title: Phaeohyphomycosis in transplant recipients: Results from the Transplant Associated Infection Surveillance Network (TRANSNET).
abstract: Transplant recipients are at a high risk for developing invasive fungal infections. The agents of phaeohyphomycosis are environmental molds found worldwide, and they cause a broad spectrum of disease including skin and subcutaneous lesions, pneumonia, central nervous system disease, fungemia, and disseminated disease. Using data from the Transplant Associated Infection Surveillance Network (TRANSNET), we evaluated patients with proven and probable phaeohyphomycosis. Centers collected data on demographics, co-morbid conditions, clinical features, treatment, and three-month mortality. Fifty-six patients with phaeohyphomycosis were identified from 15 centers, comprising 26 stem cell transplant (SCT) and 30 solid organ transplant (SOT) recipients. Median time to diagnosis post-transplant was 358 days (SCT 100 days; SOT 685 days; P = <.001). The most frequent pathogen was Alternaria species (32%). Disseminated disease was found in 55.4%. Cutaneous infection was more common in SOT (53.3% vs 23.1%; P = .021), while pulmonary disease was more common in SCT (57.7 vs. 26.7; P = .019). Voriconazole (44.6%) and amphotericin B preparations (37.5%) were the most common antifungal therapies. Overall mortality was 25% and was higher in SCT than in SOT (42% vs 10%; P = <.001). A wide variety of organisms encompass phaeohyphomycosis contributing to varying types of infection in transplant recipients. Site of infection, time to disease, and mortality varies significantly between SCT and SOT recipients. Lipid formulations of amphotericin B and voriconazole were the most common antifungals used to treat this disorder.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, USA tmccarty@uabmc.edu.
authors.forename: Todd P
authors.initials: TP
authors.lastname: McCarty
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Baddley
authors.affiliation: Departments of Medicine, Pediatrics, and Microbiology and Immunology, New York-Presbyterian Hospital -Weill Cornell Medical Center, New York, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, USA.
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.affiliation: Department of Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.affiliation: Departments of Medicine, Pathology, and Epidemiology, The Johns Hopkins Hospital, Baltimore, USA.
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, USA.
authors.forename: Randall
authors.initials: R
authors.lastname: Walker
authors.affiliation: Department of Medicine, University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Patterson
authors.affiliation: Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, USA.
authors.forename: Mindy G
authors.initials: MG
authors.lastname: Schuster
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, USA.
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.affiliation: Department of Medicine, University of Florida, Gainesville, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.affiliation: Department of Medicine, University of Wisconsin, Madison, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Andes
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Brandt
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Pappas
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D060446:Phaeohyphomycosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D011446:Prospective Studies; D016019:Survival Analysis; D066027:Transplant Recipients
chemical_list: D000935:Antifungal Agents
keywords: Alternaria; Exserohilum; dematiaceous mold; phaeohyphomycosis