Fearsome Four- Fungal infections in Renal transplant Recipients

• chilaka Rajesh,*  
• Utkarash Mishra,  
• Elenjickal Elias John,  
• Athul Thomas,  
• Jeethu Joseph Eapen,  
• Joy Sarojini Michael,  
• Santosh Varughese

Abstract

Aim: To study the clinical presentation, diagnostic methods, treatment and outcomes of Invasive Aspergillosis Cryptococcal infection, Mucormycosis and Histoplasmosis in renal transplant recipients. Materials & Methods: We performed a retrospective analysis of renal transplant recipients with four major fungal infections from January 2000 until December 2022 at Christian Medical College, Vellore, India. This study was approved by the institutional ethical committee vide Institutional Review Board (IRB) minute number 13641 dated 02.12.2020).We identified these cases from the electronic records of the microbiology department and renal transplant outpatient clinic. Results: A total of 1970 patients underwent renal transplantation at Christian Medical College Vellore, India during January 1, 2000 to December 31, 2022. During this period, 25 patients were diagnosed as having invasive Aspergillosis - 20 patients had pneumonia, three had right maxillary sinusitis, one each had left chronic suppurative otitis media, and skull base osteomyelitis). There were 20 patients with cryptococcal infection of which eight had disseminated infection, seven had meningitis, four had cutaneous cryptococcosis and one had pulmonary cryptococcosis. Mucormycosis was diagnosed in 14 patients, twelve of which had pulmonary mucormycosis, one had oculo-cerebral mucormycosis and one patient had acute invasive fungal maxillarysinusitis. Histoplasmosis was diagnosed in four patients, two of whom had disseminated histoplasmosis and two had cutaneous histoplasmosis. In this study, mortality was highest with mucormycosis (57%) followed by 33.3% with invasive Aspergillosis and 20% with Cryptococci infection. Conclusion: Currently, there is no standard serological test available for the routine identification of invasive fungal infections in patients. Initial cultures may yield negative results due to slow fungal growth and variations in colony appearance. Therefore, it is essential to pursue aggressive sampling methods when fungal infection is suspected. Invasive procedures such as bronchoscopic lavage and abscess aspiration play a crucial role in reaching a diagnosis. In summary, maintaining a high level of suspicion and employing thorough investigations in post-renal transplant recipients are vital for early diagnosis, prompt treatment initiation, prevention of disease spread, and reduction of mortality risk.

Keywords

Invasive Aspergillosis, Cryptococcal infections, Mucormycosis, Histoplasmosis, Renal Transplant Recipients