Invasive Aspergillosis in the Setting of Cardiac Transplantation

Among patients undergoing heart transplantation, Aspergillus is the opportunistic pathogen with the highest attributable mortality. The median time of onset from transplantation for invasive pulmonary aspergillosis (IPA) was 46 days, but the median time to first positive culture result was 104 days...

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Bibliographic Details
Published in:Clinical infectious diseases 2003-10, Vol.37 (Supplement-3), p.S281-S292
Main Authors: Montoya, J.G., Chaparro, S. V., Celis, D., Cortés, J. A., Leung, A. N., Robbins, R. C., Stevens, D. A.
Format: Article
Language:English
Subjects:
Adult
Aspergillosis
Aspergillosis - epidemiology
Aspergillosis - mortality
Aspergillosis - physiopathology
Aspergillosis - prevention & control
Aspergillus
Aspergillus fumigatus
Chemoprevention
Female
Fever
Heart diseases
Heart transplantation
Heart Transplantation - adverse effects
Humans
Immunocompromised Host
Infections
Male
Mortality
Postoperative Complications - epidemiology
Postoperative Complications - mortality
Postoperative Complications - physiopathology
Postoperative Complications - prevention & control
Predisposing factors
Radiology
Risk Factors
Transplantation
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Summary:Among patients undergoing heart transplantation, Aspergillus is the opportunistic pathogen with the highest attributable mortality. The median time of onset from transplantation for invasive pulmonary aspergillosis (IPA) was 46 days, but the median time to first positive culture result was 104 days among patients with Aspergillus colonization but no invasive disease. Most patients with IPA presented with fever and cough within the first 90 days of transplantation and with single or multiple pulmonary nodules. None of the heart transplant recipients with either IPA or invasive extrapulmonary aspergillosis (IEPA) had associated neutropenia. Human leukocyte antigen A1 locus was found significantly more frequently among patients colonized with Aspergillus than among patients with IPA (P < .006) or IEPA (P < .001). Even in the absence of neutropenia, IPA should be suspected for heart transplant recipients who have fever and respiratory symptoms within the first 3 months of transplantation, have a positive result of culture of respiratory secretions, and have abnormal radiological findings (particularly nodules).
ISSN:1058-4838
1537-6591
DOI:10.1086/376527