazole and corticosteroid therapy has many limitations. The interests of a therapeutic strategy using nebulized liposomal amphotericin B (LAmB) are to heighten antifungal lung tissue concentration, to circumvent drug interactions and decrease the potential toxicity of systemic antifungal treatments. Finally, this association leads to improved eradication of Aspergillus, thereby limiting the risk of side effects and the emergence of treatment-resistant Aspergillus strains. METHODS This is a phase II, multicentre, randomized, single blind, controlled therapeutic study, with the objective of comparing the potential benefit on exacerbation control of a maintenance therapy by LAmB nebulization. The main objective of the study is to compare the incidence of severe clinical exacerbations in ABPA treatment, between a maintenance treatment strategy with nebulized LAmB and a conventional strategy without antifungal maintenance therapy. EXPECTED RESULTS The results will guide practitioners in the management of ABPA treatments and help to define the place of aerosols of LAmB on "evidence base medicine" criteria.
Collapse
Affiliation(s)
- C Godet
- Service de maladies infectieuses et de médecine interne, CHU de Poitiers, 2, rue de la Miletrie, 86021 Poitiers cedex, France.
| | - F Couturaud
- Département de médecine interne et pneumologie, EA3878, CIC1412, CHU de Brest, 29200Brest, France
| | - S Ragot
- Inserm CIC 1402, UFR médecine pharmacie, université de Poitiers, centre d'investigation clinique, CHU de Poitiers, 86021Poitiers, France
| | - F Laurent
- Université de Bordeaux, centre de recherche cardio-thoracique de Bordeaux, Inserm U1045, CHU de Bordeaux, service d'imagerie diagnostique et thérapeutique, groupe hospitalier Sud, 33000 Bordeaux, France
| | - A L Brun
- Imaging department, Whittington hospital, N19 5NFLondon, Royaume-Uni
| | - A Bergeron
- Service de pneumologie, hôpital Saint-Louis, AP-HP, 75010Paris, France
| | - J Cadranel
- Service de pneumologie, hôpital Tenon, AP-HP, 75970Paris, France
| | | |
Collapse
|
18
|
Min Z, Veer M, Rali P, Singh A, Bhanot N. Early-onset de novo invasive pulmonary aspergillosis in an orthotopic heart transplant recipient. Lung India 2017; 34:376-379. [PMID: 28671171 PMCID: PMC5504897 DOI: 10.4103/lungindia.lungindia_454_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Invasive aspergillosis generally occurs during the first 1-6 months after heart transplantation. It has been rarely seen in the first 2 weeks postcardiac transplant. We herein describe a unique case of invasive pulmonary aspergillosis (IPA) diagnosed on day 9 postorthotopic heart transplantation. The known risk factors for IPA in cardiac transplant recipients were not identified in our case. The organ recipients from the same donor did not report Aspergillus infection. Hospital environmental samplings failed to demonstrate Aspergillus spores in the patient's room and his adjacent rooms. A diagnosis of early-onset de novo IPA was made. The patient initially received combined antifungal therapy (voriconazole plus micafungin), followed by voriconazole maintenance monotherapy with favorable clinical outcome.
Collapse
Affiliation(s)
- Zaw Min
- Division of Infectious Disease, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, USA
| | - Manik Veer
- Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, USA
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, School of Medicine, Temple University, Philadelphia, PA, USA
| | - Anil Singh
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, USA
| | - Nitin Bhanot
- Division of Infectious Disease, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, USA
| |
Collapse
|
19
|
Fatal Case of Probable Invasive Aspergillosis after Five Years of Heart Transplant: A Case Report and Review of the Literature. Case Rep Infect Dis 2015; 2015:864545. [PMID: 26380129 PMCID: PMC4561337 DOI: 10.1155/2015/864545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/11/2015] [Indexed: 11/24/2022] Open
Abstract
Invasive fungal infections are very common in solid organ transplants and occur most frequently in the first three months after transplant. A 49-year-old female with a history of two remote heart transplants with the most recent one occurring 5 years ago was admitted for increasing shortness of breath, cough, and fever. Computerized tomography (CT) scan of the chest showed left lower lung ground-glass and tree-in-bud opacities. She was started on broad spectrum antibiotics along with ganciclovir and micafungin. Ganciclovir was added due to the patient's past history of CMV infection and empiric fungal coverage with micafungin. Bronchoalveolar lavage (BAL) was performed as her respiratory status worsened and voriconazole was added for possible aspergillosis in combination therapy with micafungin. BAL galactomannan returned positive which was suggestive of aspergillosis. Patient worsened clinically and subsequently succumbed to cardiorespiratory arrest despite our best efforts. It is important to have a high degree of clinical suspicion for invasive aspergillosis in transplant patients even many years after transplant and initiate aggressive therapy due to poor outcomes.
