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Fungal Tracheobronchitis in Lung Transplant Recipients : Incidence and Utility of Diagnostic Markers

Hammarström, Helena ; Magnusson, Jesper ; Stjärne Aspelund, Anna LU ; Stenmark, Jakob ; Isaksson, Jenny ; Kondori, Nahid ; Riise, Gerdt C. ; Wennerås, Christine and Friman, Vanda (2023) In Journal of Fungi 9(1).
Abstract

Fungal tracheobronchitis caused by Aspergillus and Candida spp. is a recognized complication after lung transplantation, but knowledge of the incidence of Candida tracheobronchitis is lacking. The diagnosis relies on fungal cultures in bronchoalveolar lavage fluid (BALF), but cultures have low specificity. We aimed to evaluate the one-year incidence of fungal tracheobronchitis after lung transplantation and to assess the utility of diagnostic markers in serum and BALF to discriminate fungal tracheobronchitis from colonization. Ninety-seven consecutively included adult lung-transplant recipients were prospectively followed. BALF and serum samples were collected at 1, 3 and 12 months after transplantation and analyzed for betaglucan... (More)

Fungal tracheobronchitis caused by Aspergillus and Candida spp. is a recognized complication after lung transplantation, but knowledge of the incidence of Candida tracheobronchitis is lacking. The diagnosis relies on fungal cultures in bronchoalveolar lavage fluid (BALF), but cultures have low specificity. We aimed to evaluate the one-year incidence of fungal tracheobronchitis after lung transplantation and to assess the utility of diagnostic markers in serum and BALF to discriminate fungal tracheobronchitis from colonization. Ninety-seven consecutively included adult lung-transplant recipients were prospectively followed. BALF and serum samples were collected at 1, 3 and 12 months after transplantation and analyzed for betaglucan (serum and BALF), neutrophils (BALF) and galactomannan (BALF). Fungal tracheobronchitis was defined according to consensus criteria, modified to include Candida as a mycologic criterion. The cumulative one-year incidence of Candida and Aspergillus tracheobronchitis was 23% and 16%, respectively. Neutrophils of >75% of total leukocytes in BALF had 92% specificity for Candida tracheobronchitis. The area under the ROC curves for betaglucan and galactomannan in BALF to discriminate Aspergillus tracheobronchitis from colonization or no fungal infection were high (0.86 (p < 0.0001) and 0.93 (p < 0.0001), respectively). To conclude, the one-year incidence of fungal tracheobronchitis after lung transplantation was high and dominated by Candida spp. Diagnostic markers in BALF could be useful to discriminate fungal colonization from tracheobronchitis.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
betaglucan, fungal infection, fungal tracheobronchitis, galactomannan, lung transplant recipients
in
Journal of Fungi
volume
9
issue
1
article number
3
publisher
MDPI AG
external identifiers
  • scopus:85146798777
  • pmid:36675824
ISSN
2309-608X
DOI
10.3390/jof9010003
language
English
LU publication?
yes
id
43469c3c-59ce-43be-bea6-2e5ac1b041f1
date added to LUP
2023-02-13 13:33:04
date last changed
2024-06-13 23:38:18
@article{43469c3c-59ce-43be-bea6-2e5ac1b041f1,
  abstract     = {{<p>Fungal tracheobronchitis caused by Aspergillus and Candida spp. is a recognized complication after lung transplantation, but knowledge of the incidence of Candida tracheobronchitis is lacking. The diagnosis relies on fungal cultures in bronchoalveolar lavage fluid (BALF), but cultures have low specificity. We aimed to evaluate the one-year incidence of fungal tracheobronchitis after lung transplantation and to assess the utility of diagnostic markers in serum and BALF to discriminate fungal tracheobronchitis from colonization. Ninety-seven consecutively included adult lung-transplant recipients were prospectively followed. BALF and serum samples were collected at 1, 3 and 12 months after transplantation and analyzed for betaglucan (serum and BALF), neutrophils (BALF) and galactomannan (BALF). Fungal tracheobronchitis was defined according to consensus criteria, modified to include Candida as a mycologic criterion. The cumulative one-year incidence of Candida and Aspergillus tracheobronchitis was 23% and 16%, respectively. Neutrophils of &gt;75% of total leukocytes in BALF had 92% specificity for Candida tracheobronchitis. The area under the ROC curves for betaglucan and galactomannan in BALF to discriminate Aspergillus tracheobronchitis from colonization or no fungal infection were high (0.86 (p &lt; 0.0001) and 0.93 (p &lt; 0.0001), respectively). To conclude, the one-year incidence of fungal tracheobronchitis after lung transplantation was high and dominated by Candida spp. Diagnostic markers in BALF could be useful to discriminate fungal colonization from tracheobronchitis.</p>}},
  author       = {{Hammarström, Helena and Magnusson, Jesper and Stjärne Aspelund, Anna and Stenmark, Jakob and Isaksson, Jenny and Kondori, Nahid and Riise, Gerdt C. and Wennerås, Christine and Friman, Vanda}},
  issn         = {{2309-608X}},
  keywords     = {{betaglucan; fungal infection; fungal tracheobronchitis; galactomannan; lung transplant recipients}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{MDPI AG}},
  series       = {{Journal of Fungi}},
  title        = {{Fungal Tracheobronchitis in Lung Transplant Recipients : Incidence and Utility of Diagnostic Markers}},
  url          = {{http://dx.doi.org/10.3390/jof9010003}},
  doi          = {{10.3390/jof9010003}},
  volume       = {{9}},
  year         = {{2023}},
}