ASPERGILLUS INFECTIONS A MAJOR MENACE FOR ORGAN TRANSPLANT PATIENTS

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In the past several decades there has been much progress in techniques and treatments for bone marrow and solid organ transplants. Many thousands of transplant patients have not only had their lives saved, but have been able to lead active and productive lives following transplants.

Nina Singh et al. Aspergillosis in solid organ transplantation. American Journal of Transplantation 2013;13:228-241. AND
Joanna Schaenman. Is universal antifungal prophylaxis mandatory on lung transplant patients? Current Opinion in Infectious Disease 2013; In Press,

In spite of this progress, transplant patients are still very susceptible to infection due to their invasive surgeries and the immunosuppressive drugs they receive to reduce the risk of organ rejection. One of most common life-threatening infections that affect bone and organ transplant patients involves the common mold Aspergillus . The four species most commonly causing infection are Aspergillus fumigatus, flavus, niger and terreus.

Invasive Aspergillus infections (aspergillosis) are very common in transplant patients. They occur in about 3 to 15% of bone marrow transplant patients, 0.7 to 4% of kidney transplant patients, 1 to 9% of liver transplant patients, 1 to 14% of heart transplant patients, and 4 to 23% of lung transplant patients. Mortality rates for invasive Aspergillus infections in transplant patients ranges from 65 to 92%. Clearly, better means to prevent and treat invasive Aspergillus infections are needed.

Invasive Aspergillus infections have traditionally been treated with Amphotericin B and azole drugs such as voriconazole and itraconazole. Some of the newer antifungal drugs of the echinocandin class (such as caspofungin and micafungin) have shown great promise in successfully treating life-threatening Aspergillus and Candida infections. (Candida is a yeast-mold which also commonly cause also cause life-threatening infections in transplant patients.)

It is often difficult to detect Aspergillus infections until the infection is quite advanced and the patient may be near death. Because Aspergillus infections are so common in transplant patients and because early detection of Aspergillus infections is difficult, some experts are recommending that all transplant patients receive antifungal drugs as a routine prophylactic measure.

Other research has also reported that the use of HEPA air filtration in transplant patient rooms and better nutrition for transplant patients can significantly reduce the risk of invasive Aspergillus infections in transplant patients. All transplant patients should avoid wet or moldy environments.

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