Collapse
|
20
|
Trubiano JA, Chen S, Slavin MA. An Approach to a Pulmonary Infiltrate in Solid Organ Transplant Recipients. CURRENT FUNGAL INFECTION REPORTS 2015; 9:144-154. [PMID: 32218881 PMCID: PMC7091299 DOI: 10.1007/s12281-015-0229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The onset of a pulmonary infiltrate in a solid organ transplant (SOT) recipient is both a challenging diagnostic and therapeutic challenge. We outline the potential aetiologies of a pulmonary infiltrate in a SOT recipient, with particular attention paid to fungal pathogens. A diagnostic and empirical therapy approach to a pulmonary infiltrate, especially invasive fungal disease (IFD) in SOT recipients, is provided.
Collapse
Affiliation(s)
- Jason A. Trubiano
- Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC Australia
- Infectious Diseases, Austin Health, Melbourne, VIC Australia
- Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, VIC 3002 Australia
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, Sydney, Australia
| | - Monica A. Slavin
- Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC Australia
- Infectious Diseases, Royal Melbourne Hospital, Melbourne, VIC Australia
| |
Collapse
|
21
|
Chang DC, Burwell LA, Lyon GM, Pappas PG, Chiller TM, Wannemuehler KA, Fridkin SK, Park BJ. Comparison of the Use of Administrative Data and an Active System for Surveillance of Invasive Aspergillosis. Infect Control Hosp Epidemiol 2015; 29:25-30. [DOI: 10.1086/524324] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Administrative data, such as International Classification of Diseases, Ninth Revision (ICD-9) codes, are readily available and are an attractive option for surveillance and quality assessment within a single institution or for interinstitutional comparisons. To understand the usefulness of administrative data for the surveillance of invasive aspergillosis, we compared information obtained from a system based on ICD-9 codes with information obtained from an active, prospective surveillance system, which used more extensive case-finding methods (Transplant Associated Infection Surveillance Network).Methods.Patients with suspected inyasive aspergillosis were identified by aspergillosis-related ICD-9 codes assigned to hematopoietic stem cell transplant recipients and solid organ transplant recipients at a single hospital from April 1, 2001, through January 31, 2005. Suspected cases were classified as proven or probable invasive aspergillosis by medical record review using standard definitions. We calculated the sensitivity and positive predictive value (PPV) of identifying invasive aspergillosis by individual ICD-9 codes and by combinations of codes.Results.The sensitivity of code 117.3 was modest (63% [95% confidence interval {CI}, 38%-84%]), as was the PPV (71% [95% CI, 44%-90%]); the sensitivity of code 117.9 was poor (32% [95% CI, 13%-57%]), as was the PPV (15% [95% CI, 6%-31%]). The sensitivity of codes 117.3 and 117.9 combined was 84% (95% CI, 60%-97%); the PPV of the combined codes was 30% (95% CI, 18%-44%). Overall, ICD-9 codes triggered a review of medical records for 64 medical patients, only 16 (25%) of whom had proven or probable invasive aspergillosis.Conclusions.A surveillance system that involved multiple ICD-9 codes was sufficiently sensitive to identify most cases of invasive aspergillosis; however, the poor PPV of ICD-9 codes means that this approach is not adequate as the sole tool used to classify cases. Screening ICD-9 codes to trigger a medical record review might be a useful method of surveillance for invasive aspergillosis and quality assessment, although more investigation is needed.
Collapse
|
22
|
Ballázs C, Akhyari P, Mehdiani A, Kamiya H, Reinecke P, Felsberg J, Saeed D, Lichtenberg A, Boeken U. Septic-Metastasizing Aspergillus-Encephalitis Mimicking Massive Cerebral Infarction in a Heart Transplant Recipient: A Case Report. EXP CLIN TRANSPLANT 2014; 14:349-52. [PMID: 25476237 DOI: 10.6002/ect.2014.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Invasive fungal infection after solid-organ transplantation is known as a severe complication and carries with it a high risk of infection-related mortality. Among patients after heart transplant Aspergillus species most often cause atypical pneumonia. The incidence of invasive aspergillosis after heart transplant has been reported from 3% to 14%. It is the opportunistic pathogen with the highest mortality, ranging from 50% to 80%. Prompt antifungal therapy is crucial, but rapid diagnostic procedures with sufficient sensitivity and specificity are lacking at the moment. We present a rare case of a patient with massive metastasizing invasive aspergillosis within 1 month after heart transplant, undetected before death.
