Post-transplant colonization with non-Aspergillus molds and risk of development of invasive fungal disease in lung transplant recipients

Silveira, Fernanda P., Kwak, Eun J., Paterson, David L., Pilewski, Joseph M., McCurry, Kenneth R. and Husain, Shahid (2008) Post-transplant colonization with non-Aspergillus molds and risk of development of invasive fungal disease in lung transplant recipients. Journal of Heart and Lung Transplantation, 27 8: 850-855. doi:10.1016/j.healun.2008.05.021


Author Silveira, Fernanda P.
Kwak, Eun J.
Paterson, David L.
Pilewski, Joseph M.
McCurry, Kenneth R.
Husain, Shahid
Title Post-transplant colonization with non-Aspergillus molds and risk of development of invasive fungal disease in lung transplant recipients
Journal name Journal of Heart and Lung Transplantation   Check publisher's open access policy
ISSN 1053-2498
1557-3117
Publication date 2008-08-01
Year available 2008
Sub-type Article (original research)
DOI 10.1016/j.healun.2008.05.021
Open Access Status Not yet assessed
Volume 27
Issue 8
Start page 850
End page 855
Total pages 6
Editor J. K. Kirklin
P. Homes
Place of publication St. Louis, Mo., U.S.A.
Publisher Mosby-Year Book
Language eng
Subject C1
920109 Infectious Diseases
110309 Infectious Diseases
Abstract Background: The clinical significance and risk of progression to invasive disease of the non-Aspergillus molds from the bronchoalveolar lavage (BAL) of lung transplant (LTx) recipients are not known. Methods: We reviewed the medical records from March 1996 to March 2006 of all LTx recipients whose BAL culture grew non-Aspergillus mold. The clinical characteristics, administration of prophylaxis, and outcomes were recorded. Results: Eighty-five non-Aspergillus molds were isolated from the BAL of 75 patients. Of these LTx recipients, 14.5% had a BAL with non-Aspergillus mold. Emphysema was the most common underlying diagnosis for transplantation (41.3%) and the most common isolate was Cladosporium. Isolation of a non-Aspergillus mold occurred at a median of 415 days after LTx. Prophylaxis with an anti-mold agent was noted in 44.7% (38 of 85) of the isolates. Median follow-up was 765 days. There were no cases of proven invasive fungal infection up to 1 year after isolation of the mold; and only 1 case of probable zygomycosis. Conclusions: Isolation of non-Aspergillus molds in the BAL of LTx recipients may not be associated with the development of invasive disease, irrespective of anti-fungal prophylaxis. These results suggest that initiation of targeted anti-fungal prophylaxis after isolation of non-Aspergillus molds from BAL may not be warranted.
Formatted abstract
Background
The clinical significance and risk of progression to invasive disease of the non-Aspergillus molds from the bronchoalveolar lavage (BAL) of lung transplant (LTx) recipients are not known.

Methods

We reviewed the medical records from March 1996 to March 2006 of all LTx recipients whose BAL culture grew non-Aspergillus mold. The clinical characteristics, administration of prophylaxis, and outcomes were recorded.

Results

Eighty-five non-Aspergillus molds were isolated from the BAL of 75 patients. Of these LTx recipients, 14.5% had a BAL with non-Aspergillus mold. Emphysema was the most common underlying diagnosis for transplantation (41.3%) and the most common isolate was Cladosporium. Isolation of a non-Aspergillus mold occurred at a median of 415 days after LTx. Prophylaxis with an anti-mold agent was noted in 44.7% (38 of 85) of the isolates. Median follow-up was 765 days. There were no cases of proven invasive fungal infection up to 1 year after isolation of the mold; and only 1 case of probable zygomycosis.

Conclusions

Isolation of non-Aspergillus molds in the BAL of LTx recipients may not be associated with the development of invasive disease, irrespective of anti-fungal prophylaxis. These results suggest that initiation of targeted anti-fungal prophylaxis after isolation of non-Aspergillus molds from BAL may not be warranted.

Keyword Cardiac & Cardiovascular Systems
Respiratory System
Surgery
Transplantation
Cardiovascular System & Cardiology
Respiratory System
Surgery
Transplantation
CARDIAC & CARDIOVASCULAR SYSTEMS
RESPIRATORY SYSTEM
TRANSPLANTATION
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Presented in part at the American Transplant Congress, May 2007, San Francisco, CA.

 
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Created: Sun, 29 Mar 2009, 21:07:42 EST by Carmen Buttery on behalf of UQ Centre for Clinical Research