Pre-emptive therapy with azoles in lung transplant patients

Pulmonary fungal infection is diagnosed in up to 15-25% of lung transplant recipients and frequently bears a fatal outcome. This prospective uncontrol led study addresses the efficacy and safety of pre-emptive azole therapy ag ainst fungal infection in these patients, Fluconazole or itraconazole have been systematically used according to repo rted fungus sensitivity after the discovery of fungi in lower respiratory t ract samples, Patients were treated until the bronchial suture was normal a nd the cultures of the following bronchoscopy remained negative. Fungi were found post-transplantation in the low er respiratory tract speci mens of 26 out of 31 (84%) patients, predominantly Candida albicans (20 pat ients) and Aspergillus fumigatus (16 patients). Mycelia characteristic of C andida spp, or Aspergillus spp, were found in necrotic tissue at the bronch ial suture of nine patients, The mean duration of the 38 treatments was 3.6 +/-2.6 months (range, 0.5-12 months). After a median follow-up of 16 (range , 0-48) months, two cases of extended ulcerative and pseudo membranous Aspe rgillus fumigatus bronchitis were observed and healed under itraconazole tr eatment, In conclusion, pre-emptive azole therapy may be effective and well-tolerate d in lung transplant patients where fungi are found in the airways or pleur a.