Collapse
Affiliation(s)
- Christina Ballázs
- From the 1Department of Cardiovascular Surgery, Heinrich Heine University, Düsseldorf, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Risk factors for invasive fungal disease in heart transplant recipients. J Heart Lung Transplant 2014; 34:227-32. [PMID: 25455750 DOI: 10.1016/j.healun.2014.09.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 09/23/2014] [Accepted: 09/24/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Heart transplant (HT) recipients are at risk for invasive fungal disease (IFD), a morbid and potentially fatal complication. METHODS We performed a retrospective cohort study to evaluate the incidence and risk factors for IFD in HT recipients from 1995 to 2012 at a single center. IFD cases were classified as proven or probable IFD according to current consensus definitions of the European Organization for Research and Treatment of Cancer/Mycoses Study Group. We calculated IFD incidence rates and used Cox proportional hazards models to determine IFD risk factors. RESULTS Three hundred sixty patients underwent HT during the study period. The most common indications were dilated (39%) and ischemic (37%) cardiomyopathy. There were 23 (6.4%) cases of proven (21) or probable (2) IFD, for a cumulative incidence rate of 1.23 per 100 person-years (95% CI 0.78 to 1.84). Candida (11) and Aspergillus (5) were the most common etiologic fungi. Thirteen cases (56%) occurred within 3 months of HT, with a 3-month incidence of 3.8% (95% CI 2.2 to 6.4). Delayed chest closure (HR 3.3, 95% CI 1.4 to 7.6, p = 0.01) and the addition of OKT3, anti-thymocyte globulin or daclizumab to standard corticosteroid induction therapy (HR 2.7, 95% CI 1.1 to 6.2, p = 0.02) were independently associated with an increased risk of IFD. CONCLUSIONS IFD incidence was greatest within the first 3 months post-HT, largely reflecting early surgical-site and nosocomial Candida and Aspergillus infections. Patients receiving additional induction immunosuppression or delayed chest closure were at increased risk for IFD. Peri-transplant anti-fungal prophylaxis should be considered in this subset of HT recipients.
Collapse
|
24
|
Muñoz P, Vena A, Cerón I, Valerio M, Palomo J, Guinea J, Escribano P, Martínez-Sellés M, Bouza E. Invasive pulmonary aspergillosis in heart transplant recipients: Two radiologic patterns with a different prognosis. J Heart Lung Transplant 2014; 33:1034-40. [DOI: 10.1016/j.healun.2014.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 05/20/2014] [Accepted: 05/28/2014] [Indexed: 01/15/2023] Open
|
25
|
Impact of Targeted Antifungal Prophylaxis in Heart Transplant Recipients at High Risk for Early Invasive Fungal Infection. Transplantation 2014; 97:1192-7. [DOI: 10.1097/01.tp.0000441088.01723.ee] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
26
|
Álvarez Lerma F, Olaechea Astigarraga P, Palomar Martínez M, Rodríguez Carvajal M, Machado Casas JF, Jiménez Quintana MM, Esteve Urbano F, Ballesteros Herráez JC, Zavala Zegarra E. [Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the intensive care units]. Med Intensiva 2014; 39:149-59. [PMID: 24713089 DOI: 10.1016/j.medin.2014.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 02/03/2014] [Accepted: 02/11/2014] [Indexed: 11/18/2022]
Abstract
UNLABELLED The presence of respiratory fungal infection in the critically ill patient is associated with high morbidity and mortality. OBJECTIVES To assess the incidence of respiratory infection caused by Aspergillus spp. independently of the origin of infection in patients admitted to Spanish ICUs, as well as to describe the rates, characteristics, outcomes and prognostic factors in patients with this type of infection. MATERIAL AND METHODS An observational, retrospective, open-label and multicenter study was carried out in a cohort of patients with respiratory infection caused by Aspergillus spp. admitted to Spanish ICUs between 2006 and 2012 (months of April, May and June), and included in the ENVIN-HELICS registry (108,244 patients and 825,797 days of ICU stay). Variables independently related to in-hospital mortality were identified by multiple logistic regression analysis. RESULTS A total of 267 patients from 79 of the 198 participating ICUs were included (2.46 cases per 1000 ICU patients and 3.23 episodes per 10,000 days of ICU stay). From a clinical point of view, infections were classified as ventilator-associated pneumonia in 93 cases (34.8%), pneumonia unrelated to mechanical ventilation in 120 cases (44.9%), and tracheobronchitis in 54 cases (20.2%). The study population included older patients (mean 64.8±17.1 years), with a high severity level (APACHE II score 22.03±7.7), clinical diseases (64.8%) and prolonged hospital stay before the identification of Aspergillus spp. (median 11 days), transferred to the ICU mainly from hospital wards (58.1%) and with high ICU (57.3%) and hospital (59.6%) mortality rates, exhibiting important differences depending on the type of infection involved. Independent mortality risk factors were previous admission to a hospital ward (OR=7.08, 95%CI: 3.18-15.76), a history of immunosuppression (OR=2.52, 95%CI: 1.24-5.13) and severe sepsis or septic shock (OR=8.91, 95%CI: 4.24-18.76). CONCLUSIONS Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the ICU in Spain are infrequent, and affect a very selected group of patients, characterized by high mortality and conditioned by non-modifiable risk factors.
