Fungal infections following lung transplantation
- Scott M Palmer, MD, MHS
Scott M Palmer, MD, MHS
- Professor of Medicine
- Duke University Medical Center
- Aimee Zaas, MD, MHS
Aimee Zaas, MD, MHS
- Associate Professor of Medicine
- Duke University Medical Center
- Cameron Wolfe, MBBS (Hons)
Cameron Wolfe, MBBS (Hons)
- Director Biopreparedness
- Duke Preparedness & Response Center
- Division of Infectious Diseases
- Duke University
- Section Editors
- Elbert P Trulock, MD
Elbert P Trulock, MD
- Section Editor — Lung Transplantation
- Professor of Medicine
- Washington University School of Medicine
- Kieren A Marr, MD
Kieren A Marr, MD
- Section Editor — Compromised Host Infections; Fungal Infections
- Professor of Medicine and Oncology
- Johns Hopkins University School of Medicine
Lung transplantation is an effective treatment for a wide range of advanced lung diseases. While the survival of lung transplant recipients continues to improve , outcomes after lung transplantation remain inferior to other types of solid organ transplantation. Infectious complications contribute substantially to morbidity and mortality following lung transplantation.
Fungal infections are a frequent complication in lung transplant recipients, with one year cumulative incidence of 8.6 percent . Aspergillus and Candida species cause the majority of fungal infections in lung transplant recipients; Cryptococcus spp, the agents of mucormycosis, endemic fungi (Histoplasma, Coccidioides, and Blastomyces spp), Scedosporium spp, Fusarium spp, and dematiaceous molds are other important causes (table 1) [3,4].
This topic reviews fungal infections in lung transplant recipients. Bacterial, viral, and mycobacterial infections in lung transplant recipients, as well as the evaluation, treatment, and prophylaxis of infection in solid organ transplant recipients, are reviewed separately. (See "Bacterial infections following lung transplantation" and "Prevention of cytomegalovirus infection in lung transplant recipients" and "Tuberculosis in solid organ transplant candidates and recipients" and "Nontuberculous mycobacterial infections in solid organ transplant candidates and recipients" and "Evaluation for infection before solid organ transplantation" and "Infection in the solid organ transplant recipient" and "Prophylaxis of infections in solid organ transplantation".)
RISK OF INFECTION
Lung transplant recipients are at high risk of infectious complications due to the following factors:
●The high level of immunosuppression required to prevent rejection
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- RISK OF INFECTION
- TIMELINE OF INFECTION
- EVALUATION FOR INFECTION
- Risk factors
- Clinical manifestations
- - Tracheobronchial aspergillosis
- - Pulmonary aspergillosis
- - Other sites
- - Galactomannan, beta-D-glucan, and PCR
- - Tracheobronchial aspergillosis
- - Pulmonary and disseminated aspergillosis
- OTHER FUNGAL INFECTIONS
- Endemic fungi
- Pneumocystis jirovecii
- Invasive fungal infections
- - Approach to prophylaxis
- - Efficacy
- Nebulized amphotericin B
- Pneumocystis pneumonia
- SUMMARY AND RECOMMENDATIONS
- Clinical manifestations and diagnosis
- Treatment of aspergillosis
- Antifungal prophylaxis