title: Fungal infection by Mucorales order in lung transplantation: 4 case reports.
abstract: Mucorales is a fungus that causes systemic, highly lethal infections in immunocompromised patients. The overall mortality of pulmonary mucormycosis can reach 95%. This work is a review of medical records of 200 lung transplant recipients between the years of 2003 and 2013, in order to identify the prevalence of Mucorales in the Lung Transplantation service of Heart Institute (InCor), Hospital das Clínicas da Universidade de São Paulo, Brazil, by culture results from bronchoalveolar lavage and necropsy findings. We report 4 cases found at this analyses: 3 in patients with cystic fibrosis and 1 in a patient with bronchiectasis due to Kartagener syndrome. There were 2 unfavorable outcomes related to the presence of Mucorales, 1 by reduction of immunosuppression, another by invasive infection. Another patient died from renal and septic complications from another etiology. One patient was diagnosed at autopsy just 5 days after lung transplantation, with the Mucor inside the pulmonary vein with a precise, well-defined involvement only of donor's segment, leading to previous colonization hypothesis. There are few case reports of Mucorales infection in lung transplantation in the literature. Surveillance for the presence of Mucor can lead to timely fungal treatment and reduce morbidity and mortality in the immunocompromised patients, especially lung transplant recipients.
authors.affiliation: Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. Electronic address: fdidier@gmail.com.
authors.forename: F M F D
authors.initials: FM
authors.lastname: Neto
authors.affiliation: Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: P C L B
authors.initials: PC
authors.lastname: Camargo
authors.affiliation: Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: A N
authors.initials: AN
authors.lastname: Costa
authors.affiliation: Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: R H O B
authors.initials: RH
authors.lastname: Teixeira
authors.affiliation: Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: R M
authors.initials: RM
authors.lastname: Carraro
authors.affiliation: Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: J E
authors.initials: JE
authors.lastname: Afonso
authors.affiliation: Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: S V
authors.initials: SV
authors.lastname: Campos
authors.affiliation: Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: M N
authors.initials: MN
authors.lastname: Samano
authors.affiliation: Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: L M
authors.initials: LM
authors.lastname: Fernandes
authors.affiliation: Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: L G
authors.initials: LG
authors.lastname: Abdalla
authors.affiliation: Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: P M
authors.initials: PM
authors.lastname: Pêgo-Fernandes
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000382:microbiology*; D006801:Humans; D016867:Immunocompromised Host; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification*; D009091:Mucormycosis / Q000175:diagnosis / Q000382:microbiology*; D055815:Young Adult