Collapse
Affiliation(s)
- F Álvarez Lerma
- Servicio de Medicina Intensiva, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
| | | | - M Palomar Martínez
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova, Lleida, España
| | - M Rodríguez Carvajal
- Servicio de Medicina Intensiva, Hospital General de Huelva Juan Ramón Jiménez, Huelva, España
| | - J F Machado Casas
- Servicio de Medicina Intensiva, Complejo Hospitalario de Jaén, Jaén, España
| | - M M Jiménez Quintana
- Unidad de Cuidados Intensivos, Hospital Médico-Quirúrgico Virgen de las Nieves, Granada, España
| | - F Esteve Urbano
- Servicio de Medicina Intensiva, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | | | - E Zavala Zegarra
- Unidad de Cuidados Intensivos Quirúrgica, Hospital Clinic i Provincial, IDIBAPS, Barcelona, España
| |
Collapse
|
27
|
Uribe LG, Cortés JA, Granados CE, Montoya JG. Antifungal prophylaxis following heart transplantation: systematic review. Mycoses 2014; 57:429-36. [DOI: 10.1111/myc.12179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/12/2014] [Accepted: 01/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Luis G. Uribe
- Department of Medicine; Division of Infectious Diseases and Geographic Medicine; Stanford University School of Medicine; Stanford CA USA
- Department of Internal Medicine; School of Medicine; Universidad Nacional de Colombia; Bogotá Colombia
- Fundación Cardiovascular de Colombia; Bucaramanga Colombia
| | - Jorge A. Cortés
- Department of Internal Medicine; School of Medicine; Universidad Nacional de Colombia; Bogotá Colombia
| | - Carlos E. Granados
- Department of Internal Medicine; School of Medicine; Universidad Nacional de Colombia; Bogotá Colombia
| | - José G. Montoya
- Department of Medicine; Division of Infectious Diseases and Geographic Medicine; Stanford University School of Medicine; Stanford CA USA
| |
Collapse
|
28
|
Muñoz P, Cerón I, Valerio M, Palomo J, Villa A, Eworo A, Fernández-Yáñez J, Guinea J, Bouza E. Invasive aspergillosis among heart transplant recipients: A 24-year perspective. J Heart Lung Transplant 2014; 33:278-88. [DOI: 10.1016/j.healun.2013.11.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 11/05/2013] [Accepted: 11/12/2013] [Indexed: 12/17/2022] Open
|
29
|
Soman SO, Vijayaraghavan G, Padmaja NP, Warrier AR, Unni M. Aspergilloma of the heart. Indian Heart J 2014; 66:238-40. [PMID: 24814126 DOI: 10.1016/j.ihj.2013.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/07/2013] [Accepted: 12/04/2013] [Indexed: 11/26/2022] Open
Affiliation(s)
- Suman Omana Soman
- Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
| | - G Vijayaraghavan
- Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - N P Padmaja
- Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Anoop R Warrier
- Department of Infectious Disease, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Madhavan Unni
- Department of Radio Diagnosis, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| |
Collapse
|
30
|
Maly J, Szarszoi O, Netuka I, Dorazilova Z, Pirk J. Fungal infections associated with long-term mechanical circulatory support-diagnosis and management. J Card Surg 2013; 29:95-100. [PMID: 24279890 DOI: 10.1111/jocs.12258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Left ventricular assist devices (LVADs) are increasingly used as a treatment option for advanced heart failure. Fungal infections present a serious concern given the high association with major adverse events including death in this group of patients. The objective of this review is to summarize the incidence, risk factors, method for diagnosis, complication rate, and outcomes in patients with VADs who develop fungal infections.
