[Aspergillus lung pathology in transplant patients].
Invasive pulmonary aspergillosis, with or without dissemination to other organs, is a severe complication in patients who have undergone transplantation. The incidence of this disease is conditioned by the type of transplantation, the intensity of immunosuppressive regimens, and local epidemiology. The latter factor underscores the importance of air conditioning systems, and special caution is needed in case of hospital renovation. The clinical picture is frequently characterized by persisting fever, despite antibiotic treatments, but is otherwise non specific. Computerized tomography and magnetic resonance imaging show typical lesions more often than do conventional chest x-ray films. The sensitivity of broncho-alveolar lavage is poor, and DNA amplification techniques for Aspergillus might increase the diagnostic yield in the future. Also, detection of Aspergillus antigens in serum and urine might prove useful, but further studies are needed before a standardized test can be recommended for diagnostic purpose. Intravenous amphotericin B is the treatment of choice. Liposomal and other lipid formulations of this drug represent interesting alternatives, although very expensive. Itraconazole is emerging as a promising drug, because of fewer side effects than amphotericin. However, improvement of its formulation is still necessary.
Kaiser
L
L
Division des Maladies Infectieuses, Hôpital Cantonal Universitaire, Genève, Suisse.
Rochat
T
T
D000389:Air Conditioning; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000097:blood / Q000652:urine; D001228:Aspergillosis / Q000188:drug therapy / Q000517:prevention & control; D001230:Aspergillus / Q000235:genetics / Q000276:immunology; D018893:Bronchoalveolar Lavage; D004337:Drug Carriers; D004783:Environmental Microbiology; D005784:Gene Amplification; D005800:Genes, Fungal / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D017964:Itraconazole / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008081:Liposomes; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D008284:Maintenance and Engineering, Hospital; D016377:Organ Transplantation / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents; D000946:Antigens, Fungal; D004337:Drug Carriers; D007166:Immunosuppressive Agents; D008081:Liposomes; D017964:Itraconazole; D000666:Amphotericin B