Factors Associated with Invasive Lung Aspergillosis and the Significance of Positive Aspergillus Culture After Liver Transplantation

Overview

Journal J Infect Dis

Publisher Oxford University Press

Specialty Infectious Diseases

Date 1992 Dec 1

PMID 1431256

Citations 25

Authors

S Kusne

J Torre-Cisneros

R Manez

W Irish

M Martin

J Fung

R L Simmons

T E Starzl

Affiliations

Soon will be listed here.

Abstract

From January 1981 to December 1990, 2180 patients underwent orthotopic liver transplantation at the University of Pittsburgh. Thirty-two patients (1.5%) were identified with invasive aspergillosis (29 lung, 2 intraabdominal, 1 meningitis). Of 29 patients with invasive lung disease, only 23 (79%) had positive culture (Aspergillus fumigatus, 20; Aspergillus flavus, 3). Forty-eight variables were analyzed and compared in 23 patients with invasive disease with positive cultures and 9 patients with colonization only. The variables associated with pulmonary invasive disease, by univariate analysis, were surgical time (P = .03), presence of laparotomies (P = .02), higher creatinine level at time of Aspergillus isolation (P = .01), and use of OKT3 (P = .02). However, in a multivariate analysis, only the last two (creatinine, OKT3) were associated with invasive lung aspergillosis. Of 4 patients with positive abdominal wound culture, 2 had local invasive aspergillosis. Therefore, positive cultures of Aspergillus organisms from respiratory secretions and wound drainage may represent invasive disease and should not be ignored.

Citing Articles

Clinicomycological Study of the Spectrum of Pulmonary Aspergillosis at a Tertiary Care Hospital in Central India.

Krishna A, Keche A, Tg R, Das P Cureus. 2024; 16(3):e56147.

PMID: 38618367 PMC: 11015873. DOI: 10.7759/cureus.56147.

Invasive aspergillosis in liver transplant recipients, an infectious complication with low incidence but significant mortality.

Farahani A, Ghiasvand F, Davoudi S, Ahmadinejad Z World J Transplant. 2023; 13(5):264-275.

PMID: 37746042 PMC: 10514749. DOI: 10.5500/wjt.v13.i5.264.

Fungal Infections in Liver Transplant Recipients.

Scolarici M, Jorgenson M, Saddler C, Smith J J Fungi (Basel). 2021; 7(7).

PMID: 34210106 PMC: 8304186. DOI: 10.3390/jof7070524.

Renal aspergillosis in a liver transplant patient: A case report and review of literature.

Smolovic B, Vukcevic B, Muhovic D, Ratkovic M World J Clin Cases. 2019; 6(16):1155-1159.

PMID: 30613674 PMC: 6306632. DOI: 10.12998/wjcc.v6.i16.1155.

Neutrophil Interactions Stimulate Evasive Hyphal Branching by Aspergillus fumigatus.

Ellett F, Jorgensen J, Frydman G, Jones C, Irimia D PLoS Pathog. 2017; 13(1):e1006154.

PMID: 28076396 PMC: 5261818. DOI: 10.1371/journal.ppat.1006154.

References

Kusne S, Dummer J, Singh N, Iwatsuki S, Makowka L, Esquivel C . Infections after liver transplantation. An analysis of 101 consecutive cases. Medicine (Baltimore). 1988; 67(2):132-43. PMC: 2979316. DOI: 10.1097/00005792-198803000-00006. View

Murphy J . Immunity to fungi. Curr Opin Immunol. 1989; 2(3):360-7. DOI: 10.1016/0952-7915(89)90142-8. View

Bodey G, Vartivarian S . Aspergillosis. Eur J Clin Microbiol Infect Dis. 1989; 8(5):413-37. DOI: 10.1007/BF01964057. View

Gerson S, Talbot G, Hurwitz S, Strom B, Lusk E, Cassileth P . Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia. Ann Intern Med. 1984; 100(3):345-51. DOI: 10.7326/0003-4819-100-3-345. View

