Despite that Aspergillus infection is a dreadful disease in heart transplant patients there is no data regarding the natural history of aspergillosis in the this patient population. A study of 591 heart transplant (HTx) recipients was carried out to determine the incidence, clinical manifestations and outcome of invasive pulmonary aspergillosis (IPA). We found 55 patients (9.3%) with aspergillus infection during an eighteen-year period (1980-1998). Among this group 29 patients (4.9%) presented with IPA. The patients were more likely to be male (86.2%), mean age 42 and with cardiomyopathy (51.7%) as their indication for HTx. Fever was the most common symptom (58.6 %), followed by dyspnea and cough (13.7% each one). All 29 patients had abnormal chest radiographs and nodular appearance was found in 21 patients (72.3%), followed by diffuse infiltrates in 5 (17.2%). The median time of onset was 46 days after transplantation (72.4% within 90 days). None of the patients were neutropenic at the time of diagnosis (mean WBC 9093, range 3100-15700 and mean PMN 7126, range 2479-14758). The majority of patients received steroid therapy 24 (82.8%), 13 (44.8%) developed rejection and 9 (31%) presented with CMV co-infection. The majority did not receive prophylaxis 24 (82.8%) and 3 of the 5 patients that received prophylaxis developed the disease and died with signs of persistent infection. A total of 25 (86.2%) received treatment with amphotericin B. The mean dose of amphotericin B used to treat these patients was 1640 mg. After a follow-up of 29 months, 18 (62.1%) patients were free of aspergillosis disease and the mortality rate was 24% (7/29). A significant reduction in cases of IPA was observed after the introduction of the routine use of inhaled amphotericin B prophylaxis. Febrile patients with nodular infiltrates, on corticosteroids within first 90 days of HTx have a high risk for developing IPA. In contrast within patients with hematological malignancies neutropenia does not appear to be a risk factor for IPA in HTx.
Full conference title:
37th Annual Meeting of the Infectious Diseases Society of America (IDSA), November 18-21.
- IDSA 37th