Heart Transplant Patient with Invasive Pulmonary Aspergillosis

Czech version

Authors: P. Šajgalík ¹; L. Špinarová ¹; P. Hude ¹; J. Krejčí ¹; J. Godava ¹; M. Tošková ²; Z. Ráčil ²; J. Vítovec ¹; P. Němec ³
Authors‘ workplace: I. interní kardioangiologická klinika LF MU a Mezinárodní centrum klinického výzkumu FN u sv. Anny v Brně – ICRC ¹; Interní hematoonkologická klinika LF MU a FN Brno ²; Centrum kardiovaskulární a transplantační chirurgie Brno ³
Published in: Kardiol Rev Int Med 2012, 14(2): 130-132
Category: Case report - competitive

Overview

Heart Transplant Patient with Invasive Pulmonary Aspergillosis. Invasive aspergillosis is a rare, but serious disease with high mortality rates especially immunodefecient patients. Early diagnoses, appropriate therapy and monitoring of disease activity are most important aspects in successful outcomes. We present a case of 41-year old woman three months after heart transplantation, in the time frame when these infectious complications are likely to occur. We would like to highlight insidious onset of the disease process, the nonrepresentative Chest X-ray, the opportunity of noninvasive diagnostic methods specifically the use of the fungal galactomanan cell wall antigen detection. Because of therapy for infectious complications in the immunosuppressed host occurs not only in transplant centers but in other medical facilities, we would like to highlight the importance of drug interactions between immunosuppressives and antibiotics and antimycotics leading to needed controls of blood concentrations.

Keywords:
orthotopic heart transplantation – invasive aspergillosis – drug interaction – tacrolimus – voriconazole – galactomanan

Sources

1. Minari A, Husni R, Avery RK et al. The incidence of invasive aspergillosis among solid organ transplant recipients and implicationsfor prophylaxis in lung transplants. Transpl Infect Dis 2002; 4: 195–200.

2. Ráčil Z, Mayer J, Bartáková H et al. Invazivní aspergilóza: současné možnosti diagnostiky. Vnitř Lék 2007; 53 (Suppl): S1–S27.

3. Pappas PG, Alexander BD, Andes BD et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis 2010; 50: 1101–1111.

4. Špinarová L, Vítovec J. Imunosupresivní léčba po transplantaci srdce. Kardiol Rev 2009; 11: 63–65.

5. Špinarová L, Vítovec J. Kombinační léčba po transplantaci srdce. Remedia 2006; 16: 268–273.

6. Ráčil Z, Kocmanová I, Wagnerová B et al. Využití detekce galaktomananů pro diagnostiku unvazivní aspergilozy u hematoonkologikcých nemocných. Vnitř Lék 2008; 54: 45–52.

7. Ráčil Z, Kocmanová I, Wagnerová B et al. Časná diagnostika invazivních mykotických infekcí u hematoonkologických nemocných pomocí serologických metod. Vnitř Lék 2007; 53: 990–999.