Melanized fungal infections in kidney transplant recipients: contributions to optimize clinical management

Melanized fungal infections in kidney transplant recipients: contributions to optimize clinical management

Author Santos, D. W. Autor UNIFESP Google Scholar
Camargo, L. P. Autor UNIFESP Google Scholar
Goncalves, S. S. Autor UNIFESP Google Scholar
Ogawa, M. M. Google Scholar
Tomimori, J. Autor UNIFESP Google Scholar
Enokihara, M. M. Google Scholar
Medina-Pestana, J. O. Google Scholar
Colombo, A. L. Autor UNIFESP Google Scholar
Abstract Objectives: This is a retrospective and observational study addressing clinical and therapeutic aspects of melanized fungal infections in kidney transplant recipients. Methods: We retrospectively reviewed medical records of all patients admitted between January 1996 and December 2013 in a single institution who developed infections by melanized fungi. Results: We reported on 56 patients aged between 30 and 74 years with phaeohyphomycosis or chromoblastomycosis (0.54 cases per 100 kidney transplants). The median time to diagnosis post-transplant was 31.2 months. Thirty-four (60.8%) infections were reported in deceased donor recipients. Fifty-one cases of phaeohyphomycosis were restricted to subcutaneous tissues, followed by two cases with pneumonia and one with brain involvement. Most dermatological lesions were represented by cysts (23/51

45.1%) or nodules (9/51

17.9%). Exophiala spp. (34.2%) followed by Alternaria spp. (7.9%) were the most frequent pathogens. Graft loss and death occurred in two patients and one patient, respectively. Regarding episodes of subcutaneous phaeohyphomycosis, a complete surgical excision without antifungal therapy was possible in 21 of 51 (41.2%) patients. Long periods of itraconazole were required to treat the other 30 (58.8%) episodes of subcutaneous disease. All four cases of chromoblastomycosis were treated only with antifungal therapy. Conclusions: Melanized fungal infections should be considered in the differential diagnosis of all chronic skin lesions in transplant recipients. It is suggested that the impact of these infections on graft function and mortality is low. The reduction in immunosuppression should be limited to severely ill patients. (C) 2016 Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.
Keywords Chromoblastomycosis
Kidney transplantation
Melanized fungi
Phaeohyphomycosis
Exophiala spp.
xmlui.dri2xhtml.METS-1.0.item-coverage Oxford
Language English
Sponsor Ethical Committee of the UNIFESP
CNPq
Grant number Ethical Committee of the UNIFESP: 0524/08
CNPq: 307510/2015-8
Date 2017
Published in Clinical Microbiology And Infection. Oxford, v. 23, n. 5, p. -, 2017.
ISSN 1198-743X (Sherpa/Romeo, impact factor)
Publisher Elsevier Sci Ltd
Extent -
Origin http://dx.doi.org/10.1016/j.cmi.2016.12.024
Access rights Closed access
Type Article
Web of Science ID WOS:000404469900014
URI https://repositorio.unifesp.br/handle/11600/54539

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