Invasive Pulmonary Mycoses in Lung Transplant Recipients
Invasive Pulmonary Mycoses in Lung Transplant RecipientsTuesday, December 12, 2017 - 08:26Slide presentation
Publication date: May 2018 Source:Respiratory Investigation, Volume 56, Issue 3 Author(s): Jiro Fujita
Conclusions Aspergillus colonization is associated with gene expression profiles related to defense responses including cytokine signaling. Epithelial wounding, as well as the innate immune response to chitin that is present in the fungal cell wall, may be key in the link between Aspergillus colonization and CLAD.
Conclusions Isolation of NTM or Aspergillus species from lung transplant recipients is uncommon. Adequate pre-transplant control and post-transplant management of NTM and Aspergillus infections allows for safe lung transplantation.
We present a case of primary Aspergillus appendicitis diagnosed by histologic examination in a patient who underwent lung transplantation.
Infections remain an important risk factor for chronic lung allograft dysfunction (CLAD) and mortality following lung transplantation. In particular, Pseudomonas aeruginosa, Aspergillus fumigatus, respiratory viruses and cytomegalovirus remain published risk factors for CLAD. Recent studies have shown that plasma levels of the donor fraction of cell free DNA (%ddcfDNA) are increased during episodes of acute lung rejection and other allograft injury. We hypothesize that plasma %ddcfDNA may be higher in subjects with pathogen associated allograft injury.
Dectin-1 is a pattern-recognition receptor encoded by the CLEC7A gene. Cytokine expression triggered by Dectin-1 activation is integral to early pathogen-specific responses. rs16910526 is a CLEC7A single nucleotide polymorphism (SNP) associated with increased risk of invasive fungal disease. Defective pathogen-specific immune responses lead to chronic immune activation. Aspergillus colonization increases the risk of chronic lung allograft dysfunction (CLAD) and death. We hypothesized that rs16910526 polymorphisms yielding decreased Dectin-1 protein expression would reduce CLAD-free survival.
We studied cytokine patterns predictive of subsequent invasive aspergillosis (IA) in lung transplant recipients (LTRs) with Aspergillus spp (Asp) colonization post-transplant.
Necrotizing bronchial dehiscence following lung transplantation is a rare and deadly complication with no strict management consensus. Here, we report the case of a patient who underwent bilateral sequential lung transplantation for cystic fibrosis through a clamshell incision and developed, on postoperative day 17, complete bilateral anastomotic dehiscence. The latter was attributed to a Pseudomonas aeruginosa and Aspergillus necrotizing infection. The patient was managed surgically using a bilateral posterolateral thoracotomy approach with resection of the bronchial margins, end-to-end re-anastomosis and intercostal muscle coverage.
Glória Teixeira Sousa, Cristina Cunha, Yan Liu, Ten Feizi, Axel A. Brakhage, Kyung J. Kwon-Chung, Neil A. R. Gow, Matteo Zanda, Monica Piras, Chiara Zanato, Martin Jaeger, Mihai G. Netea, Frank L. van de Veerdonk, João F. Lacerda, António Campos, Agostinho Carvalho, Janet A. Willment, Jean-Paul Latgé &Gordon D. Brown Resistance to infection is critically dependent on the ability of pattern recognition receptors to recognize microbial invasion and induce protective immune responses. One such family of receptors are the C-type lectins, which are central to antifungal immunity. These recept...
We report a case of successful treatment of probable invasive pulmonary aspergillosis due to A. lentulus and polymicrobial infection with Pseudomonas aeruginosa in a patient with relapsing granulomatosis with polyangiitis and recent high-dose steroid therapy.