Collapse
Affiliation(s)
- Jiri Maly
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | | | | | | |
Collapse
|
31
|
|
32
|
Shields RK, Nguyen MH, Shullo MA, Silveira FP, Kwak EJ, Abdel Massih RC, Toyoda Y, Bermudez CA, Bhama JK, Kormos RL, Clancy CJ. Invasive aspergillosis among heart transplant recipients is rare but causes rapid death due to septic shock and multiple organ dysfunction syndrome. ACTA ACUST UNITED AC 2012; 44:982-6. [PMID: 22830948 DOI: 10.3109/00365548.2012.705018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Between 2000 and 2011, proven or probable invasive aspergillosis (IA) was diagnosed in 1.7% (8/455) of heart transplant (HTx) recipients at our center, in the absence of antifungal prophylaxis. All patients had invasive pulmonary infections and 75% (6/8) were diagnosed during 2 separate 3-month periods. Cases were notable for their association with septic shock and multiple organ dysfunction syndrome (MODS) (75%, 6/8 each), non-specific clinical and radiographic findings, and rapid mortality despite mould-active antifungal therapy (88%, 7/8; occuring at a median 11 days after diagnosis). All patients had predisposing conditions known to be risk factors for IA. For patients with early IA (within 90 days of HTx), conditions included hemodialysis, thoracic re-operation, and the presence of another case in the institution within the preceding 3 months. For late-onset IA, conditions included hemodialysis and receipt of augmented immunosuppression. Clinicians should suspect IA in HTx recipients with risk factors who present with non-specific and unexplained respiratory syndromes, including those in septic shock and MODS, and institute prompt antifungal therapy without waiting for the results of cultures or other diagnostic tests.
Collapse
Affiliation(s)
- Ryan K Shields
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Pelaez T, Munoz P, Guinea J, Valerio M, Giannella M, Klaassen CHW, Bouza E. Outbreak of Invasive Aspergillosis After Major Heart Surgery Caused by Spores in the Air of the Intensive Care Unit. Clin Infect Dis 2012; 54:e24-31. [DOI: 10.1093/cid/cir771] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|
34
|
O'Reilly Zwald F, Brown M. Skin cancer in solid organ transplant recipients: advances in therapy and management: part I. Epidemiology of skin cancer in solid organ transplant recipients. J Am Acad Dermatol 2011; 65:253-261. [PMID: 21763561 DOI: 10.1016/j.jaad.2010.11.062] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 11/04/2010] [Accepted: 11/06/2010] [Indexed: 12/25/2022]
Abstract
Skin cancer is the most frequent malignancy in organ transplant recipients, 95% of which are nonmelanoma skin cancer, especially squamous cell and basal cell carcinomas. This paper also discusses the incidence of other tumors (eg, melanoma, Merkel cell carcinoma, and Kaposi sarcoma) that are also increased in organ transplant patients compared to the general population. Part I of this two-part series describes the latest data concerning the epidemiologic and pathogenic aspects of nonmelanoma skin cancer development in solid organ transplant recipients. This review also highlights the concept of "field cancerization," represented by extensive areas of actinic damage and epidermal dysplasia, which accounts for increased risk of aggressive skin cancer development in susceptible patients.
Collapse
Affiliation(s)
- Fiona O'Reilly Zwald
- Department of Dermatology and Division of Transplantation, Department of Surgery, Emory University, Atlanta, Georgia.
| | - Marc Brown
- Department of Dermatology and Oncology, University of Rochester, Rochester, New York
| |
Collapse
|
35
|
Zaoutis TE, Webber S, Naftel DC, Chrisant MA, Kaufman B, Pearce FB, Spicer R, Dipchand AI. Invasive fungal infections in pediatric heart transplant recipients: incidence, risk factors, and outcomes. Pediatr Transplant 2011; 15:465-9. [PMID: 21108712 DOI: 10.1111/j.1399-3046.2010.01415.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
There are limited data on the incidence or risk factors for IFI in pediatric heart transplant recipients. The purpose of this study was to describe the incidence and types of IFI, to determine risk factors for outcomes of IFI, and to assist in decision-making concerning the need for prophylactic strategies in pediatric heart transplant recipients. Data from a multi-institutional registry of 1854 patients transplanted between 01/93 and 12/04 were analyzed to determine risk factors and outcomes of children with IFI post-heart transplantation. One hundred and thirty-nine episodes of IFI occurred in 123 patients and made up 6.8% of the total number of post-transplant infections. IFI was most commonly attributed to yeast (66.2%), followed by mold (15.8%) and Pneumocystis jiroveci (13%). Ninety percent of the yeast infections were caused by Candida spp., and Aspergillus spp. was causative in 82% of the mold infections. There was a significantly increased risk of fungal infection associated with pretransplant invasive procedures (e.g., ECMO, prior surgery, VAD, mechanical ventilation) with an incremental risk with increasing numbers of invasive procedures (early phase 0 vs. 1, RR 1.3; 0 vs. 3, RR 2.3; p<0.001). In multivariate analysis, previous surgery (p=0.05) and mechanical support at transplantation (p=0.01) remained significant. Forty-nine percent of recipients with IFI died, all within six months post-transplant. Invasive fungal infections are uncommon in pediatric heart transplant recipients. Risk and mortality are highest in the first six months post-transplant especially in patients with previous surgery and those requiring mechanical support. Prophylactic strategies for high-risk patients should be considered and warrants further study.
