Fungal pneumonia in transplant recipients.

Fungal pneumonia is an infrequent but devastating complication of solid organ transplantation. The suspicion of fungal pulmonary infections caused by the dimorphic fungi is based on particular knowledge about the recipient's past or present residence in an endemic area. Some fungi, such as Cryptococcus neoformans, Candida sp and Mucor sp are associated with concomitant diabetes mellitus. The level of immunosuppressive therapy is also a major predisposing factor. For some fungi, such as Coccidioides immitis and C neoformans, serologic tests may assist in diagnosis. For aspergillus, Candida sp and Mucor sp culture evidence is not sufficient to determine pulmonary involvement since these fungi may be nonpathogenic saprophytes. Histopathologic proof is required. In patients with abnormal host defenses, treatment of fungal pneumonia is complex. In solid organ transplant recipients it is made more difficult by drug interactions with cyclosporine. Amphotericin B exhibits synergistic nephrotoxicity with cyclosporine and ketoconazole competes with cyclosporine for hepatic metabolism in an unpredictable manner that may result in increased cyclosporine toxicity.