Cytomegalovirus and Aspergillus spp. coinfection in organ transplantation: A case report and review of the literature

Solak Y., Biyik Z., Cizmecioglu A., Genc N., Ozbek O., Gaipov A., Yeksan M.

Research output: Contribution to journal › Article

Abstract

With the advent of potent immunosuppressive options, acute rejection episodes have decreased at the expense of increased incidence of opportunistic infections in solid organ recipients. In the absence of any preventive therapy, 30-75 % of transplant recipients develop cytomegalovirus (CMV) infection. Candida spp. and Aspergillus spp. account for more than 80 % of invasive fungal infections in solid organ recipients. This co-occurrence of two commonly seen opportunistic infections may end up in fatality. Here, we present a case of concomitant Aspergillus spp. and CMV infection and discuss the relevant literature. A 54-year-old male patient presented with fever, shortness of breath, and chest pain on the 9th posttransplant week after renal transplantation. CMV-DNA by polymerase chain reaction (PCR) was 1,680,000 copies/ml, thus, valganciclovir dose was increased. There were inspiratory crackles at both lung bases, and chest computed tomography (CT) revealed multiple fungal balls throughout the right lung. Galactomannan antigen was positive, and voriconazole and other antimicrobials were subsequently added to the treatment. At the end of the therapy, on control CT, pneumonic consolidation had disappeared, sputum cultures didn't show Aspergillus spp., and CMV-DNA reduced to 700 copies/ml. The patient showed a favorable clinical response to combined treatment; fever, dyspnea, and pleuritic chest pain disappeared. Both CMV disease and aspergillosis may present as pulmonary disease; thus, the characterization of one may not preclude the search for the other and the timely initiation of treatment is of paramount importance for good outcomes. © 2012 Japanese Society of Nephrology.
Original languageEnglish
Pages (from-to)59-67
Number of pages9
JournalCEN Case Reports
Volume2
Issue number1
DOIs
Publication statusPublished - 2013

Fingerprint

Organ Transplantation
Aspergillus
Cytomegalovirus
Coinfection
Opportunistic Infections
Cytomegalovirus Infections
Chest Pain
Dyspnea
Lung
Fever
Tomography
Therapeutics
Aspergillosis
Nephrology
Respiratory Sounds
DNA-Directed DNA Polymerase
Immunosuppressive Agents
Sputum
Candida
Kidney Transplantation

Keywords

  • Doppler flowmetry
  • adult
  • amphotericin B
  • article
  • aspergillosis
  • case report
  • community acquired pneumonia
  • computer assisted tomography
  • corticosteroid
  • cytomegalovirus infection
  • deep vein thrombosis
  • dyspnea
  • fever
  • galactomannan
  • ganciclovir
  • hospitalization
  • human
  • imipenem
  • itraconazole
  • loading drug dose
  • low molecular weight heparin
  • lung biopsy
  • malaise
  • male
  • methylprednisolone
  • mixed infection
  • mycophenolate mofetil
  • organ transplantation
  • piperacillin plus tazobactam
  • pneumothorax
  • polymerase chain reaction
  • prednisone
  • priority journal
  • tacrolimus
  • terbinafine
  • thorax pain
  • thymocyte antibody
  • tigecycline
  • urine culture
  • valaciclovir
  • valganciclovir
  • voriconazole

Cite this

Cytomegalovirus and Aspergillus spp. coinfection in organ transplantation: A case report and review of the literature. / Y., Solak; Z., Biyik; A., Cizmecioglu; N., Genc; O., Ozbek; A., Gaipov; M., Yeksan.

In: CEN Case Reports, Vol. 2, No. 1, 2013, p. 59-67.