Collapse
|
36
|
Salman N, Törün SH, Budan B, Somer A. Invasive aspergillosis in hematopoietic stem cell and solid organ transplantation. Expert Rev Anti Infect Ther 2011; 9:307-15. [PMID: 21417870 DOI: 10.1586/eri.11.13] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Invasive aspergillosis (IA) is currently an important cause of morbidity and mortality in hematopoietic stem cell transplant and solid organ transplant recipients. A high index of suspicion and careful clinical and radiological examinations are the keys to identifying infected patients early. Chest computerized axial tomography is extremely useful in diagnosing pulmonary aspergillosis. Microbiologic or histologic identification of infection, however, remain essential. Successful management of invasive fungal infections depends on timely and appropriate treatment. There are multiple variables associated with survival in transplant patients with IA. Understanding these prognostic factors may assist in the development of treatment algorithms and clinical trials. In contrast to adult patients, large prospective comparative studies have not been performed in pediatric patients with IA. Moreover, pediatric subgroups have not been analyzed in published studies that include a broader age range. Clinicians treating pediatric IA are largely left with the results of uncontrolled trials, observatory surveys, salvage therapy data and extrapolations from adult studies to guide their treatment choices. The aim of this article is to state the main characteristics of IA in both pediatric and adult populations.
Collapse
Affiliation(s)
- Nuran Salman
- Department of Pediatric Infectious Diseases, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | | | | | | |
Collapse
|
37
|
Hsu JL, Ruoss SJ, Bower ND, Lin M, Holodniy M, Stevens DA. Diagnosing invasive fungal disease in critically ill patients. Crit Rev Microbiol 2011; 37:277-312. [PMID: 21749278 DOI: 10.3109/1040841x.2011.581223] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fungal infections are increasing, with a changing landscape of pathogens and emergence of new groups at risk for invasive disease. We review current diagnostic techniques, focusing on studies in critically ill patients. Microbiological cultures, the current "gold standard", demonstrate poor sensitivity, thus diagnosis of invasive disease in the critically ill is difficult. This diagnostic dilemma results in under- or over-treatment of patients, potentially contributing to poor outcomes and antifungal resistance. While other current diagnostic tests perform moderately well, many lack timeliness, efficacy, and are negatively affected by treatments common to critically ill patients. New nucleic acid-based research is promising.
Collapse
Affiliation(s)
- Joe L Hsu
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Abstract
The objective of this study was to describe in heart transplant recipients severe sepsis due to fungal infection, which is associated with high mortality. This was a retrospective study including 366 patients who underwent heart transplantation from 1987 to 2009 in whom severe sepsis due to fungal infection developed, with multiple-organ failure. Sepsis was diagnosed on the basis of a positive culture for the infective agent, such as Cryptococcus, Aspergillus, Candida, or Nocardia, from an appropriate source such as blood, wound, or sputum. In 10 patients, severe sepsis due to fungal infection was treated temporally by reducing or sparing immunosuppression; 7 of these patients survived after intensive care. Only 1 patient required pulsed therapy because of an acute rejection episode. Early diagnosis with aggressive diagnostic techniques and use of combination therapy must be considered to reduce the risk of death in heart transplant recipients with fungal infection.
Collapse
|
40
|
Hansen TN, Plambeck CJ, Barron MJ, Pagel PS, DeAnda A, Neustein S. CASE 3-2010 Dynamic partial obstruction of the tricuspid valve inlet produced by anterior mediastinal aspergillosis invading the right atrium. J Cardiothorac Vasc Anesth 2010; 24:506-12. [PMID: 20510248 DOI: 10.1053/j.jvca.2010.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas N Hansen
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
INTRODUCTION Invasive aspergillosis is a major cause of mortality in allogeneic bone marrow transplant recipients and patients treated for blood malignancies. The diagnostic tools, treatments and preventive strategies, essentially developed for neutropaenic patients, have not been assessed in populations whose immune systems are considered to be competent. STATE OF THE ART Beside the standard picture of chronic Aspergillus infection, the incidence of invasive aspergillosis is increasing in non neutropaenic patients, such as those with chronic lung diseases or systemic disease treated with long-term immunosuppressive drugs and solid organ transplant recipients. This study reviews the specific features of invasive aspergillosis in non neutropaenic subjects (NNS) and discusses the value of the diagnostic tools and treatment in this population. PROSPECTS A better understanding of the pathophysiology and the epidemiological characteristics of invasive aspergillosis would provide a means of adapting the staging and classification of the disease for NNS. CONCLUSIONS Invasive aspergillosis is under diagnosed in NNS who may already be colonised when they receive immunosuppressive treatment; this can lead to an adverse outcome in patients who are considered to be a moderate risk population.
