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Aspergillus in Solid Organ and Stem Cell Transplant Patients: Emerging Options for Diagnosis and Management

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Emerging Transplant Infections

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Abstract

Invasive aspergillosis is a major cause of morbidity and mortality in hematopoietic stem cell transplant and solid organ transplant recipients. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has decreased the mortality rates associated with invasive aspergillosis.

This review provides an update on the epidemiology of this disease in transplant patients, the associated risk factors that have been identified in each transplant population, and the current approaches for diagnosis, management, and prevention of invasive aspergillosis.

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References

  1. Pappas PG, Alexander BD, Andes DR, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis. 2010;50(8):1101–11.

    Article  PubMed  Google Scholar 

  2. Bongomin F, Gago S, Oladele RO, Denning DW. Global and multi-national prevalence of fungal diseases-estimate precision. J Fungi (Basel). 2017;3(4):57.

    Article  Google Scholar 

  3. Kontoyiannis DP, Marr KA, Park BJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001–2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis. 2010;50(8):1091–100.

    Article  PubMed  Google Scholar 

  4. Marr KA, Carter RA, Boeckh M, Martin P, Corey L. Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood. 2002;100(13):4358–66.

    Article  CAS  PubMed  Google Scholar 

  5. Steinbach WJ, Marr KA, Anaissie EJ, et al. Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry. J Inf. 2012;65(5):453–64.

    Article  Google Scholar 

  6. Gavalda J, Len O, San JR, et al. Risk factors for invasive aspergillosis in solid-organ transplant recipients: a case-control study. Clin Infect Dis. 2005;41(1):52–9.

    Article  CAS  PubMed  Google Scholar 

  7. Schauwvlieghe A, Rijnders BJA, Philips N, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med. 2018;6(10):782–92.

    Article  PubMed  Google Scholar 

  8. Desbois AC, Poiree S, Snanoudj R, et al. Prognosis of invasive aspergillosis in kidney transplant recipients: a case-control study. Transplant Direct. 2016;2(8):e90.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fukuda T, Boeckh M, Carter RA, et al. Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood. 2003;102(3):827–33.

    Article  CAS  PubMed  Google Scholar 

  10. Grossi P, De Maria R, Caroli A, Zaina MS, Minoli L. Infections in heart transplant recipients: the experience of the Italian heart transplantation program. Italian Study Group on Infections in Heart Transplantation. J Heart Lung Transplant. 1992;11(5):847–66.

    CAS  PubMed  Google Scholar 

  11. Lortholary O, Gangneux JP, Sitbon K, et al. Epidemiological trends in invasive aspergillosis in France: the SAIF network (2005–2007). Clin Microbiol Infect. 2011;17(12):1882–9.

    Article  CAS  PubMed  Google Scholar 

  12. San Juan R, Aguado JM, Lumbreras C, et al. Incidence, clinical characteristics and risk factors of late infection in solid organ transplant recipients: data from the RESITRA study group. Am J Transplant. 2007;7(4):964–71.

    Article  CAS  PubMed  Google Scholar 

  13. Carvalho-Dias VMH, Sola CBS, Cunha CA, Shimakura SE, Pasquini R, Queiroz-Telles F. Invasive aspergillosis in hematopoietic stem cell transplant recipients: a retrospective analysis. Braz J Infect Dis. 2008;12:385–9.

    Article  PubMed  Google Scholar 

  14. Singh N, Arnow PM, Bonham A, et al. Invasive aspergillosis in liver transplant recipients in the 1990s. Transplantation. 1997;64(5):716–20.

    Article  CAS  PubMed  Google Scholar 

  15. Aguilar CA, Hamandi B, Fegbeutel C, et al. Clinical risk factors for invasive aspergillosis in lung transplant recipients: results of an international cohort study. J Heart Lung Transplant. 2018;36(4):S24.

    Article  Google Scholar 

  16. Meis JF, Chowdhary A, Rhodes JL, Fisher MC, Verweij PE. Clinical implications of globally emerging azole resistance in Aspergillus fumigatus. Philos Trans R Soc Lond Ser B Biol Sci. 2016;371(1709).

    Google Scholar 

  17. Verweij PE, Chowdhary A, Melchers WJ, Meis JF. Azole resistance in Aspergillus fumigatus: can we retain the clinical use of mold-active antifungal azoles? Clin Infect Dis. 2016;62(3):362–8.

