Special Issue "Fungal Infections in Transplant Recipients"

A special issue of Journal of Fungi (ISSN 2309-608X).

Deadline for manuscript submissions: closed (25 May 2015).

Special Issue Editor

Dr. Shmuel Shoham
E-Mail Website
Guest Editor
Johns Hopkins University School of Medicine Baltimore, MD, USA
Interests: Antifungal therapy; Fungal infection; transplant infections; cancer infections

Special Issue Information

Dear Colleagues,

Solid organ and hematopoietic stem cell transplant recipients are at major risk of developing invasive fungal infections. Advances in prevention, diagnosis and treatment have made a major impact on morbidity and mortality related to such infections. However, rates of invasive fungal infection remain substantial, diagnostic tests for early detection are often inaccurate, treatment can prove toxic, long and costly and devastating outcomes of infection are all too common.

This Special Issue of the Journal of Fungi will examine interactions between immunocompromised hosts and fungal pathogens, as well as issues in the epidemiology, diagnosis and treatment of invasive fungal infections in transplant recipients. A solid understanding of the state of the art and science in these fields is essential for improving patient care now, and for improving diagnostic and therapeutic approaches in the future.

Dr. Shmuel Shoham
Guest Editor

Manuscript Submission Information

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Keywords

  • transplant
  • aspergillus
  • candida
  • diagnosis
  • antifungal
  • mycosis

Published Papers (6 papers)

