Phaeohyphomycosis in transplant recipients: Results from the Transplant Associated Infection Surveillance Network (TRANSNET)

Todd P. McCarty, John W. Baddley, Thomas J. Walsh, Barbara D. Alexander, Dimitrios P. Kontoyiannis, Trish M. Perl, Randall Walker, Thomas F. Patterson, Mindy G. Schuster, G. M. Lyon, John R. Wingard, David R. Andes, Benjamin J. Park, Mary E. Brandt, Peter G. Pappas

Research output: Contribution to journalArticle

Abstract

Transplant recipients are at a high risk for developing invasive fungal infections. The agents of phaeohyphomycosis are environmental molds found worldwide, and they cause a broad spectrum of disease including skin and subcutaneous lesions, pneumonia, central nervous system disease, fungemia, and disseminated disease. Using data from the Transplant Associated Infection Surveillance Network (TRANSNET), we evaluated patients with proven and probable phaeohyphomycosis. Centers collected data on demographics, co-morbid conditions, clinical features, treatment, and three-month mortality. Fifty-six patients with phaeohyphomycosis were identified from 15 centers, comprising 26 stem cell transplant (SCT) and 30 solid organ transplant (SOT) recipients. Median time to diagnosis post-transplant was 358 days (SCT 100 days; SOT 685 days; P = <.001). The most frequent pathogen was Alternaria species (32%). Disseminated disease was found in 55.4%. Cutaneous infection was more common in SOT (53.3% vs 23.1%; P = .021), while pulmonary disease was more common in SCT (57.7 vs. 26.7; P = .019). Voriconazole (44.6%) and amphotericin B preparations (37.5%) were the most common antifungal therapies. Overall mortality was 25% and was higher in SCT than in SOT (42% vs 10%; P = <.001). A wide variety of organisms encompass phaeohyphomycosis contributing to varying types of infection in transplant recipients. Site of infection, time to disease, and mortality varies significantly between SCT and SOT recipients. Lipid formulations of amphotericin B and voriconazole were the most common antifungals used to treat this disorder.

Original languageEnglish (US)
Pages (from-to)440-446
Number of pages7
JournalMedical mycology
Volume53
Issue number5
DOIs
StatePublished - 2015

Keywords

  • Alternaria
  • Dematiaceous mold
  • Exserohilum
  • Phaeohyphomycosis

ASJC Scopus subject areas

  • Infectious Diseases

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    McCarty, T. P., Baddley, J. W., Walsh, T. J., Alexander, B. D., Kontoyiannis, D. P., Perl, T. M., Walker, R., Patterson, T. F., Schuster, M. G., Lyon, G. M., Wingard, J. R., Andes, D. R., Park, B. J., Brandt, M. E., & Pappas, P. G. (2015). Phaeohyphomycosis in transplant recipients: Results from the Transplant Associated Infection Surveillance Network (TRANSNET). Medical mycology, 53(5), 440-446. https://doi.org/10.1093/mmy/myv018