Collapse
|
42
|
Haddad F, Deuse T, Pham M, Khazanie P, Rosso F, Luikart H, Valantine H, Leon S, Vu TA, Hunt SA, Oyer P, Montoya JG. Changing trends in infectious disease in heart transplantation. J Heart Lung Transplant 2009; 29:306-15. [PMID: 19853478 DOI: 10.1016/j.healun.2009.08.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 08/09/2009] [Accepted: 08/09/2009] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND During the past 25 years, advances in immunosuppression and the use of selective anti-microbial prophylaxis have progressively reduced the risk of infection after heart transplantation. This study presents a historical perspective of the changing trends of infectious disease after heart transplantation. METHODS Infectious complications in 4 representative eras of immunosuppression and anti-microbial prophylaxis were analyzed: (1) 38 in the pre-cyclosporine era (1978-1980), (2) 72 in the early cyclosporine era (1982-1984), where maintenance immunosuppression included high-dose cyclosporine and corticosteroid therapy; (3) 395 in the cyclosporine era (1988-1997), where maintenance immunosuppression included cyclosporine, azathioprine, and lower corticosteroid doses; and (4) 167 in the more recent era (2002-2005), where maintenance immunosuppression included cyclosporine and mycophenolate mofetil. RESULTS The overall incidence of infections decreased in the 4 cohorts from 3.35 episodes/patient to 2.03, 1.35, and 0.60 in the more recent cohorts (p < 0.001). Gram-positive bacteria are emerging as the predominant cause of bacterial infections (28.6%, 31.4%, 51.0%, 67.6%, p = 0.001). Cytomegalovirus infections have significantly decreased in incidence and occur later after transplantation (88 +/- 77 days, pre-cyclosporine era; 304 +/- 238 days, recent cohort; p < 0.001). Fungal infections also decreased, from an incidence of 0.29/patient in the pre-cyclosporine era to 0.08 in the most recent era. A major decrease in Pneumocystis jiroveci and Nocardia infections has also occurred. CONCLUSIONS The overall incidence and mortality associated with infections continues to decrease in heart transplantation and coincides with advances in immunosuppression, the use of selective anti-microbial prophylaxis, and more effective treatment regimens.
Collapse
Affiliation(s)
- François Haddad
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford University, Stanford, California 94305, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Safdar A, Shelburne SA, Evans SE, Dickey BF. Inhaled therapeutics for prevention and treatment of pneumonia. Expert Opin Drug Saf 2009; 8:435-49. [PMID: 19538104 DOI: 10.1517/14740330903036083] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The lungs are the most common site of serious infection owing to their large surface area exposed to the external environment and minimum barrier defense. However, this architecture makes the lungs readily available for topical therapy. Therapeutic aerosols include those directed towards improving mucociliary clearance of pathogens, stimulation of innate resistance to microbial infection, cytokine stimulation of immune function and delivery of antibiotics. In our opinion inhaled antimicrobials are underused, especially in patients with difficult-to-treat lung infections. The use of inhaled antimicrobial therapy has become an important part of the treatment of airway infection with Pseudomonas aeruginosa in cystic fibrosis and the prevention of invasive fungal infection in patients undergoing heart and lung transplantation. Cytokine inhaled therapy has also been explored in the treatment of neoplastic and infectious disease. The choice of pulmonary drug delivery systems remains critical as air-jet and ultrasonic nebulizer may deliver sub-optimum drug concentration if not used properly. In future development of this field, we recommend an emphasis on the study of the use of aerosolized hypertonic saline solution to reduce pathogen burden in the airways of subjects infected with microbes of low virulence, stimulation of innate resistance to prevent pneumonia in immunocompromised subjects using cytokines or synthetic pathogen-associated molecular pattern analogues and more opportunities for the use of inhaled antimicrobials. These therapeutics are still in their infancy but show great promise.
