Opportunistic mycelial fungal infections in organ transplant recipients: emerging importance of non-Aspergillus mycelial fungi.
To determine the spectrum and impact of mycelial fungal infections, particularly those due to non-Aspergillus molds, 53 liver and heart transplant recipients with invasive mycelial infections were prospectively identified in a multicenter study. Invasive mycelial infections were due to Aspergillus species in 69.8% of patients, to non-Aspergillus hyalohyphomycetes in 9.4%, to phaeohyphomycetes in 9.4%, to zygomycetes in 5.7%, and to other causes in 5.7%. Infections due to mycelial fungi other than Aspergillus species were significantly more likely to be associated with disseminated (P=.005) and central nervous system (P=.07) infection than were those due to Aspergillus species. Overall mortality at 90 days was 54.7%. The associated mortality rate was 100% for zygomycosis, 80% for non-Aspergillus hyalohyphomycosis, 54% for aspergillosis, and 20% for phaeohyphomycosis. Thus, non-Aspergillus molds have emerged as significant pathogens in organ transplant recipients. These molds are more likely to be associated with disseminated infections and to be associated with poorer outcomes than is aspergillosis.
Husain
Shahid
S
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Alexander
Barbara D
BD
Munoz
Patricia
P
Avery
Robin K
RK
Houston
Sally
S
Pruett
Timothy
T
Jacobs
Richard
R
Dominguez
Edward A
EA
Tollemar
Jan G
JG
Baumgarten
Katherine
K
Yu
Chen M
CM
Wagener
Marilyn M
MM
Linden
Peter
P
Kusne
Shimon
S
Singh
Nina
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000401:mortality; D001230:Aspergillus; D002177:Candidiasis / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000401:mortality*; D009894:Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology*; D016377:Organ Transplantation / Q000009:adverse effects*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology*; D011446:Prospective Studies
D000935:Antifungal Agents