Nephrol Dial Transplant (1993) 8: 168-172
© 1993 European Renal Association-European Dialysis and Transplant Association
research-article
High mortality in systemic fungal infections following renal transplantation in third-world countries
1Departments of Nephrology, Postgraduate Institute of Medical Education & Research Chandigarh, India 2Departments ofMicrobiology, Postgraduate Institute of Medical Education & Research Chandigarh, India 3Departments ofTransplant Surgery Postgraduate Institute of Medical Education & Research Chandigarh, India 4Departments ofPathology, Postgraduate Institute of Medical Education & Research Chandigarh, India
Correspondence and offprint requests to: Correspondence and offprint requests to: Professor K. S. Chugh, Professor of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
Amongst 310 recipients of live related renal transplants, systemic fungal infections were observed in 19 patients (6.1%). These included cryptococcosis in eight (42%), candidiasis in seven (37%), mucor-mycosis in two (11 %), aspergillosis in one (5.5%), and a mixed cryptococcal and Aspergillus infection in one patient (5.5%). Infections occurred within 12 months of transplantation in seven patients and after 13–37 months in the remaining patients. Prolonged fever not responding to antibiotics was the most common presentation. Central nervous system was involved in all patients with cryptococcosis, while Candida infection primarily involved the urinary tract. Both patients with mucormycosis exhibited signs and symptoms of florid rhinocerebral disease and a rapid downhill course. Pulmonary manifestations were the most prominent features of patients with aspergillosis. Parenteral amphotericin B with or without 5-fluorocytosine was started in all, but three patients could receive the therapy only for 1–3 weeks. Three patients with cryptococcosis developed amphotericin-related complications and were changed to oral fluconazole. Seven patients recovered and 12 (63%) died.
None of the patients had cytomegalovirus infection preceding the onset of fungal disease. The high frequency of fungal infections amongst our allograft recipients could not be ascribed to over immunosup-pression, since 16 patients (84%) were only on maintenance doses of immunosuppressive drugs and in 13 (68.4%) graft function was normal at the time of diagnosis.
The high frequency of fungal infections in our patients was most probably related to the poor hygienic and sanitary conditions which continue to be prevalent in the tropical environment of third-world countries. Delays in the diagnosis and late institution of therapy result in a high mortality. A high index of suspicion, appropriate investigations and early treatment are vital to reduce morbidity and mortality due to fungal infections amongst allograft recipients.
Keywords: fungal infections; renal transplantation; cryptococcosis; mucormycosis; candidiasis; aspergillosis
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