Prophylaxis against fungal infections in solid organ and hematopoietic stem cells transplantation
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Date
2012
Journal Title
Journal ISSN
Volume Title
Publisher
SOC CHILENA INFECTOLOGIA
Abstract
Invasive fungal infections are an important cause of morbidity and mortality in SOT and HSCT recipients. The main species involved are Candida spp. and Aspergillus spp, less frequently Cryptococcus spp., causal agents of mucormycosis and Fusarium spp. Usually occur within the first six months post-transplant, but they do it later, especially during episodes of rejection, which maintains the state of immune system involvement. Prophylaxis recommendations are specific to each type of transplant. In liver transplantation use of fluconazole is recommended only in selected cases by high risk factor for invasive fungal infections (A1). If the patient has a high risk of aspergillosis, there are some suggestions for adults population to use amphotericin B-deoxycholate, liposomal amphotericin B or caspofungin (C2) without being validated none of these recommendations in pediatric population. In adult lung transplant patients where the risk of aspergillosis is higher than in other locations, we recommend universal prophylaxis with itraconazole 200 mg/day, nebulised liposomal amphotericin B or voriconazole (C2), no validated recommendations for pediatrics. In HSCT, universal prophylaxis is recommended only in allogeneic and autologous selected cases. The most accepted indication is fluconazole (A1), and posaconazole (A1) or micafungin (A1) in selected cases with high risk of aspergillosis.
Description
Keywords
Fungus, Candida, Aspergillus, yeasts, moulds, prophylaxis, amphotericin, fluconazole, voriconazole, posaconazole, caspofungin, micafungin, transplants, solid organ transplantation, hematopoietic stem cells transplantation, INVASIVE PULMONARY ASPERGILLOSIS, LIPOSOMAL AMPHOTERICIN-B, ANTIFUNGAL PROPHYLAXIS, RISK-FACTORS, PROLONGED NEUTROPENIA, ORAL ITRACONAZOLE, CONTROLLED-TRIAL, SINGLE-CENTER, DOUBLE-BLIND, RECIPIENTS