Invasive aspergillosis in solid organ transplant patients: diagnosis, prophylaxis, treatment, and assessment of response

BMC Infectious Diseases

Christoph Lichtenstern¹  Frédéric Lamoth²  Jörg Janne Vehreschild³  Dionysios Neofytos⁴  Carolina Garcia-Vidal⁵  Alessandro Perrella⁶ 

[1] Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, Germany;Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, 1011, Lausanne, Switzerland;Department of Laboratories, Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland;Medical Department II, Hematology and Oncology, University Hospital of Frankfurt, Frankfurt, Germany;Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany;German Centre for Infection Research, partner site Bonn-Cologne, University of Cologne, Cologne, Germany;Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland;Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, FungiCLINIC Research group (AGAUR), Barcelona, Spain;VII Department of Infectious Disease and Immunology, Hospital D. Cotugno, Naples, Italy;CLSE-Liver Transplant Unit, Hospital A. Cardarelli, Naples, Italy;

关键词: Aspergillus;    Invasive pulmonary aspergillosis;    Microbiome;    Mucorales;    Mucormycosis;    Solid organ transplantation;   

DOI  :  10.1186/s12879-021-05958-3

来源: Springer

【 摘 要 】

BackgroundInvasive aspergillosis (IA) is a rare complication in solid organ transplant (SOT) recipients. Although IA has significant implications on graft and patient survival, data on diagnosis and management of this infection in SOT recipients are still limited.MethodsDiscussion of current practices and limitations in the diagnosis, prophylaxis, and treatment of IA and proposal of means of assessing treatment response in SOT recipients.ResultsLiver, lung, heart or kidney transplant recipients have common as well as different risk factors to the development of IA, thus each category needs a separate evaluation. Diagnosis of IA in SOT recipients requires a high degree of awareness, because established diagnostic tools may not provide the same sensitivity and specificity observed in the neutropenic population. IA treatment relies primarily on mold-active triazoles, but potential interactions with immunosuppressants and other concomitant therapies need special attention.ConclusionsCriteria to assess response have not been sufficiently evaluated in the SOT population and CT lesion dynamics, and serologic markers may be influenced by the underlying disease and type and severity of immunosuppression. There is a need for well-orchestrated efforts to study IA diagnosis and management in SOT recipients and to develop comprehensive guidelines for this population.

【 授权许可】

CC BY