    Article  CAS  PubMed  Google Scholar 

  18. Lescar J, Meyer I, Akshita K, et al. Aspergillus fumigatus harbouring the sole Y121F mutation shows decreased susceptibility to voriconazole but maintained susceptibility to itraconazole and posaconazole. J Antimicrob Chemother. 2014;69(12):3244–7.

    Article  CAS  PubMed  Google Scholar 

  19. Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63(4):e1–e60.

    Article  PubMed  PubMed Central  Google Scholar 

  20. van der Linden JWM, Arendrup MC, Warris A, et al. Prospective multicenter international surveillance of azole resistance in Aspergillus fumigatus. Emerg Infect Dis. 2015;21(6):1041–4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. van der Linden JWM, Snelders E, Kampinga GA, et al. Clinical implications of azole resistance in Aspergillus fumigatus, The Netherlands, 2007–2009. Emerg Infect Dis. 2011;17(10):1846–54.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Baddley JW, Marr KA, Andes DR, et al. Patterns of susceptibility of Aspergillus isolates recovered from patients enrolled in the transplant-associated infection surveillance network. J Clin Microbiol. 2009;47(10):3271–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Shalhoub S, Luong ML, Howard SJ, et al. Rate of cyp51A mutation in Aspergillus fumigatus among lung transplant recipients with targeted prophylaxis. J Antimicrob Chemother. 2015;70(4):1064–7.

    CAS  PubMed  Google Scholar 

  24. Lamoth F, Chung SJ, Damonti L, Alexander BD. Changing epidemiology of invasive mold infections in patients receiving azole prophylaxis. Clin Infect Dis. 2017;64(11):1619–21.

    Article  PubMed  Google Scholar 

  25. De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46(12):1813–21.

    Article  PubMed  Google Scholar 

  26. Husain S, Sole A, Alexander BD, et al. The 2015 International Society for Heart and Lung Transplantation Guidelines for the management of fungal infections in mechanical circulatory support and cardiothoracic organ transplant recipients: executive summary. J Heart Lung Transplant. 2016;35(3):261–82.

    Article  PubMed  Google Scholar 

  27. Singh N, Husain S. Aspergillus infections after lung transplantation: clinical differences in type of transplant and implications for management. J Heart Lung Transplant. 2003;22(3):258–66.

    Article  PubMed  Google Scholar 

  28. Singh N, Paterson DL. Aspergillus infections in transplant recipients. Clin Microbiol Rev. 2005;18(1):44–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Ullmann AJ, Aguado JM, Arikan-Akdagli S, et al. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 2018;24(Suppl 1):e1–e38.

    Article  PubMed  Google Scholar 

  30. Cuenca-Estrella M, Bassetti M, Lass-Florl C, Racil Z, Richardson M, Rogers TR. Detection and investigation of invasive mould disease. J Antimicrob Chemother. 2011;66(Suppl 1):i15–24.

    Article  CAS  PubMed  Google Scholar 

  31. Odabasi Z, Mattiuzzi G, Estey E, et al. Beta-D-glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome. Clin Infect Dis. 2004;39(2):199–205.

    Article  CAS  PubMed  Google Scholar 

  32. Mercier T, Guldentops E, Lagrou K, Maertens J. Galactomannan, a Surrogate marker for outcome in invasive aspergillosis: finally coming of age. Front Microbiol. 2018;9:661.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Husain S, Paterson DL, Studer SM, et al. Aspergillus galactomannan antigen in the bronchoalveolar lavage fluid for the diagnosis of invasive aspergillosis in lung transplant recipients. Transplantation. 2007;83(10):1330–6.

    Article  CAS  PubMed  Google Scholar 

  34. Clancy CJ, Jaber RA, Leather HL, et al. Bronchoalveolar lavage galactomannan in diagnosis of invasive pulmonary aspergillosis among solid-organ transplant recipients. J Clin Microbiol. 2007;45(6):1759–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Leeflang MM, Debets-Ossenkopp YJ, Visser CE, et al. Galactomannan detection for invasive aspergillosis in immunocompromized patients. Cochrane Database Syst Rev. 2008;(4):Cd007394.

    Google Scholar 

  36. Kwak EJ, Husain S, Obman A, et al. Efficacy of galactomannan antigen in the Platelia Aspergillus enzyme immunoassay for diagnosis of invasive aspergillosis in liver transplant recipients. J Clin Microbiol. 2004;42(1):435–8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Husain S, Kwak EJ, Obman A, et al. Prospective assessment of Platelia Aspergillus galactomannan antigen for the diagnosis of invasive aspergillosis in lung transplant recipients. Am J Transplant. 2004;4(5):796–802.

