Improved outcome of pulmonary aspergillosis in heart transplant recipientswith early diagnosis and itraconazole treatment

Pulmonary aspergillosis is a severe complication in heart transplant recipi ents. The drug of choice for this infection is amphotericin B, but its use is limited because of its side effects. We observed six cases of pulmonary aspergillosis in a group of 200 patients who had received heart transplants from January 1988 to January 1999. Predisposing factors such as previous r ejection, neutropenia and/or cytomegalovirus reactivation were present in a ll patients. The clinical presentation was characterized by fever and a non -productive cough. X-rays showed monolateral or diffuse infiltrate with or without nodular lesions. The median interval between symptoms and diagnosis was 5 d (range 4-7). Diagnosis was made by culturing trans-tracheal aspira te samples. Aspergillus fumigatus was isolated in 3 patients and A. niger i n the other 3. All patients were treated with itraconazole at 200-400 mg/da y for 20-60 d and all recovered. One patient treated with the lowest dosage for the shortest term had a recurrence after 1 month and needed a second 3 0-day course of itraconazole at a higher dosage. No si,significant side eff ects were registered. Itraconazole is effective in the therapy of pulmonary aspergillosis, particularly when an early diagnosis is made.