Collapse
Affiliation(s)
- Amar Safdar
- The University of Texas, Department of Infectious Diseases, M. D. Anderson Cancer Center, Infection Control and Employee Health, 402, 1515 Holcombe Boulevard, Texas 77030, Houston, USA.
| | | | | | | |
Collapse
|
44
|
Schaenman JM, Rosso F, Austin JM, Baron EJ, Gamberg P, Miller J, Oyer PE, Robbins RC, Montoya JG. Trends in invasive disease due to Candida species following heart and lung transplantation. Transpl Infect Dis 2009; 11:112-21. [PMID: 19254327 DOI: 10.1111/j.1399-3062.2009.00364.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although invasive candidiasis (IC) causes significant morbidity and mortality in patients who undergo heart, lung, or heart-lung transplantation, a systematic study in a large cohort of thoracic organ transplant recipients has not been reported to date. Clinical and microbiological data were reviewed for 1305 patients who underwent thoracic organ transplantation at Stanford University Medical Center between 1980 and 2004. We identified and analyzed 76 episodes of IC in 68 patients (overall incidence 5.2% per patient).The incidence of IC was higher in lung (LTx) and heart-lung transplant (HLTx) recipients as compared with heart transplant (HTx) recipients (risk ratio [RR] 1.7, 95% confidence interval [CI] 1.1-2.7).The incidence of IC decreased over time in all thoracic organ transplant recipients, decreasing from 6.1% in the 1980-1986 time period to 2.1% in the 2001-2004 era in the HTx recipients, and from 20% in the 1980-1986 period to 1.8% in the 2001-2004 period in the LTx and HLTx recipients.The most common site of infection differed between the HTx and LTx cohorts, with bloodstream or disseminated disease in the former and tracheobronchitis in the latter. IC in the first year after transplant was significantly associated with death in both HTx (RR 2.9, 95% CI 1.8-4.6, P=0.001) and LTx and HLTx patients (RR 3.0, 95% CI 1.9-4.6, P<0.001). The attributable mortality from IC decreased during the 25-year period of observation, from 36% to 20% in the HTx recipients and from 39% to 15% in the LTx and HLTx recipients. There were a significant number of cases caused by non-albicans Candida species in all patients, with a trend toward higher mortality in the HTx group. In conclusion, the incidence and attributable mortality of IC in thoracic organ transplant recipients has significantly declined over the past 25 years.The use of newer antifungal agents for prophylaxis and treatment, the decrease in the incidence of cytomegalovirus disease, and the use of more selective immunosuppression, among other factors, may have been responsible for this change.
Collapse
Affiliation(s)
- J M Schaenman
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California 94305, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Peleg AY, Lasalvia MT, Mylonakis E, Silveira FP. Prophylaxis against pulmonary viral and fungal infections in solid organ transplant recipients. Curr Infect Dis Rep 2009; 11:209-15. [PMID: 19366563 PMCID: PMC7089285 DOI: 10.1007/s11908-009-0031-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pulmonary viral and fungal infections in solid organ transplant recipients are one of the most common and potentially life-threatening infections. Understanding the strategies used for prophylaxis and prevention of these infections is critical for the health and well-being of transplant recipients. Prophylactic measures range from simple patient education to complex chemoprophylactic interventions; however, a multifaceted approach is most often required. This article focuses on strategies to prevent pulmonary viral and fungal infections in transplant recipients, with an emphasis on recent evidence that may influence practice guidelines.
Collapse
Affiliation(s)
- Anton Y Peleg
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Harvard Medical School, 110 Francis Street, LMOB Suite GB, Boston, MA 02215, USA.
| | | | | | | |
Collapse
|
46
|
Pulmonary Aspergillosis in Solid Organ Transplant Patients: A Report From Iran. Transplant Proc 2008; 40:3663-7. [DOI: 10.1016/j.transproceed.2008.06.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 06/27/2008] [Indexed: 11/21/2022]
|
47
|
Boilson BA, Miller DV, Pereira NL. Late Allograft Failure After Heart Transplantation: 2 Unusual Cases. J Heart Lung Transplant 2008; 27:1050-4. [DOI: 10.1016/j.healun.2008.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/29/2008] [Accepted: 05/21/2008] [Indexed: 11/16/2022] Open
|
48
|
Abstract
A pulmonary cavity is a gas-filled area of the lung in the center of a nodule or area of consolidation and may be clinically observed by use of plain chest radiography or computed tomography. Cavities are present in a wide variety of infectious and noninfectious processes. This review discusses the differential diagnosis of pathological processes associated with lung cavities, focusing on infections associated with lung cavities. The goal is to provide the clinician and clinical microbiologist with an overview of the diseases most commonly associated with lung cavities, with attention to the epidemiology and clinical characteristics of the host.
Collapse
|
49
|
Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Segal BH, Steinbach WJ, Stevens DA, van Burik JA, Wingard JR, Patterson TF. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2008; 46:327-60. [PMID: 18177225 DOI: 10.1086/525258] [Citation(s) in RCA: 1834] [Impact Index Per Article: 114.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Thomas J Walsh
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Gangneux JP, Camus C, Philippe B. Épidémiologie et facteurs de risque de l’aspergillose invasive du sujet non neutropénique. Rev Mal Respir 2008; 25:139-53. [DOI: 10.1016/s0761-8425(08)71512-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|