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Review

Phaeohyphomycosis in Solid Organ Transplant Recipients: A Case Series and Narrative Review of the Literature

by
Davide Lo Porto
1,*,
Andrea Cona
1,
Francesca Todaro
1,
Elena De Carolis
2,
Francesca Cardinale
1,
Neha Hafeez
3,
Giuseppina Di Martino
1,
Pier Giulio Conaldi
1,
Maurizio Sanguinetti
2,
Paolo Antonio Grossi
4 and
Alessandra Mularoni
1
1
Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Via E. Tricomi, 5, 90127 Palermo, Italy
2
Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
3
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
4
Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, 21100 Varese, Italy
*
Author to whom correspondence should be addressed.
J. Fungi 2023, 9(3), 283; https://doi.org/10.3390/jof9030283
Submission received: 22 January 2023 / Revised: 15 February 2023 / Accepted: 20 February 2023 / Published: 21 February 2023
(This article belongs to the Special Issue Fungal Diseases in Europe)
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Abstract

Phaeohyphomycosis comprises a variety of infections caused by pigmented fungi. Solid organ transplant (SOT) recipients are particularly at risk of invasive infections due to their prolonged immunosuppression. Here, we describe three cases of phaeohyphomycosis in SOT recipients who were successfully treated with surgical excision and/or antifungal therapy. We additionally carried out a narrative review of the literature on phaeohyphomycosis in 94 SOT recipients from 66 published studies describing 40 different species of fungi. The most reported fungus was Alternaria (21%). The median time from transplant to diagnosis was 18 months (IQR 8.25–48), and kidney transplants were the most reported. Antifungal regimens were not homogeneous, though there was a prevalence of itraconazole- and voriconazole-based treatments. Clinical outcomes included recovery in 81% and death in 5% of infected SOT recipients. Susceptibility testing was done in 26.6% of the cases, with heterogeneous results due to the variety of species isolated. While the wide diversity of dematiaceous fungi and their host range make it difficult to offer a uniform approach for phaeohyphomycosis, an early diagnosis and therapy are critical in preventing the dissemination of disease in the immunocompromised host.
Keywords: Alternaria alternata; Alternaria infectoria; Curvularia hawaiiensis; phaeohyphomycosis; SOT; voriconazole; itraconazole; posaconazole; transplantation Alternaria alternata; Alternaria infectoria; Curvularia hawaiiensis; phaeohyphomycosis; SOT; voriconazole; itraconazole; posaconazole; transplantation

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MDPI and ACS Style

Lo Porto, D.; Cona, A.; Todaro, F.; De Carolis, E.; Cardinale, F.; Hafeez, N.; Di Martino, G.; Conaldi, P.G.; Sanguinetti, M.; Grossi, P.A.; et al. Phaeohyphomycosis in Solid Organ Transplant Recipients: A Case Series and Narrative Review of the Literature. J. Fungi 2023, 9, 283. https://doi.org/10.3390/jof9030283

AMA Style

Lo Porto D, Cona A, Todaro F, De Carolis E, Cardinale F, Hafeez N, Di Martino G, Conaldi PG, Sanguinetti M, Grossi PA, et al. Phaeohyphomycosis in Solid Organ Transplant Recipients: A Case Series and Narrative Review of the Literature. Journal of Fungi. 2023; 9(3):283. https://doi.org/10.3390/jof9030283

Chicago/Turabian Style

Lo Porto, Davide, Andrea Cona, Francesca Todaro, Elena De Carolis, Francesca Cardinale, Neha Hafeez, Giuseppina Di Martino, Pier Giulio Conaldi, Maurizio Sanguinetti, Paolo Antonio Grossi, and et al. 2023. "Phaeohyphomycosis in Solid Organ Transplant Recipients: A Case Series and Narrative Review of the Literature" Journal of Fungi 9, no. 3: 283. https://doi.org/10.3390/jof9030283

APA Style

Lo Porto, D., Cona, A., Todaro, F., De Carolis, E., Cardinale, F., Hafeez, N., Di Martino, G., Conaldi, P. G., Sanguinetti, M., Grossi, P. A., & Mularoni, A. (2023). Phaeohyphomycosis in Solid Organ Transplant Recipients: A Case Series and Narrative Review of the Literature. Journal of Fungi, 9(3), 283. https://doi.org/10.3390/jof9030283

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