Aspergillosis in lung transplantation: incidence, risk factors, and prophylactic strategies.
Invasive aspergillosis remains a significant cause of morbidity and mortality in transplantation, especially lung and allogeneic bone marrow transplant recipients. The epidemiology, classic and newly recognized risk factors, and incidence of aspergillosis are reviewed. Risk factors include environmental exposures, airway colonization, profound immunosuppression, neutropenia, prior cytomegalovirus infection, and renal dysfunction. Clinical and radiographic presentations of invasive aspergillosis are discussed, including some unusual manifestations in lung transplant recipients. Early and accurate diagnosis of aspergillosis remains a challenge, and diagnostic strategies are reviewed, with an emphasis on the chest computerized tomography scan and on transbronchial or open lung biopsy. Recent advances include prophylactic and pre-emptive antifungal strategies, newer therapeutic agents, and improved risk stratification.
Gordon
S M
SM
Department of Infectious Disease, Infection Control, and Transplant Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. gordons@ccf.org
Avery
R K
RK
D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D003937:Diagnosis, Differential; D006801:Humans; D015994:Incidence; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016040:Lung Transplantation; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents