Incidence and clinical predictors of primary opportunistic deep cutaneous mycoses in solid organ transplant recipients: a multicenter cohort study.
BACKGROUND
Primary opportunistic deep cutaneous fungal infections may cause significant morbidity and mortality in solid organ transplant recipients (OTR), but no data exist about their incidence, timing, and clinical predictors in a long-term follow-up.


METHODS
A series of 3293 consecutive OTR including 1991 kidney, 929 heart, and 373 liver transplant recipients were enrolled. Patients were regularly followed up since time at transplantation (mean 5.5 yr +/-5.9 SD) and primary opportunistic fungal infections registered. Persons-year at risk (PYs), incidence rates (IR), incidence rate ratios (IRR), and 95% confidence intervals were computed.


RESULTS
Twenty-two cases of deep cutaneous mycoses were detected, (IR 1.2 cases per 1000 PYs) after a mean follow-up time since transplantation of 2.5 yr +/- 2.0 SD (median 1.8 yr). Six patients had subsequent systemic involvement and three patients died of systemic dissemination. A higher risk for mycoses was observed in the first two yr after transplantation, (IRR 35.9, p < 0.0001), in renal transplant recipients (IRR 5.1 p = 0.030), and in patients transplanted after the age of 50 (IRR 11.5 p = 0.020).


CONCLUSIONS
Primary deep cutaneous opportunistic mycoses in OTR occur mainly in the first two yr after transplantation, in renal transplant recipients, and in older patients.
Tessari
Gianpaolo
G
Section of Dermatology, University of Verona, 10032 Verona, Italy. gianpaolo.tessari@azosp.vr.it
Naldi
Luigi
L
Piaserico
Stefano
S
Boschiero
Luigino
L
Nacchia
Francesco
F
Forni
Alberto
A
Rugiu
Carlo
C
Faggian
Giuseppe
G
Dall'olio
Elena
E
Fortina
Anna Belloni
AB
Alaibac
Mauro
M
Sassi
Fabrizia
F
Gotti
Eliana
E
Fiocchi
Roberto
R
Fagioli
Stefano
S
Girolomoni
Giampiero
G
D000328:Adult; D015331:Cohort Studies; D003881:Dermatomycoses / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors