Opportunistic fungal infections in patients treated with heart transplantation--own centre experiences.
The aim of this study was to analyse frequency, type and course of fungal infection in patients treated with heart transplantation (HT) and to estimate the efficacy of diagnostic procedures in patients before and after HT. The study was conducted on 30 patients (group I) aged 20-64 referred for HT and treated after HT in Coronary Disease Department in Cracow. Standard immunosuppressive protocol consisting of CSA-A, Aza, Prednisone was administered to all recipients after HT. As a control group 40 healthy persons aged 25-65 were examined. In all persons quantitative and mycoserological examinations were carried out according to a special protocol. In some justified cases despite serological and quantitative examinations, bronchoscopy with BAL, biopsy procedure, histological examination of tissue were performed in patients after HT. The commonest infections in patients after HT were oropharyngeal Candida infections. They mostly occurred in the first months after HT, and were observed in 67% of recipients. Besides, in two patients deep Aspergillus infections were documented. Quantitative mycological examinations were very useful in diagnosing early stages of superficial mycoses. In none of these patients before HT were permanent oropharyngeal yeast and Aspergillus colonizations observed. Diagnosis of deep Aspergillus mycoses was difficult. Even antigen detection did not allow for making definitive diagnosis, because antigen was found in some recipients without infections and in some healthy persons. Definitive diagnosis depended on histological and mycological examinations of tissue sections obtained by surgical procedure and in second case by autopsy.
Konduracka
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Coronary Disease Department, Medical College of Jagiellonian Universitety of Cracow, Poland.
D000328:Adult; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000453:epidemiology*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012016:Reference Values; D013183:Sputum / Q000382:microbiology; D014556:Urine / Q000382:microbiology