Phaeohyphomycosis fungal infections in solid organ transplant recipients: clinical presentation, pathology, and treatment

Schieffelin, J. S., Garcia-Diaz, J. B., Loss, G. E., Beckman, E. N., Keller, R. A., Staffeld-Coit, C., Garces, J. C. and Pankey, G. A. (2014) Phaeohyphomycosis fungal infections in solid organ transplant recipients: clinical presentation, pathology, and treatment. Transplant Infectious Disease, 16 2: 270-278. doi:10.1111/tid.12197


Author Schieffelin, J. S.
Garcia-Diaz, J. B.
Loss, G. E.
Beckman, E. N.
Keller, R. A.
Staffeld-Coit, C.
Garces, J. C.
Pankey, G. A.
Title Phaeohyphomycosis fungal infections in solid organ transplant recipients: clinical presentation, pathology, and treatment
Journal name Transplant Infectious Disease   Check publisher's open access policy
ISSN 1399-3062
1398-2273
Publication date 2014-04-01
Year available 2014
Sub-type Article (original research)
DOI 10.1111/tid.12197
Open Access Status Not Open Access
Volume 16
Issue 2
Start page 270
End page 278
Total pages 9
Place of publication Malden, MA, United States
Publisher Wiley-Blackwell Publishing
Language eng
Formatted abstract
Background
Dematiaceous, or dark-pigmented, fungi are known to cause infections such as phaeohyphomycosis, chromoblastomycosis, and mycetoma. These fungi are becoming increasingly important opportunistic pathogens in solid organ transplant recipients (SOTR). We present a retrospective chart review of 27 SOTR who developed phaeohyphomycosis infections post transplant from 1988 to 2009.

Methods
Cases were reviewed for fungal species isolated, date and source of culture, immunosuppressive and fungal therapy used, and outcome. The majority of isolates obtained were from the skin and soft tissue, with 3 pulmonary and brain abscesses.

Results
The time from transplantation to onset of infection ranged from 2 months to 11 years. The species isolated were Exophiala (11), Ochroconis (3), Alternaria (2), Phoma (2), Wangiella (1), Cladosporium (1), Aureobasidium (1), Chaetomium (1), Coniothyrium (1), and non-sporulating fungi (2). An additional 4 patients had infections confirmed by pathology, but no cultures were done. Most of the affected skin lesions were surgically debrided and treated with itraconazole; 2 patients were treated with voriconazole and 2 with amphotericin D. Death from fungal disease occurred only in patients with pulmonary and brain abscesses.

Conclusions
As the number of SOTR increases, so does the incidence of fungal infections in that population. Surgery, along with antifungal therapy and a reduction in immunosuppression, are the cornerstones of treatment.
Keyword Transplantation
Phaeohyphomycosis
Dematiaceous fungi
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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