Successful Treatment of Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management
Background Scedosporium fungal infection is an emerging disease which is difficult to diagnose and treat. Patients undergoing lung transplant may be colonized prior to transplantation and are at risk for lethal allograft infection after transplantation. Objectives To identify and evaluate treatment...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2019-01-01
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| Series: | Allergy & Rhinology |
| Online Access: | https://doi.org/10.1177/2152656719827253 |
| _version_ | 1818612724848918528 |
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| author | Elisabeth H. Ference MD, MPH Bernard M. Kubak MD Paul Zhang MD, MPH Jeffrey D. Suh MD |
| author_facet | Elisabeth H. Ference MD, MPH Bernard M. Kubak MD Paul Zhang MD, MPH Jeffrey D. Suh MD |
| author_sort | Elisabeth H. Ference MD, MPH |
| collection | DOAJ |
| description | Background Scedosporium fungal infection is an emerging disease which is difficult to diagnose and treat. Patients undergoing lung transplant may be colonized prior to transplantation and are at risk for lethal allograft infection after transplantation. Objectives To identify and evaluate treatment options. Methods This study is a retrospective review of patients treated at a tertiary academic medical center from 2007 to 2017 with positive sinonasal cultures. A review of the literature was also performed to identify additional cases. Results Two lung transplant patients had a positive culture for Scedosporium . The literature search resulted in 37 citations, which yielded only 2 prior cases of Scedosporium paranasal sinus colonization or infection in lung transplant recipients. Three of the 4 patients had cystic fibrosis. Two of the patients were colonized before initial transplant, while 1 patient was colonized before subsequent transplant. Three of the 4 patients survived, and all 3 had disease isolated to their sinuses and lungs treated with sinus surgery, while the fourth had disseminated disease and did not undergo sinus surgery. All patients were treated with multiple antifungals due to resistance patterns. One surviving patient cleared both sinus and lung cultures in less than 1 month, while the other 2 surviving patients achieved negative cultures after a minimum of 6 months. Conclusions Surgery may be especially important in patients with fungal sinus colonization or infection before or after lung transplantation. Chronic sinusitis is an important source for persistent fungal colonization and reinfection of the allograft which could be removed with surgical debridement before causing highly morbid pulmonary disease. |
| first_indexed | 2024-12-16T15:50:47Z |
| format | Article |
| id | doaj.art-da1e9672feb74c38a931856efd988278 |
| institution | Directory Open Access Journal |
| issn | 2152-6567 |
| language | English |
| last_indexed | 2024-12-16T15:50:47Z |
| publishDate | 2019-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Allergy & Rhinology |
| spelling | doaj.art-da1e9672feb74c38a931856efd9882782022-12-21T22:25:42ZengSAGE PublishingAllergy & Rhinology2152-65672019-01-011010.1177/2152656719827253Successful Treatment of Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for ManagementElisabeth H. Ference MD, MPHBernard M. Kubak MDPaul Zhang MD, MPHJeffrey D. Suh MDBackground Scedosporium fungal infection is an emerging disease which is difficult to diagnose and treat. Patients undergoing lung transplant may be colonized prior to transplantation and are at risk for lethal allograft infection after transplantation. Objectives To identify and evaluate treatment options. Methods This study is a retrospective review of patients treated at a tertiary academic medical center from 2007 to 2017 with positive sinonasal cultures. A review of the literature was also performed to identify additional cases. Results Two lung transplant patients had a positive culture for Scedosporium . The literature search resulted in 37 citations, which yielded only 2 prior cases of Scedosporium paranasal sinus colonization or infection in lung transplant recipients. Three of the 4 patients had cystic fibrosis. Two of the patients were colonized before initial transplant, while 1 patient was colonized before subsequent transplant. Three of the 4 patients survived, and all 3 had disease isolated to their sinuses and lungs treated with sinus surgery, while the fourth had disseminated disease and did not undergo sinus surgery. All patients were treated with multiple antifungals due to resistance patterns. One surviving patient cleared both sinus and lung cultures in less than 1 month, while the other 2 surviving patients achieved negative cultures after a minimum of 6 months. Conclusions Surgery may be especially important in patients with fungal sinus colonization or infection before or after lung transplantation. Chronic sinusitis is an important source for persistent fungal colonization and reinfection of the allograft which could be removed with surgical debridement before causing highly morbid pulmonary disease.https://doi.org/10.1177/2152656719827253 |
| spellingShingle | Elisabeth H. Ference MD, MPH Bernard M. Kubak MD Paul Zhang MD, MPH Jeffrey D. Suh MD Successful Treatment of Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management Allergy & Rhinology |
| title | Successful Treatment of Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management |
| title_full | Successful Treatment of Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management |
| title_fullStr | Successful Treatment of Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management |
| title_full_unstemmed | Successful Treatment of Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management |
| title_short | Successful Treatment of Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management |
| title_sort | successful treatment of sinusitis in two lung transplant recipients review of the literature and recommendations for management |
| url | https://doi.org/10.1177/2152656719827253 |
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