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Special Issue: Fungal Infection in Patients with Organ Transplantation

  • Stephan Eschertzhuber
Chapter

Abstract

Impairment of the immunological competence of patients facilitates the colonization and invasive infection with ubiquitary present fungal spores. The group of predisposed individuals consists of patients suffering from hematological malignancy and human immunodeficiency virus (HIV) infection or those undergoing solid organ transplantation, neonates, patients with long-term intensive care dependency, or patients with severe burns. Despite major achievements in risk stratification, diagnosis, and treatment of fungal infections, these infections contribute substantially to morbidity and mortality in these clinical settings. After solid organ transplantation, the risk for invasive fungal infection is highest after small bowel transplantation followed by lung, liver, pancreas, heart, and kidney transplantations. Besides host characteristics and the specific organ-related predisposition, several risk factors for developing an invasive fungal infection were identified. In this chapter the issues of fungal infections in immunocompromised patients with a special focus on solid organ transplantation recipients are reviewed.

References

  1. 1.
    Ison MG, Nalesnik MA (2011) An update on donor-derived disease trans-mission in organ transplantation. Am J Transplant 11:1123–1130CrossRefGoogle Scholar
  2. 2.
    Echenique IA, Ison MG (2013) Update on donor-derived infections in liver transplantation. Liver Transpl 19(6):575–585.  https://doi.org/10.1002/j.idc.2013.02.001CrossRefPubMedGoogle Scholar
  3. 3.
    Pappas PG, Alexander BD, Andes DR, Hadley S, Kauffmann CA, Freifeld A et al (2010) Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis 50(8):1101–1111.  https://doi.org/10.1086/651262CrossRefGoogle Scholar
  4. 4.
    Silveira FP, Kusne S, The AST Infectious Diseases Community of Practice (2013) Candida infections in solid organ transplantation. Am J Transplant 13:220–227.  https://doi.org/10.1111/ajt.12114CrossRefPubMedGoogle Scholar
  5. 5.
    Singh NM, Husain S, The AST Infectious Diseases Community of Practice (2013) Aspergillosis in solid organ transplantation. Am J Transplant 13(Suppl 4):228–241.  https://doi.org/10.1111/ajt.12115.CrossRefPubMedGoogle Scholar
  6. 6.
    Neofytos D, Fishman JA, Horn D, Anaissie E, Chang CH, Olyaei A et al (2010) Epidemiology and outcome of invasive fungal infections in solid organ transplant recipients. Transpl Infect Dis 12(3):220–229.  https://doi.org/10.1111/j.1399-3062.2010.00492.xCrossRefPubMedGoogle Scholar
  7. 7.
    Bush WW (1999) Overview of transplantation immunology and the pharmacotherapy of adult solid organ transplant recipients: focus on immunosuppression. AACN Clin Issues 10(2):253–269CrossRefGoogle Scholar
  8. 8.
    Shoham S, Marr KA (2012) Invasive fungal infections in solid organ transplant recipients. Future Microbiol 7(5):639–655.  https://doi.org/10.2217/fmb.12.28CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Singh N (2000) Antifungal prophylaxis for solid organ transplant recipients: seeking clarity. Clin Infect Dis 31(2):545–553CrossRefGoogle Scholar
  10. 10.
    Gavaldà J, Meije Y, Fortún J, Roilides E, Saliba F, Lortholary O et al (2014) Invasive fungal infections in solid organ transplant recipients. Clin Microbiol Infect 20(Suppl 7):27–48.  https://doi.org/10.1111/1469-0691.12660CrossRefPubMedGoogle Scholar
  11. 11.
    Delgado J, Calvo N, Gomis A, Pérez-Flores I, Rodríguez A, Ridao N et al (2010) Candiduria in renal transplant recipients: incidence, clinical repercussion, and treatment indication. Transplant Proc 42(8):2944–2946.  https://doi.org/10.1016/j.transproceed.2010.08.019CrossRefPubMedGoogle Scholar
  12. 12.
    Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L et al (2016) Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 62(4):e1–e50.  https://doi.org/10.1093/cid/civ933
  13. 13.