    Article  PubMed  Google Scholar 

  38. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis. 2006;42(10):1417–27.

    Article  CAS  PubMed  Google Scholar 

  39. Maertens J, Maertens V, Theunissen K, et al. Bronchoalveolar lavage fluid galactomannan for the diagnosis of invasive pulmonary aspergillosis in patients with hematologic diseases. Clin Infect Dis. 2009;49(11):1688–93.

    Article  PubMed  Google Scholar 

  40. Akamatsu N, Sugawara Y, Kaneko J, Tamura S, Makuuchi M. Preemptive treatment of fungal infection based on plasma (1 –> 3)beta-D-glucan levels after liver transplantation. Infection. 2007;35(5):346–51.

    Article  CAS  PubMed  Google Scholar 

  41. Bhaskaran A, Kabbani D, Singer LG, et al. (1,3) beta-d-Glucan in bronchoalveolar lavage of lung transplant recipients for the diagnosis of invasive pulmonary aspergillosis. Med Mycol. 2017;55(2):173–9.

    Article  CAS  PubMed  Google Scholar 

  42. Arvanitis M, Ziakas PD, Zacharioudakis IM, Zervou FN, Caliendo AM, Mylonakis E. PCR in diagnosis of invasive aspergillosis: a meta-analysis of diagnostic performance. J Clin Microbiol. 2014;52(10):3731–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Luong ML, Clancy CJ, Vadnerkar A, et al. Comparison of an Aspergillus real-time polymerase chain reaction assay with galactomannan testing of bronchoalveolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in lung transplant recipients. Clin Infect Dis. 2011;52(10):1218–26.

    Article  CAS  PubMed  Google Scholar 

  44. Greene RE, Schlamm HT, Oestmann JW, et al. Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis. 2007;44(3):373–9.

    Article  PubMed  Google Scholar 

  45. Singh N, Suarez JF, Avery R, et al. Risk factors and outcomes in lung transplant recipients with nodular invasive pulmonary aspergillosis. J Inf Secur. 2013;67(1):72–8.

    Google Scholar 

  46. Qin J, Fang Y, Dong Y, et al. Radiological and clinical findings of 25 patients with invasive pulmonary aspergillosis: retrospective analysis of 2150 liver transplantation cases. Br J Radiol. 2012;85(1016):e429–e35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Lim C, Seo JB, Park SY, et al. Analysis of initial and follow-up CT findings in patients with invasive pulmonary aspergillosis after solid organ transplantation. Clin Radiol. 2012;67(12):1179–86.

    Article  CAS  PubMed  Google Scholar 

  48. Singh N, Winston DJ, Limaye AP, et al. Performance characteristics of galactomannan and beta-d-glucan in high-risk liver transplant recipients. Transplantation. 2015;99(12):2543–50.

    Article  CAS  PubMed  Google Scholar 

  49. Husain S, Camargo JF. Invasive aspergillosis in solid-organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13544.

    Google Scholar 

  50. Dudakova A, Spiess B, Tangwattanachuleeporn M, et al. Molecular tools for the detection and deduction of azole antifungal drug resistance phenotypes in Aspergillus species. Clin Microbiol Rev. 2017;30(4):1065–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Pan Z, Fu M, Zhang J, Zhou H, Fu Y, Zhou J. Diagnostic accuracy of a novel lateral-flow device in invasive aspergillosis: a meta-analysis. J Med Microbiol. 2015;64(7):702–7.

    Article  CAS  PubMed  Google Scholar 

  52. Heldt S, Hoenigl M. Lateral flow assays for the diagnosis of invasive Aspergillosis: current status. Curr Fungal Infect Rep. 2017;11(2):45–51.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Hoenigl M, Heldt S, Prattes J, et al. 2567. Diagnosis of invasive aspergillosis in hematological malignancy patients receiving mold-active antifungals: performance of Interleukin-6 and -8, Asp LFD, and Aspergillus PCR in same-day blood and bronchoalveolar lavage fluid samples. Open Forum Infectious Diseases. 2018;5(Suppl 1):S73-S.