Weiland D, Ferguson R, Peterson P, Snover D, Simmons R, Najarian J . Aspergillosis in 25 renal transplant patients. Epidemiology, clinical presentation, diagnosis, and management. Ann Surg. 1983; 198(5):622-9. PMC: 1353135. DOI: 10.1097/00000658-198311000-00011. View

Denning D, Follansbee S, Scolaro M, Norris S, Edelstein H, Stevens D . Pulmonary aspergillosis in the acquired immunodeficiency syndrome. N Engl J Med. 1991; 324(10):654-62. DOI: 10.1056/NEJM199103073241003. View

Castaldo P, Stratta R, Wood R, Markin R, Patil K, Shaefer M . Clinical spectrum of fungal infections after orthotopic liver transplantation. Arch Surg. 1991; 126(2):149-56. DOI: 10.1001/archsurg.1991.01410260033005. View

Starzl T, Demetris A, Van Thiel D . Liver transplantation (1). N Engl J Med. 1989; 321(15):1014-22. PMC: 3091023. DOI: 10.1056/NEJM198910123211505. View

Gustafson T, Schaffner W, Lavely G, Stratton C, Johnson H, HUTCHESON Jr R . Invasive aspergillosis in renal transplant recipients: correlation with corticosteroid therapy. J Infect Dis. 1983; 148(2):230-8. DOI: 10.1093/infdis/148.2.230. View

10.

Nalesnik M, Myerowitz R, Jenkins R, Lenkey J, Herbert D . Significance of Aspergillus species isolated from respiratory secretions in the diagnosis of invasive pulmonary aspergillosis. J Clin Microbiol. 1980; 11(4):370-6. PMC: 273406. DOI: 10.1128/jcm.11.4.370-376.1980. View

11.

Cuervas-Mons V, Millan I, Gavaler J, Starzl T, Van Thiel D . Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation. Hepatology. 1986; 6(5):922-7. PMC: 2975559. DOI: 10.1002/hep.1840060519. View

12.

Wajszczuk C, Dummer J, Ho M, Van Thiel D, Starzl T, Iwatsuki S . Fungal infections in liver transplant recipients. Transplantation. 1985; 40(4):347-53. PMC: 3035843. DOI: 10.1097/00007890-198510000-00002. View

13.

Pursell K, Telzak E, Armstrong D . Aspergillus species colonization and invasive disease in patients with AIDS. Clin Infect Dis. 1992; 14(1):141-8. DOI: 10.1093/clinids/14.1.141. View

14.

Pepys J, RIDDELL R, Citron K, Clayton Y, SHORT E . Clinical and immunologic significance of Aspergillus fumigatus in the sputum. Am Rev Respir Dis. 1959; 80:167-80. DOI: 10.1164/arrd.1959.80.2.167. View

15.

Goldstein G . Overview of the development of Orthoclone OKT3: monoclonal antibody for therapeutic use in transplantation. Transplant Proc. 1987; 19(2 Suppl 1):1-6. View

16.

Kusne S, Dummer J, Singh N, Makowka L, Esquivel C, Starzl T . Fungal Infections After Liver Transplantation. Transplant Proc. 2010; 20(1):650-651. PMC: 3002114. View

17.

Treger T, Visscher D, Bartlett M, Smith J . Diagnosis of pulmonary infection caused by Aspergillus: usefulness of respiratory cultures. J Infect Dis. 1985; 152(3):572-6. DOI: 10.1093/infdis/152.3.572. View

18.

Yu V, Muder R, Poorsattar A . Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis. Results from a three-year prospective study. Am J Med. 1986; 81(2):249-54. DOI: 10.1016/0002-9343(86)90259-7. View

19.

Murray H . Interferon-gamma, the activated macrophage, and host defense against microbial challenge. Ann Intern Med. 1988; 108(4):595-608. DOI: 10.7326/0003-4819-108-4-595. View