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Infection
Published in: Infection 6/2019

Open Access 01-12-2019 | Computed Tomography | Review

Invasive mould infections in solid organ transplant patients: modifiers and indicators of disease and treatment response

Authors: Tobias Welte, Oscar Len, Patricia Muñoz, Luigina Romani, Russell Lewis, Alessandro Perrella

Published in: Infection | Issue 6/2019

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Abstract

Purpose

Invasive mould infections, in particular invasive aspergillosis (IA), are comparatively frequent complications of immunosuppression in patients undergoing solid organ transplantation (SOT). Guidelines provide recommendations as to the procedures to be carried out to diagnose and treat IA, but only limited advice for SOT recipients.

Methods

Literature review and expert consensus summarising the existing evidence related to prophylaxis, diagnosis, treatment and assessment of response to IA and infections by Mucorales in SOT patients

Results

Response to therapy should be assessed early and at regular intervals. No indications of improvement should lead to a prompt change of the antifungal treatment, to account for possible infections by Mucorales or other moulds such as Scedosporium. Imaging techniques, especially CT scan and possibly angiography carried out at regular intervals during early and long-term follow-up and coupled with a careful clinical diagnostic workout, should be evaluated as diagnostic tools and outcome predictors, and standardised to improve therapy monitoring. The role of biomarkers such as the galactomannan test and PCR, as well as selected inflammation parameters, has not yet been definitively assessed in the SOT population and needs to be studied further. The therapeutic workup should consider a reduction of immunosuppressive therapy.

Conclusions

The role of immunosuppression and immune tolerance mechanisms in the response to invasive fungal infection treatment is an important factor in the SOT population and should not be underestimated. The choice of the antifungal should consider not only their toxicity but also their effects on the immune system, two features that are intertwined.
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Metadata
Title
Invasive mould infections in solid organ transplant patients: modifiers and indicators of disease and treatment response
Authors
Tobias Welte
Oscar Len
Patricia Muñoz
Luigina Romani
Russell Lewis
Alessandro Perrella
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
Infection / Issue 6/2019
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-019-01360-z

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