    Article  PubMed Central  Google Scholar 

  54. Marr KA, Datta K, Mehta S, et al. Urine antigen detection as an aid to diagnose invasive aspergillosis. Clin Infect Dis. 2018;67(11):1705–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Koo S, Thomas HR, Daniels SD, et al. A breath fungal secondary metabolite signature to diagnose invasive aspergillosis. Clin Infect Dis. 2014;59(12):1733–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Croston TL, Nayak AP, Lemons AR, et al. Influence of Aspergillus fumigatus conidia viability on murine pulmonary microRNA and mRNA expression following subchronic inhalation exposure. Clin Exp Allergy. 2016;46(10):1315–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Georgiadou SP, Sipsas NV, Marom EM, Kontoyiannis DP. The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin Infect Dis. 2011;52(9):1144–55.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Park SY, Kim SH, Choi SH, et al. Clinical and radiological features of invasive pulmonary aspergillosis in transplant recipients and neutropenic patients. Transpl Infect Dis. 2010;12(4):309–15.

    Article  CAS  PubMed  Google Scholar 

  59. Thornton CR. Molecular imaging of invasive pulmonary aspergillosis using ImmunoPET/MRI: the future looks bright. Front Microbiol. 2018;9:691.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Boyd AE, Modi S, Howard SJ, Moore CB, Keevil BG, Denning DW. Adverse reactions to voriconazole. Clin Infect Dis. 2004;39(8):1241–4.

    Article  PubMed  Google Scholar 

  61. Eiden C, Peyriere H, Cociglio M, et al. Adverse effects of voriconazole: analysis of the French Pharmacovigilance Database. Ann Pharmacother. 2007;41(5):755–63.

    Article  CAS  PubMed  Google Scholar 

  62. Pascual A, Calandra T, Bolay S, Buclin T, Bille J, Marchetti O. Voriconazole therapeutic drug monitoring in patients with invasive mycoses improves efficacy and safety outcomes. Clin Infect Dis. 2008;46(2):201–11.

    Article  CAS  PubMed  Google Scholar 

  63. Stott KE, Hope WW. Therapeutic drug monitoring for invasive mould infections and disease: pharmacokinetic and pharmacodynamic considerations. J Antimicrob Chemother. 2017;72(Suppl 1):i12–i8.

    Article  CAS  PubMed  Google Scholar 

  64. Herbrecht R, Denning DW, Patterson TF, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002;347(6):408–15.

    Article  CAS  PubMed  Google Scholar 

  65. Seyedmousavi S, Verweij PE, Mouton JW. Isavuconazole, a broad-spectrum triazole for the treatment of systemic fungal diseases. Expert Rev Anti-Infect Ther. 2015;13(1):9–27.

    Article  CAS  PubMed  Google Scholar 

  66. Maertens JA, Raad II, Marr KA, et al. Isavuconazole versus voriconazole for primary treatment of invasive mould disease caused by Aspergillus and other filamentous fungi (SECURE): a phase 3, randomised-controlled, non-inferiority trial. Lancet. 2016;387(10020):760–9.

    Article  CAS  PubMed  Google Scholar 

  67. Walsh TJ, Raad I, Patterson TF, et al. Treatment of invasive aspergillosis with posaconazole in patients who are refractory to or intolerant of conventional therapy: an externally controlled trial. Clin Infect Dis. 2007;44(1):2–12.

    Article  CAS  PubMed  Google Scholar 

  68. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 8th ed. Philadelphia: PA Elsevier/Saunders; 2015.

    Google Scholar 

  69. Mikulska M, Viscoli C. Current role of echinocandins in the management of invasive aspergillosis. Curr Infect Dis Rep. 2011;13(6):517–27.

    Article  PubMed  Google Scholar 

  70. Maertens J, Boogaerts M, Raad I, et al. Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy. Clin Infect Dis. 2004;39(11):1563–71.

    Article  CAS  PubMed  Google Scholar 

  71. Marr KA, Schlamm HT, Herbrecht R, et al. Combination antifungal therapy for invasive aspergillosis: a randomized trial. Ann Intern Med. 2015;162(2):81–9.

    Article  PubMed  Google Scholar 

  72. Denning DW, Marr KA, Lau WM, et al. Micafungin (FK463), alone or in combination with other systemic antifungal agents, for the treatment of acute invasive aspergillosis. J Inf Secur. 2006;53(5):337–49.

    Google Scholar 

  73. Chandrasekar PH, Ito JI. Amphotericin B lipid complex in the management of invasive aspergillosis in immunocompromised patients. Clin Infect Dis. 2005;40(Suppl_6):S392–400.

    Article  CAS  PubMed  Google Scholar 

  74. Neofytos D, Lombardi LR, Shields RK, et al. Administration of voriconazole in patients with renal dysfunction. Clin Infect Dis. 2012;54(7):913–21.

