Diagnosis and treatment of fungal infections in allogeneic stem cell and solid organ transplant recipients.
BACKGROUND
Invasive fungal diseases (IFD) are severe complications in patients receiving immunosuppression after solid organ or allogeneic stem cell transplantation. Extensive study has been conducted on therapeutic strategies for IFD in neutropenic patients, mostly those with hematological malignancy. There is an ongoing discussion on whether these studies may be applied to transplant patients as well.


METHODS
We have reviewed relevant literature on transplantation and clinical mycology of the last 20 years and selected articles relevant for today's treatment decisions. This article reports on the epidemiology of IFD in transplant recipients and current antifungal drugs in the context of tansplantation medicine. For invasive aspergillosis and invasive candidiasis, we give a detailed report of current clinical evidence.


RESULTS
This review is intended as a quick-start for clinicians and other care providers new to transplant care and as an update for experienced transplant physicians. In a field in which evidence is scarce and conflicting, we provide evidence-based strategies for diagnosing and treating the most relevant IFD in transplant recipients.


CONCLUSIONS
Physicians treating transplant patients should maintain a high level of awareness towards IFD. They should know the local epidemiology of IFD to make the optimal decision between current diagnostic and therapeutic strategies. Prophylaxis or early treatment should be considered given the high mortality of IFD.
Vehreschild
Jörg J
JJ
Hospital of the University of Cologne, Department I of Internal Medicine, Clinical Trials Unit II for Infectious Diseases (BMBF 01KI0771), Kerpener Strasse 62, 50937 Köln, Germany. janne.vehreschild@ctuc.de
Rüping
Maria J G T
MJ
Steinbach
Angela
A
Cornely
Oliver A
OA
D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000517:prevention & control*; D002177:Candidiasis / Q000188:drug therapy; D025141:Drug Resistance, Fungal / Q000502:physiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007165:Immunosuppression Therapy; D009181:Mycoses / Q000175:diagnosis*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D033581:Stem Cell Transplantation; D013234:Stem Cells / Q000382:microbiology*; D014184:Transplantation, Homologous / Q000379:methods; D019737:Transplants / Q000382:microbiology*
D000935:Antifungal Agents