Patricia Muñoz1, Ines Cerón2, Maricela Valerio2, Jesús Palomo3, Adolfo Villa3, Alia Eworo2, Juan Fernández-Yáñez3, Jesús Guinea4, Emilio Bouza4. 1. Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid; CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca; Red Española para la Investigación en Patología Infecciosa (RD06/0008/1025), Madrid. Electronic address: pmunoz@micro.hggm.es. 2. Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid. 3. Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 4. Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid; CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca; Red Española para la Investigación en Patología Infecciosa (RD06/0008/1025), Madrid.
Abstract
BACKGROUND: Invasive aspergillosis is a well-known complication in severely immunosuppressed patients, including heart transplant recipients, and associated mortality is high. Despite the severity of the disease in this population, few recent series with secular trends have addressed the problem. METHODS: We performed a descriptive study of 479 consecutive heart transplant recipients from 1988 to 2011 in a single institution. RESULTS: Overall invasive aspergillosis incidence in heart transplant recipients was 6.5% (31 of 479). Incidence decreased from 8.7% (24 of 277) in the period 1988 to 2000 (historical cohort) to 3.5% (7 of 202) afterward (p = 0.02); 4 of the 7 cases were in the context of an outbreak. The most common presentation was lung infection, but episodes occurring >3 months after transplantation (late aspergillosis) showed a higher frequency of disseminated disease and involvement of the central nervous system and of atypical sites compared with early (first 3 months) episodes. Related mortality was 36%, with a significant decrease between the historical cohort and the present cohort: 46% vs 0% (p = 0.04) and a trend toward lower related death in early vs late cases (26% vs 63%, p = 0.09). CONCLUSIONS: In our series, both incidence and mortality associated with invasive aspergillosis in heart transplant recipients showed a decrease in recent years. Careful environmental management and targeted anti-fungal prophylaxis may minimize the incidence of invasive aspergillosis in this setting.
BACKGROUND:Invasive aspergillosis is a well-known complication in severely immunosuppressed patients, including heart transplant recipients, and associated mortality is high. Despite the severity of the disease in this population, few recent series with secular trends have addressed the problem. METHODS: We performed a descriptive study of 479 consecutive heart transplant recipients from 1988 to 2011 in a single institution. RESULTS: Overall invasive aspergillosis incidence in heart transplant recipients was 6.5% (31 of 479). Incidence decreased from 8.7% (24 of 277) in the period 1988 to 2000 (historical cohort) to 3.5% (7 of 202) afterward (p = 0.02); 4 of the 7 cases were in the context of an outbreak. The most common presentation was lung infection, but episodes occurring >3 months after transplantation (late aspergillosis) showed a higher frequency of disseminated disease and involvement of the central nervous system and of atypical sites compared with early (first 3 months) episodes. Related mortality was 36%, with a significant decrease between the historical cohort and the present cohort: 46% vs 0% (p = 0.04) and a trend toward lower related death in early vs late cases (26% vs 63%, p = 0.09). CONCLUSIONS: In our series, both incidence and mortality associated with invasive aspergillosis in heart transplant recipients showed a decrease in recent years. Careful environmental management and targeted anti-fungal prophylaxis may minimize the incidence of invasive aspergillosis in this setting.
Authors: Julia A Messina; Cameron R Wolfe; Marion Hemmersbach-Miller; Carmelo Milano; Jamie L Todd; John Reynolds; Barbara D Alexander; Wiley A Schell; Christina A Cuomo; John R Perfect Journal: Transpl Infect Dis Date: 2018-06-19 Impact factor: 2.228
Authors: Alexander S Rabin; Michael M Givertz; Gregory S Couper; Margaret M Shea; Driele Peixoto; Deborah S Yokoe; Lindsey R Baden; Francisco M Marty; Sophia Koo Journal: J Heart Lung Transplant Date: 2014-10-02 Impact factor: 10.247
Authors: Ema Paulovičová; Lucia Paulovičová; Martin Hrubiško; Vadim B Krylov; Dmitry A Argunov; Nikolay E Nifantiev Journal: Front Immunol Date: 2017-10-13 Impact factor: 7.561