    Article  CAS  PubMed  Google Scholar 

  75. Yusheng Q, Fang M, Gao BX, et al. Itraconazole decreases left ventricular contractility in isolated rabbit heart: mechanism of action. Toxicol Appl Pharmacol. 2013;268(2):113–22.

    Article  CAS  Google Scholar 

  76. Okuyan H, Altin C. Heart failure induced by itraconazole. Indian J Pharm. 2013;45(5):524–5.

    Article  Google Scholar 

  77. Dodds-Ashley E. Management of drug and food interactions with azole antifungal agents in transplant recipients. Pharmacotherapy. 2010;30(8):842–54.

    Article  CAS  PubMed  Google Scholar 

  78. Wiederhold NP, Locke JB, Bartizal K, Daruwala P. Rezafungin (CD101) demonstrates potent in vitro activity against Aspergillus, including azole-resistant Aspergillus fumigatus isolates and cryptic species. J Antimicrob Chemother. 2018;73(11):3063–7.

    Article  CAS  PubMed  Google Scholar 

  79. Ghannoum M, Long L, Larkin EL, et al. Evaluation of the antifungal activity of the novel oral glucan synthase inhibitor SCY-078, singly and in combination, for the treatment of invasive aspergillosis. Antimicrob Agents Chemother. 2018;62(6)

    Google Scholar 

  80. Oliver JD, Sibley GEM, Beckmann N, et al. F901318 represents a novel class of antifungal drug that inhibits dihydroorotate dehydrogenase. Proc Natl Acad Sci U S A. 2016;113(45):12809–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Perfect JR. The antifungal pipeline: a reality check. Nat Rev Drug Discov. 2017;16:603.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Upton A, Kirby KA, Carpenter P, Boeckh M, Marr KA. Invasive aspergillosis following hematopoietic cell transplantation: outcomes and prognostic factors associated with mortality. Clin Infect Dis. 2007;44(4):531–40.

    Article  PubMed  Google Scholar 

  83. Singh N, Limaye AP, Forrest G, et al. Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients: a prospective, multicenter, observational study. Transplantation. 2006;81(3):320–6.

    Article  CAS  PubMed  Google Scholar 

  84. Hamadeh I, Shahid Z, Copelan EA. Use of isavuconazole for prophylaxis against invasive fungal infections in allogeneic stem cell transplant patients: a real world experience. Biol Blood Marrow Transplant. 2018;24(3):S390.

    Article  Google Scholar 

  85. Eschenauer GA, Kwak EJ, Humar A, et al. Targeted versus universal antifungal prophylaxis among liver transplant recipients. Am J Transplant. 2015;15(1):180–9.

    Article  CAS  PubMed  Google Scholar 

  86. Bhaskaran A, Mumtaz K, Husain S. Anti-Aspergillus prophylaxis in lung transplantation: a systematic review and meta-analysis. Curr Infect Dis Rep. 2013;15(6):514–25.

    Article  PubMed  Google Scholar 

  87. Reichenspurner H, Gamberg P, Nitschke M, et al. Significant reduction in the number of fungal infections after lung-, heart-lung, and heart transplantation using aerosolized amphotericin B prophylaxis. Transplant Proc. 1997;29(1–2):627–8.

    Article  CAS  PubMed  Google Scholar 

  88. Ullmann AJ, Lipton JH, Vesole DH, et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med. 2007;356(4):335–47.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Multi-Organ Transplant Unit, Division of Infectious Diseases, University Health Network, Toronto, ON, Canada

    Armelle Pérez-Cortés Villalobos & Shahid Husain

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  1. Armelle Pérez-Cortés Villalobos
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  2. Shahid Husain
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Correspondence to Shahid Husain .

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Editors and Affiliations

  1. Miller School of Medicine, University of Miami, Miami, FL, USA

    Michele I. Morris

  2. Massachusetts General Hospital, Harvard University, Boston, MA, USA

    Camille Nelson Kotton

  3. Duke University, Durham, NC, USA

    Camille Wolfe

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  1. Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA

    Michele I. Morris

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Pérez-Cortés Villalobos, A., Husain, S. (2020). Aspergillus in Solid Organ and Stem Cell Transplant Patients: Emerging Options for Diagnosis and Management. In: Morris, M., Kotton, C., Wolfe, C. (eds) Emerging Transplant Infections. Springer, Cham. https://doi.org/10.1007/978-3-030-01751-4_44-1

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