The isolation of Aspergillus fumigatus from respiratory tract specimens in heart transplant recipients is highly predictive of invasive aspergillosis.
BACKGROUND
Prompt recognition of invasive pulmonary aspergillosis (IPA) after heart transplantation is essential for achieving a successful outcome. However, the significance of the isolation of from respiratory specimens in heart transplant recipients is not established.


METHODS
From 1990 to 1999, we analyzed first respiratory specimens with spp. growth from heart transplant patients in our institution. All specimens were cultured in both fungal and conventional media. Diagnosis of proven and probable IPA or colonization was made according to criteria of the Mycoses Study Group.


RESULTS
During the 10-year study period, spp. was recovered from 30 episodes from 27 heart transplant recipients (incidence: 10.5%). Three episodes were classified as indeterminate and were included in the analysis in a double way, first considering them as true positives and afterward as true negatives, so ranges were obtained. After applying diagnostic criteria, 18 of 30 episodes were proven or probable IPA, and 9 episodes were colonizations. Accordingly, 7 to 8% of heart transplant recipients suffered an IPA, and the overall positive predictive value (PPV) was 60% to 70%. When analyzed by species, the PPV of recovering was 78% to 91%, whereas it was 0% for other species. The PPV increased to 88% to 100% when was recovered from a respiratory specimen other than sputum and decreased to 50% to 67% when it was recovered from sputum. The sensitivities of fungal and conventional media for the recovery of spp. were 95% to 100% and 33% to 38%, respectively.


CONCLUSIONS
The isolation of from the respiratory tract of a heart transplant recipient is highly predictive of invasive aspergillosis.
Muñoz
Patricia
P
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. pmunoz@micro.hggm.es.
Alcalá
Luis
L
Sánchez Conde
Matilde
M
Palomo
Jesús
J
Yáñez
Juan
J
Pelaez
Teresa
T
Bouza
Emilio
E
D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis* / Q000453:epidemiology; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D001431:Bacteriological Techniques; D003470:Culture Media; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000382:microbiology; D011237:Predictive Value of Tests; D012137:Respiratory System / Q000382:microbiology
D003470:Culture Media