Phaeohyphomycosis fungal infections in solid organ transplant recipients: clinical presentation, pathology, and treatment

• Published in: Transplant infectious disease 2014-04, Vol.16 (2), p.270-278
• Main Authors: Schieffelin, J.S., Garcia-Diaz, J.B., Loss Jr, G.E., Beckman, E.N., Keller, R.A., Staffeld-Coit, C., Garces, J.C., Pankey, G.A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alternaria; Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; Aureobasidium; Brain Abscess - drug therapy; Brain Abscess - microbiology; Chaetomium; Cladosporium; Coniothyrium; Debridement; dematiaceous fungi; Exophiala; Female; Humans; Immunosuppression - adverse effects; Itraconazole - therapeutic use; Lung Abscess - drug therapy; Lung Abscess - microbiology; Male; Middle Aged; Opportunistic Infections - microbiology; Opportunistic Infections - therapy; Organ Transplantation - adverse effects; phaeohyphomycosis; Phaeohyphomycosis - microbiology; Phaeohyphomycosis - therapy; Phoma; Retrospective Studies; Time Factors; transplantation; Voriconazole - therapeutic use; Wangiella; Young Adult
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12197

Background Dematiaceous, or dark‐pigmented, fungi are known to cause infections such as phaeohyphomycosis, chromoblastomycosis, and mycetoma. These fungi are becoming increasingly important opportunistic pathogens in solid organ transplant recipients (SOTR). We present a retrospective chart review of 27 SOTR who developed phaeohyphomycosis infections post transplant from 1988 to 2009. Methods Cases were reviewed for fungal species isolated, date and source of culture, immunosuppressive and fungal therapy used, and outcome. The majority of isolates obtained were from the skin and soft tissue, with 3 pulmonary and brain abscesses. Results The time from transplantation to onset of infection ranged from 2 months to 11 years. The species isolated were Exophiala (11), Ochroconis (3), Alternaria (2), Phoma (2), Wangiella (1), Cladosporium (1), Aureobasidium (1), Chaetomium (1), Coniothyrium (1), and non‐sporulating fungi (2). An additional 4 patients had infections confirmed by pathology, but no cultures were done. Most of the affected skin lesions were surgically debrided and treated with itraconazole; 2 patients were treated with voriconazole and 2 with amphotericin D. Death from fungal disease occurred only in patients with pulmonary and brain abscesses. Conclusions As the number of SOTR increases, so does the incidence of fungal infections in that population. Surgery, along with antifungal therapy and a reduction in immunosuppression, are the cornerstones of treatment.