INVASIVE FUNGAL-INFECTIONS IN RENAL-TRANSPLANT RECIPIENTS

In a retrospective analysis, 18 instances of invasive fungal infection s were observed in 512 (3.5%) renal transplant recipients. These inclu ded candidiasis (8), aspergillosis (5), cryptococcosis (3) and zygomyc osis (2). All patients with candidiasis had Candida isolated from bloo d and one or more additional sites. One of them had superadded fungaem ia with Torulopsis glabrata. Pulmonary disease in four and subcutaneou s infection in one were encountered in the five patients with aspergil losis. Central nervous system involvement in two and cutaneous lesion in one were the findings in patients with cryptococcosis. Zygomycosis involved the lung in one and the allograft itself in the other. Prolon ged fever not responding to antibacterial drugs was the most common cl inical presentation. Fungal infections occurred during the first 4 mon ths in 10 (55.5%) and 12 to 108 months in eight (44.5%) patients. Infe ctions with cytomegalovirus and hepatitis viruses were concommitantly present in 12 (66.7%) and eight (44.5%) patients respectively. Fourtee n episodes of fungal infections (77.8%) occurred in live unrelated kid ney recipients who formed only 48% of our total transplant population. Nine patients were treated with systemic and/or local amphotericin B and six with amBisome. Fluconazole was administered alone in three and in combination with amphotericin B in two. Fourteen patients died but mortality was only directly attributable to fungal infection in 11. W e conclude that invasive fungal infections continue to be an important cause of morbidity and mortality in renal transplant recipients. A hi gh index of suspicion, prompt diagnosis mid early institution of speci fic antifungal therapy are needed.