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Review

Open AccessReview
Phaeohyphomycosis in Transplant Patients
J. Fungi 2016, 2(1), 2; https://doi.org/10.3390/jof2010002 - 22 Dec 2015
Cited by 2
Abstract
Phaeohyphomycosis is caused by a large, heterogenous group of darkly pigmented fungi. The presence of melanin in their cell walls is characteristic, and is likely an important virulence factor. These infections are being increasingly seen in a variety of clinical syndromes in both [...] Read more.
Phaeohyphomycosis is caused by a large, heterogenous group of darkly pigmented fungi. The presence of melanin in their cell walls is characteristic, and is likely an important virulence factor. These infections are being increasingly seen in a variety of clinical syndromes in both immunocompromised and normal individuals. Transplant patients are especially at risk due their prolonged immunosuppression. There are no specific diagnostic tests for these fungi, though the Fontana-Masson stain is relatively specific in tissue. They are generally seen in a worldwide distribution, though a few species are only found in specific geographic regions. Management of these infections is not standardized due to lack of clinical trials, though recommendations are available based on clinical experience from case reports and series and animal models. Superficial infections may be treated without systemic therapy. Central nervous system infections are unique in that they often affect otherwise normal individuals, and are difficult to treat. Disseminated infections carry a high mortality despite aggressive therapy, usually with multiple antifungal drugs. Considerable work is needed to determine optimal diagnostic and treatment strategies for these infections. Full article
(This article belongs to the Special Issue Fungal Infections in Transplant Recipients)
Open AccessReview
Role of New Antifungal Agents in the Treatment of Invasive Fungal Infections in Transplant Recipients: Isavuconazole and New Posaconazole Formulations
J. Fungi 2015, 1(3), 345-366; https://doi.org/10.3390/jof1030345 - 15 Oct 2015
Cited by 3
Abstract
Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Transplant patients are at risk for such invasive fungal infections. The most common invasive fungal infections are invasive candidiasis in [...] Read more.
Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Transplant patients are at risk for such invasive fungal infections. The most common invasive fungal infections are invasive candidiasis in the SOT and invasive aspergillosis in the HSCT. In this article, we will discuss the epidemiology of invasive fungal infections in the transplant recipients and susceptibility patterns of the fungi associated with these infections. Additionally, the pharmacology and clinical efficacy of the new antifungal, isavuconazole, and the new posaconazole formulations will be reviewed. Isavuconazole is a new extended-spectrum triazole that was recently approved for the treatment of invasive aspergillosis and mucormycosis. Advantages of this triazole include the availability of a water-soluble intravenous formulation, excellent bioavailability of the oral formulation, and predictable pharmacokinetics in adults. Posaconazole, a broad-spectrum triazole antifungal agent, is approved for the prevention of invasive aspergillosis and candidiasis in addition to the treatment of oropharyngeal candidiasis. Posaconazole oral suspension solution has shown some limitations in the setting of fasting state absorption, elevated gastrointestinal pH, and increased motility. The newly approved delayed-release oral tablet and intravenous solution formulations provide additional treatment options by reducing interpatient variability and providing flexibility in these set of critically ill patients. This review will detail these most recent studies. Full article
(This article belongs to the Special Issue Fungal Infections in Transplant Recipients)
Open AccessReview
Pneumocystis Pneumonia in Solid-Organ Transplant Recipients
J. Fungi 2015, 1(3), 293-331; https://doi.org/10.3390/jof1030293 - 28 Sep 2015
Cited by 8
Abstract
Pneumocystis pneumonia (PCP) is well known and described in AIDS patients. Due to the increasing use of cytotoxic and immunosuppressive therapies, the incidence of this infection has dramatically increased in the last years in patients with other predisposing immunodeficiencies and remains an important [...] Read more.
Pneumocystis pneumonia (PCP) is well known and described in AIDS patients. Due to the increasing use of cytotoxic and immunosuppressive therapies, the incidence of this infection has dramatically increased in the last years in patients with other predisposing immunodeficiencies and remains an important cause of morbidity and mortality in solid-organ transplant (SOT) recipients. PCP in HIV-negative patients, such as SOT patients, harbors some specificity compared to AIDS patients, which could change the medical management of these patients. This article summarizes the current knowledge on the epidemiology, risk factors, clinical manifestations, diagnoses, prevention, and treatment of Pneumocystis pneumonia in solid-organ transplant recipients, with a particular focus on the changes caused by the use of post-transplantation prophylaxis. Full article
(This article belongs to the Special Issue Fungal Infections in Transplant Recipients)
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Open AccessReview
Diagnostic Modalities for Invasive Mould Infections among Hematopoietic Stem Cell Transplant and Solid Organ Recipients: Performance Characteristics and Practical Roles in the Clinic
J. Fungi 2015, 1(2), 252-276; https://doi.org/10.3390/jof1020252 - 10 Sep 2015
Cited by 3
Abstract
The morbidity and mortality of hematopoietic stem cell and solid organ transplant patients with invasive fungal infections (IFIs) remain high despite an increase in the number of effective antifungal agents. Early diagnosis leading to timely administration of antifungal therapy has been linked to [...] Read more.
The morbidity and mortality of hematopoietic stem cell and solid organ transplant patients with invasive fungal infections (IFIs) remain high despite an increase in the number of effective antifungal agents. Early diagnosis leading to timely administration of antifungal therapy has been linked to better outcomes. Unfortunately, the diagnosis of IFIs remains challenging. The current gold standard for diagnosis is a combination of histopathology and culture, for which the sensitivity is <50%. Over the past two decades, a plethora of non-culture-based antigen and molecular assays have been developed and clinically validated. In this article, we will review the performance of the current commercially available non-cultural diagnostics and discuss their practical roles in the clinic. Full article
(This article belongs to the Special Issue Fungal Infections in Transplant Recipients)
Open AccessReview
Cryptococcus: Shedding New Light on an Inveterate Yeast
J. Fungi 2015, 1(2), 115-129; https://doi.org/10.3390/jof1020115 - 14 Jul 2015
Cited by 3
Abstract
Cryptococcus has emerged as a significant pathogen in immunocompromised patients. While the diagnostic testing and the antifungal treatment of cryptococcal infections have become firmly established in clinical practice, new developments and areas of ambiguity merit further consideration. These include the potential for donor [...] Read more.
Cryptococcus has emerged as a significant pathogen in immunocompromised patients. While the diagnostic testing and the antifungal treatment of cryptococcal infections have become firmly established in clinical practice, new developments and areas of ambiguity merit further consideration. These include the potential for donor transmission of Cryptococcus; cirrhosis-associated cryptococcosis, particularly during transplant candidacy; the utility of serum cryptococcal antigen testing of asymptomatic individuals in high-prevalence, poor-resource areas; pathogenesis and treatment of the immune reconstitution syndrome, specifically in relation to antiretroviral therapy and immunosuppressive medications; and new challenges posed by the emerging species of Cryptococcus gatti. In this article, we summarize the literature pertaining to these topics, focusing on recent progress. Full article
(This article belongs to the Special Issue Fungal Infections in Transplant Recipients)
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Open AccessReview
Histoplasmosis and Blastomycosis in Solid Organ Transplant Recipients
J. Fungi 2015, 1(2), 94-106; https://doi.org/10.3390/jof1020094 - 30 Jun 2015
Cited by 6
Abstract
Histoplasmosis and blastomycosis are geographically restricted dimorphic fungi that cause infection after the conidia produced in the mold phase are inhaled into the lungs. In the lungs, at 37 °C, these organisms undergo transformation into the yeast phase. In transplant recipients, infection can [...] Read more.
Histoplasmosis and blastomycosis are geographically restricted dimorphic fungi that cause infection after the conidia produced in the mold phase are inhaled into the lungs. In the lungs, at 37 °C, these organisms undergo transformation into the yeast phase. In transplant recipients, infection can occur by exposure to the mold in the environment, by reactivation of infection that had occurred previously and had been controlled by the host until immunosuppressive medications were given post-transplantation, and finally by transmission from the donor organ in the case of histoplasmosis. In transplant recipients, disseminated infection is common, and pulmonary infection is more likely to be severe than in a non-immunosuppressed person. Diagnosis has been improved, allowing earlier treatment, with the use of rapid antigen tests performed on serum and urine. Initial treatment, for all but the mildest cases of acute pulmonary histoplasmosis, should be with a lipid formulation of amphotericin B. After clinical improvement has occurred, step-down therapy with itraconazole is recommended for a total of 12 months for most transplant recipients, but some patients will require long-term suppressive therapy to prevent relapse of disease. Full article
(This article belongs to the Special Issue Fungal Infections in Transplant Recipients)
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