Original articleDeep cutaneous fungal infections in solid-organ transplant recipients
Graphical abstract
Section snippets
Patients and methods
Epidemiologic, clinical, fungal, and transplant parameters were retrospectively collected in s-OTRs with a diagnosis of DCFI in centers belonging to the Skin and Organ Transplantation Group of the French Society of Dermatology.
s-OTR adult patients were included if they had a proven diagnosis of invasive fungal infection, as defined by European Organization for Research and Treatment of Cancer–Mycoses Study Group.6 DCFI was defined as a dermal fungal infection, including systemic fungal
Demographic and transplant data
Forty-six patients who received diagnoses from 1998 through 2016 from 8 centers were included in the study. The median age at diagnosis was 56.5 years (range, 16-72 years), with a male-to-female sex ratio of 2.54. Forty-eight percent of patients originated from Europe. Characteristics of s-OTRs with DCFIs are reported in Table I. Median and mean delays between transplant and diagnosis of DCFI were, respectively, 13.4 and 28 months (range, 2-144 months). Patients received transplants at a mean
Discussion
This multicenter observational study has highlighted a large diversity of DCFIs in s-OTRs in France. Primary DCFI in s-OTRs occurred mostly in the first 2 years after transplant, which is in line with a previous series of 22 s-OTR patients in Italy, to our knowledge the only previous series reported in Europe.13 In that case-control, multicenter, cohort, retrospective study, risk factors reported for DCFI were the first 2-year period after transplant, being a kidney transplant recipient, and
Conclusion
This observational study has highlighted the large diversity of DCFIs observed in s-OTRs, with the highest prevalence found for phaeohyphomycoses. Nodular lesions on lower limbs and granulomatous findings on histopathology were helpful diagnostic clues. Appropriate therapeutic management by a multidisciplinary team of dermatologists, transplant specialists, pathologists, and mycologists, based on specific, mostly systemic, antifungal treatment; surgery; and IS modulation, is required to obtain
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Funding sources: Supported by Skin and Organ Transplantation Group of the French Society of Dermatology (Groupe Peau et Greffe d'organe de la Société Française de Dermatologie).
Disclosure: Dr Lebbé received research grants or honoraria from Roche, Bristol-Myers Squibb, Merck Sharpe & Dohme, GlaxoSmithKline, Novartis, and Amgen outside the submitted work. Drs Galezowski, Delyon, Le Cleach, Guégan, Ducroux, Alanio, Lastennet, Moguilet, Dadban, Leccia, Pelletier, Francès, and Barete have no conflicts of interest to declare.
IRB approval status: Informed consent in accordance with the Declaration of Helsinki.