    Benedetti E, Gruessner AC, Troppmann C, Papalois BE, Sutherland DE, Dunn DL et al (1996) Intra-abdominal infections after pancreatic transplantation: incidence, treatment, and outcome. J Am Coll Surg 183(4):307–316PubMedGoogle Scholar
  14. 14.
    Raghuram A, Restrepo A, Safadjou S, Cooley J, Orloff M, Hardy D et al (2012) Invasive fungal infections following liver transplantation: incidence, risk factors, survival, and impact of fluconazole-resistant Candida parapsilosis (2003-2007). Liver Transpl 18(9):1100–1109.  https://doi.org/10.1002/lt.23467CrossRefPubMedGoogle Scholar
  15. 15.
    Husain S, Tollemar J, Dominguez EA, Baumgarten K, Humar A, Paterson DL et al (2003) Changes in the spectrum and risk factors for invasive candidiasis in liver transplant recipients: prospective, multicenter, case-controlled study. Transplantation 75(12):2023–2029CrossRefGoogle Scholar
  16. 16.
    Liu X, Ling Z, Li L, Ruan B (2011) Invasive fungal infections in liver transplantation. Int J Infect Dis 15(5):e298–e304.  https://doi.org/10.1016/j.ijid.2011.01.005CrossRefPubMedGoogle Scholar
  17. 17.
    Unterpertinger R, Sieger J, Schneeberger S, Bosmuller C, Aigner M, Lass-Floerl C et al (2016) Inzidnez invasiver fungaler infektionen nach lebertransplantation. Transpl Int 29(Suppl S4):1–23Google Scholar
  18. 18.
    Fischer L, Sterneck M (2005) Invasive fungal infections in patients after liver transplantation. Mycoses 48(Suppl 1):27–35CrossRefGoogle Scholar
  19. 19.
    Lichtenstern C, Hochreiter M, Zehnter VD, Brenner T, Hofer S, Mieth M et al (2013) Pretransplant model for end stage liver disease score predicts posttransplant incidence of fungal infections after liver transplantation. Mycoses 56(3):350–357.  https://doi.org/10.1111/myc.12041CrossRefPubMedGoogle Scholar
  20. 20.
    Wang JL, Chang CH, Young-Xu Y, Chan KA (2010) Systematic review and meta-analysis of the tolerability and hepatotoxicity of antifungals in empirical and definitive therapy for invasive fungal infection. Antimicrob Agents Chemother 54(6):2409–2419.  https://doi.org/10.1128/AAC.01657-09CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Echenique IA, Angarone MP, Gordon RA, Rich J, Anderson AS, McGee EC et al (2017) Invasive fungal infection after heart transplantation: a 7-year, single-center experience. Transpl Infect Dis 19(1).  https://doi.org/10.1111/tid.12650CrossRefGoogle Scholar
  22. 22.
    Hummel M, Thalmann U, Jautzke G, Staib F, Seibold M, Hetzer R (1992) Fungal infections following heart transplantation. Mycoses 35(1-2):23–34CrossRefGoogle Scholar
  23. 23.
    Rabin AS, Givertz MM, Couper GS, Shea MM, Peixoto D, Yokoe DS et al (2015) Risk factors for invasive fungal disease in heart transplant recipients. Transpl Infect Dis 17(2):259–266.  https://doi.org/10.1111/tid.12362CrossRefGoogle Scholar
  24. 24.
    Husain S, Sole A, Alexander BD, Aslam S, Avery R, Benden C et al (2016) 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 35(3):261–282.  https://doi.org/10.1016/j.healun.2016.01.007CrossRefPubMedGoogle Scholar
  25. 25.
    Gustafsson F, Rogers JG (2017) Left ventricular assist device therapy in advanced heart failure: patient selection and outcomes. Eur J Heart Fail 19(5):595–602.  https://doi.org/10.1002/ejhf.779CrossRefPubMedGoogle Scholar
  26. 26.
    Kubak BM (2002) Fungal infection in lung transplantation. Transpl Infect Dis 4(Suppl 3):24–31CrossRefGoogle Scholar
  27. 27.
    Kusne S, Manez R, Bonet H, Abu-Elmagd K, Furukawa H, Irish W et al (1994) Infectious complications after small bowel transplantation in adults. Transplant Proc 26(3):1682–1683PubMedPubMedCentralGoogle Scholar
  28. 28.
    Florescu DF, Islam KM, Grant W, Mercer DF, Langnas A, Botha J et al (2010) Incidence and outcome of fungal infections in pediatric small bowel transplant recipients. Transpl Infect Dis 12(6):497–504.  https://doi.org/10.1111/j.1399-3062.2010.00542.xCrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Anesthesia and Intensive CareMedical University InnsbruckInnsbruckAustria

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