Prevention

There are no firm recommendations for prophylaxis against Aspergillus infections in transplant recipients. Some advocate the use liposomal amphotericin B in select high risk liver recipients; however, this approach is not without expense or potential significant toxicity. In lung and heart-lung recipients, inhaled amphotericin B may reduce the frequency of Aspergillus infections. Some centers advocate the use of oral itraconazole for lung recipients with demonstrated airway colonization by Aspergillus species.

Zygomycosis

Infections caused by molds, such as Rhizopus species, Mucor species, and Absidia species, are reported in up to 9% of transplant recipients. Exposure occurs as a result of inhalation or cutaneous inoculation of spores. Risk factors for such infections include corticosteroid therapy, metabolic abnormalities such as diabetic ketoacidosis, or deferoxamine therapy. Typical clinical presentations include rhinocerebral infection, nodular or cavitary pulmonary disease, gastrointestinal involvement, skin and soft tissue infection, and disseminated disease. The diagnosis is made by biopsy of involved areas, both by histopathology and culture. Amphotericin B remains the therapy of choice, although surgical debridement is the optimal therapy to control these, often fatal, infections.

Cryptococcus neoformans

Overview

Cryptococcus neoformans, a fungus present in soil and bird-droppings, is acquired by inhalation. Infections caused by C. neoformans occur throughout the post-transplant course, and only approximately one half of cases occur within the first year after transplantation.

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