Article information
Abstract
In solid organ recipients, as with other immunosuppressed patients, infections by Candida spp. and Aspergillus spp. are the most frequent invasive mycoses. Infections by Cryptococcus spp. and fungi of the Mucorales order are less common. Infections by Fusarium spp. and Scedosporium spp. are very uncommon, except in patients undergoing hematopoietic stem cell transplant and patients with prolonged neutropenia. The risk factors for fungal infection are immunosuppression, surgery, viral co-infection, and environmental exposure. Diagnosis is challenging: blood culture is of little use, except in candidiasis and cryptococcosis, and the poor accuracy of antigen-based techniques, except in cryptococcosis, favors widespread use of empirical therapy. A delay in the initiation of therapy increases the already high mortality of these infections. The agents used to treat fungal infection are azoles, echinocandins, and lipid amphotericin. Administration depends on antifungal activity, drug-drug interactions with calcineurin inhibitors, and safety profiles (effects on grafts and other side effects).
Keywords:
Fungal infection
Solid organ recipients
Transplant
Resumen
En los receptores de órgano sólido, y en otros pacientes inmunodeprimidos, las infecciones por Candida spp. y Aspergillus spp. son las micosis invasivas más frecuentes. Las infecciones por Cryptococcus spp. y por hongos del orden Mucorales son menos frecuentes. Las infecciones por Fusarium spp. y Scedosporium spp. son muy infrecuentes, excepto en pacientes sometidos a trasplante de células madre hematopoyéticas y pacientes con neutropenia prolongada. Los factores de riesgo para infección fúngica son la inmunosupresión, cirugía, coinfección viral y exposición al entorno. El diagnóstico constituye un reto: la poca utilidad del hemocultivo, excepto en la candidiasis y la criptococcosis, y la poca precisión de las técnicas basadas en antígeno, excepto en la criptococcosis, favorecen el uso extendido del tratamiento empírico. El retraso en el inicio del tratamiento aumenta la ya alta mortalidad de estos procesos. Los fármacos utilizados para tratar las infecciones fúngicas son azoles, equinocandinas y amfotericina asociada a lípido. La administración depende de la actividad antifúngica, las interacciones farmacológicas con los inhibidores de la calcineurina y el perfil de seguridad (efecto sobre el injerto y otros efectos secundarios).
Palabras clave:
Infección fúngica
Receptores de órgano sólido
Trasplante
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