Isolation of Aspergillus species from the respiratory tract of lung transplant recipients is associated with increased mortality

T. Felton*, S. Roberts, S. Brennan, A. Philips, S. Whiteside, H. Doran, C. Leonard, M. Al-Aloul, B. Isalska, N. Yonan, W. Hope

Author address: 

(Manchester, UK)

Abstract: 

Objectives: Aspergillus spp. are the leading cause of invasive fungal infection in lung transplant patients. Invasive pulmonary aspergillosis (IPA) is responsible for an unacceptably high mortality despite optimal medical therapy. We investigated the relationship between the isolation of Aspergillus spp. from the respiratory tract of lung transplant recipients and their risk of mortality. Methods: A retrospective, observational cohort study of all patients who received lung allografts between January 1999 and May 2011, at a single UK centre was performed. All patients received antifungal prophylaxis with fluconazole alone or in combination with nebulised amphotericin B deoxycholate. Patients were included in the Aspergillus group if they had at least one positive culture of Aspergillus spp. from the respiratory tract. The time from transplantation (Tx) to death was analysed using a Cox regression model. Covariates included gender, age, single vs. double lung Tx, ischaemic time, presence of airway Main clinical forms of mucormycosis were: pulmonary (82%), subcutaneous (6%), osteomyelitis (6%), and gastrointestinal (6%). Two and more organs were involved in 44% of patients. Diagnosis was established by histology and/or microscopy in all patients. In 56% of cases the diagnosis was confirmed by culture. Aetiologic agents included: Lichtheimia corymbifera (2), Rhizopus microsporus var. oligosporus (1). Rhizopus spp. (3), Rhizomucor pusillus (1), and Rhizomucor spp. (2). Antifungal therapy was performed in 13 patients (three cases were diagnosed post-mortally). Posaconazole was used in 77% of patients, amphotericin B deoxycholate 69%, caspofungin 54%, amphotericin B lipid complex 46%, and liposomal amphotericin B 8%. Combination therapy was performed in 69% of patients (amphotericin B deoxycholate + caspofungin, posaconazole + amphotericin B deoxycholate). Twelve weeks overall survival was 38%. Conclusions: 1 Main underlying diseases were acute myeloid leukemia and acute lymphoblastic leukemia; 2 Mucormycosis were diagnosed after or with invasive pulmonary aspergillosis in 50% of patients; 3 Pneumonia was most common clinical manifestation (82%); two and more organs were involved in 44% of patients; 4 Twelve weeks overall survival of haematological and oncological patients with mucormycosis was 38%.
2012

abstract No: 

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Full conference title: 

22nd European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 22nd (2012)