FUNGAL-INFECTIONS IN SOLID-ORGAN TRANSPLANT RECIPIENTS

Invasive fungal infections occur in 5% to 45% of solid organ transplan t recipients, and are a major cause of morbidity and mortality in the immunocompromised population. The net depression of host defenses and environmental factors, such as preoperative exposures to endemic mycos es or nosocomial and specific surgery-associated exposures, affect the development of invasive infection. Most fungal infections in solid or gan transplant recipients occur within the first 2 months after transp lantation. The most common pathogens in the majority of solid organ tr ansplant recipients are Candida spp, followed by Aspergillus sp. Diagn osis is best made by a high index of suspicion and aggressive acquisit ion of specimens for culture; serologic tests are useful for infection s due to Cryptococcus neoformans and Histoplasma capsulatum. Amphoteri cin B is the drug of choice for life-threatening infections. The triaz oles, fluconazole and itraconazole, may be effective alternatives for less serious infections due to susceptible organisms. Prophylactic and preemptive treatment strategies require further study.