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Fungal Infections in the Immunocompromised Patient - Section 4
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Mohammad Ghahri   |
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Abstract: (29 Views) |
The net state of immunosuppression is a complex function determined by the interplay of a number of factors: The driving force is the dose, duration, and sequence in which immunosuppressive drugs are used; the presence of immune deficiencies unrelated to treatment (e.g., those associated with underlying disease, as well as acquired deficiencies such as acquired hypoglobulinemia associated with intensive therapy with tacrolimus and mycophenolate); Compromised mucosal surfaces of the skin, such that the function of these protective surfaces is impaired; the severity and degree of neutropenia; metabolic disorders (protein-calorie malnutrition and perhaps diabetes and uremia); very young or very old age; infection with one of the immunomodulating viruses (cytomegalovirus or CMV, Epstein-Barr virus EBV, hepatitis viruses, and human immunodeficiency virus); and possibly race.
In the case of fungal infections, not only does the increased incidence of opportunistic infections but also the decreased severity of signs and symptoms make clinical diagnosis of invasive disease difficult, increasing the burden on the organism and requiring long-term treatment courses.
Immunomodulating viruses, such as CMV, in particular, plays a significant role in the pure state of immunosuppression, with 90% of opportunistic infections occurring in patients with active infection with one or more of these viruses. Indeed, the occurrence of an invasive fungal infection in a patient without viral replication is a clue to exposure to an unknown environmental agent.
The possibility of developing a fungal infection after transplantation is divided into three time periods: the first month after transplantation, the period 1 to 6 months after transplantation, and the period more than 6 months after transplantation. This time frame can be useful in three ways: In establishing a differential diagnosis in a transplant recipient who presents with a clinical infectious disease.
Present early in the post-transplant period with invasive candidiasis, cryptococcal, aspergillosis, or other fungal infections due to previously undiagnosed disease.
Called persistent immunosuppression -in the period of 1 to 6 months- it enables a range of opportunistic infections, including fungi such as Aspergillus species, Pseudosporium species, and Candida species, even in the absence of severe epidemiological exposure.
The vast majority of transplant patients are at relatively low risk of developing invasive fungal infection more than 6 months after transplantation, unless they are exposed to extreme environmental factors.
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| Keywords: Immunocompromised Host, Opportunistic Mycoses, Opportunistic Infections, Invasive Aspergillosis, Candidemia |
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Full-Text [PDF 707 kb]
(15 Downloads)
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Type of Study: Review |
Subject:
قارچ شناسی
Received: 2025/09/23 | Accepted: 2025/09/25 | Published: 2025/09/25
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