Title: Invasive aspergillosis among patients undergoing an transplantation
- Piotr Kurnatowski, Stefan Miśkiewicz
- Review articles
- Medical Mycology
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- aspergillosis, invasivefungal infection,transplantations
In the past two decades there was a significant rise in invasive fungal infection prevalence, caused mostly by Candida, Cryptococcus and Aspergillus. Patients after transplantation are the group of high risk to develop mycosis.The incidence in them ranges from several to a dozen percent. After the transplantation 3 periods can be dist-inguished, in which the probability of infection is the highest: the first month, from 1 to 6 months and over 6 months.The incidence of mycosis among these patients results mostly from immunosuppression, wound infections, allotransplant contamination, past treatment in the intensive care units, intubations and prolonged hospi-talization. Aspergillosis is a common form of mycosis. It could have a benign course (allergic sinusitis and allergic bronchitis) or a life threatening one (central nervous system mycosis or generalized mycosis).The changes mainly develop in lungs (20-40% cases) as an invasive aspergillosis, aspergilloma or allergic bronchopulmonary aspergillosis (ABPA) and also in nasal sinuses.The course of the infection can beacute and rapidwithchangestransmitted to the eyesocket, skull bone and into the skull with a morbidity to 100% in patients after bone marrow transplantations.The literature also describes cases of aspergillosis in larynx, trachea, bronchi, ear (AIDS), central nervous system and eye ball.Three main groups of diagnostic methods for the invasive aspergillosis can be distinguished: I - mycological and histopatological examina-tions, II - pectoral examinationsand III - molecular methods.There are4 strategies to prevent and treat off ward the invasive mycosis:• prophylaxis - antifungal drug is administrated during the time of high risk of infection; • empiric treatment - beginning or modify antifungal treatment in fevered neuropenic patient; • preemptive treatment - with the cases mentioned and with the additional tests (laboratory, X-ray) that will diagnose mycosis; • treatment confirmed mycosis - patients that comply with EORTC/MSG criteria for invasive mycoses.