Deep cutaneous mycoses in kidney transplant recipients: Diagnostic and therapeutic challenges

Author:

Bertin Chloé1ORCID,Sitterlé Emilie1,Scemla Anne2,Fraitag Sylvie3,Delliere Sarah45,Guegan Sarah6,Hermoso Dea Garcia4,Leclerc-Mercier Stéphanie7,Rouzaud Claire8,Lanternier Fanny48,Bougnoux Marie-Elisabeth19ORCID

Affiliation:

1. Unité de Parasitologie-Mycologie, Service de Microbiologie clinique, GHU Necker-Enfants-Malades, Assistance Publique des Hôpitaux de Paris (APHP) , Paris , France

2. Service de Néphrologie-Transplantation, GHU Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP) , Paris , France

3. Service d'Anatomo-pathologie, GHU Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP) , Paris , France

4. Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Université de Paris , Paris , France

5. Laboratoire de parasitologie-mycologie , AP-HP, Hôpital Saint-Louis, F- 75010 Paris , France

6. Service de Dermatologie, GHU Cochin, Assistance Publique des Hôpitaux de Paris (APHP) , Paris , France

7. Service de Dermatologie, GHU Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP) , Paris , France

8. Service de Maladies Infectieuses, GHU Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP) , Paris , France

9. Institut Pasteur, Université Paris Cité , INRAE, USC2019, Unité Biologie et Pathogénicité Fongiques, F- 75015 Paris , France

Abstract

Abstract Deep cutaneous mycoses (DCMs) are rare infections that extend throughout the dermis and subcutis, often occurring after inoculation with pathogenic fungi. Trends toward a growing incidence have been observed that may be partially related to an increasing population of solid organ transplant patients. The aim of this study is to describe the diagnostics and the outcomes of DCM among kidney transplant recipients so as to optimize their management. We performed a retrospective review of cases of DCM occurring among kidney transplant recipients in our institution over 12 years. Twenty cases were included. Lesions were only located on the limbs and presented mainly as single (10/20, 50%) nodular lesions (15/20, 75%), with a mean size of 3 cm. Direct mycological examination was positive for 17 patients (17/20, 85%) and the cultures were consistently positive. Thirteen different fungal species were observed, including phaehyphomycetes (n = 8), hyalohyphomycetes (n = 3), dermatophytes (n = 1), and mucorale (n = 1). The (1-3) beta-D-glucan antigen (BDG) was also consistently detected in the serum (20/20, 100%). Systematic imaging did not reveal any distant infectious lesions, but locoregional extension was present in 11 patients (11/14, 79%). Nineteen patients received antifungal treatment (19/20, 95%) for a median duration of 3 months, with surgery for 10 (10/20, 50%). There is a great diversity of fungal species responsible for DCMs in kidney transplant recipients. The mycological documentation is necessary to adapt the antifungal treatment according to the sensitivity of the species. Serum BDG positivity is a potentially reliable and useful tool for diagnosis and follow-up.

Publisher

Oxford University Press (OUP)

Reference23 articles.

1. Fungal skin and soft tissue infections;Guégan;Curr Opin Infect Dis,2016

2. Subcutaneous phaeohyphomycosis in kidney transplant recipients: a series of seven cases;Haridasan;Transpl Infect Dis Off J Transplant Soc,2017

3. Deep cutaneous fungal infections in solid-organ transplant recipients;Galezowski;J Am Acad Dermatol [Internet],2020

4. Phaeohyphomycosis in transplant recipients: results from the Transplant Associated Infection Surveillance Network (TRANSNET);McCarty;Med Mycol,2015

5. Treatment of subcutaneous phaeohyphomycosis and prospective follow-up of 17 kidney transplant recipients;Ogawa;J Am Acad Dermatol,2009

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3