Research output: Contribution to journal › Article

Y., S, Z., B, A., C, N., G, O., O, A., G & M., Y 2013, 'Cytomegalovirus and Aspergillus spp. coinfection in organ transplantation: A case report and review of the literature', CEN Case Reports, vol. 2, no. 1, pp. 59-67. https://doi.org/10.1007/s13730-012-0040-3
Y. S, Z. B, A. C, N. G, O. O, A. G et al. Cytomegalovirus and Aspergillus spp. coinfection in organ transplantation: A case report and review of the literature. CEN Case Reports. 2013;2(1):59-67. https://doi.org/10.1007/s13730-012-0040-3
Y., Solak ; Z., Biyik ; A., Cizmecioglu ; N., Genc ; O., Ozbek ; A., Gaipov ; M., Yeksan. / Cytomegalovirus and Aspergillus spp. coinfection in organ transplantation: A case report and review of the literature. In: CEN Case Reports. 2013 ; Vol. 2, No. 1. pp. 59-67.
@article{03d9c027f43c430ab63a614cb9223bb4,
title = "Cytomegalovirus and Aspergillus spp. coinfection in organ transplantation: A case report and review of the literature",
abstract = "With the advent of potent immunosuppressive options, acute rejection episodes have decreased at the expense of increased incidence of opportunistic infections in solid organ recipients. In the absence of any preventive therapy, 30-75 {\%} of transplant recipients develop cytomegalovirus (CMV) infection. Candida spp. and Aspergillus spp. account for more than 80 {\%} of invasive fungal infections in solid organ recipients. This co-occurrence of two commonly seen opportunistic infections may end up in fatality. Here, we present a case of concomitant Aspergillus spp. and CMV infection and discuss the relevant literature. A 54-year-old male patient presented with fever, shortness of breath, and chest pain on the 9th posttransplant week after renal transplantation. CMV-DNA by polymerase chain reaction (PCR) was 1,680,000 copies/ml, thus, valganciclovir dose was increased. There were inspiratory crackles at both lung bases, and chest computed tomography (CT) revealed multiple fungal balls throughout the right lung. Galactomannan antigen was positive, and voriconazole and other antimicrobials were subsequently added to the treatment. At the end of the therapy, on control CT, pneumonic consolidation had disappeared, sputum cultures didn't show Aspergillus spp., and CMV-DNA reduced to 700 copies/ml. The patient showed a favorable clinical response to combined treatment; fever, dyspnea, and pleuritic chest pain disappeared. Both CMV disease and aspergillosis may present as pulmonary disease; thus, the characterization of one may not preclude the search for the other and the timely initiation of treatment is of paramount importance for good outcomes. {\circledC} 2012 Japanese Society of Nephrology.",
keywords = "Doppler flowmetry, adult, amphotericin B, article, aspergillosis, case report, community acquired pneumonia, computer assisted tomography, corticosteroid, cytomegalovirus infection, deep vein thrombosis, dyspnea, fever, galactomannan, ganciclovir, hospitalization, human, imipenem, itraconazole, loading drug dose, low molecular weight heparin, lung biopsy, malaise, male, methylprednisolone, mixed infection, mycophenolate mofetil, organ transplantation, piperacillin plus tazobactam, pneumothorax, polymerase chain reaction, prednisone, priority journal, tacrolimus, terbinafine, thorax pain, thymocyte antibody, tigecycline, urine culture, valaciclovir, valganciclovir, voriconazole",
author = "Solak Y. and Biyik Z. and Cizmecioglu A. and Genc N. and Ozbek O. and Gaipov A. and Yeksan M.",
year = "2013",
doi = "10.1007/s13730-012-0040-3",
language = "English",
volume = "2",
pages = "59--67",
journal = "CEN Case Reports",
issn = "2192-4449",
publisher = "Springer Japan",
number = "1",

}

TY - JOUR

T1 - Cytomegalovirus and Aspergillus spp. coinfection in organ transplantation: A case report and review of the literature

AU - Y., Solak

AU - Z., Biyik

AU - A., Cizmecioglu

AU - N., Genc

AU - O., Ozbek

AU - A., Gaipov

AU - M., Yeksan

PY - 2013

Y1 - 2013

N2 - With the advent of potent immunosuppressive options, acute rejection episodes have decreased at the expense of increased incidence of opportunistic infections in solid organ recipients. In the absence of any preventive therapy, 30-75 % of transplant recipients develop cytomegalovirus (CMV) infection. Candida spp. and Aspergillus spp. account for more than 80 % of invasive fungal infections in solid organ recipients. This co-occurrence of two commonly seen opportunistic infections may end up in fatality. Here, we present a case of concomitant Aspergillus spp. and CMV infection and discuss the relevant literature. A 54-year-old male patient presented with fever, shortness of breath, and chest pain on the 9th posttransplant week after renal transplantation. CMV-DNA by polymerase chain reaction (PCR) was 1,680,000 copies/ml, thus, valganciclovir dose was increased. There were inspiratory crackles at both lung bases, and chest computed tomography (CT) revealed multiple fungal balls throughout the right lung. Galactomannan antigen was positive, and voriconazole and other antimicrobials were subsequently added to the treatment. At the end of the therapy, on control CT, pneumonic consolidation had disappeared, sputum cultures didn't show Aspergillus spp., and CMV-DNA reduced to 700 copies/ml. The patient showed a favorable clinical response to combined treatment; fever, dyspnea, and pleuritic chest pain disappeared. Both CMV disease and aspergillosis may present as pulmonary disease; thus, the characterization of one may not preclude the search for the other and the timely initiation of treatment is of paramount importance for good outcomes. © 2012 Japanese Society of Nephrology.

AB - With the advent of potent immunosuppressive options, acute rejection episodes have decreased at the expense of increased incidence of opportunistic infections in solid organ recipients. In the absence of any preventive therapy, 30-75 % of transplant recipients develop cytomegalovirus (CMV) infection. Candida spp. and Aspergillus spp. account for more than 80 % of invasive fungal infections in solid organ recipients. This co-occurrence of two commonly seen opportunistic infections may end up in fatality. Here, we present a case of concomitant Aspergillus spp. and CMV infection and discuss the relevant literature. A 54-year-old male patient presented with fever, shortness of breath, and chest pain on the 9th posttransplant week after renal transplantation. CMV-DNA by polymerase chain reaction (PCR) was 1,680,000 copies/ml, thus, valganciclovir dose was increased. There were inspiratory crackles at both lung bases, and chest computed tomography (CT) revealed multiple fungal balls throughout the right lung. Galactomannan antigen was positive, and voriconazole and other antimicrobials were subsequently added to the treatment. At the end of the therapy, on control CT, pneumonic consolidation had disappeared, sputum cultures didn't show Aspergillus spp., and CMV-DNA reduced to 700 copies/ml. The patient showed a favorable clinical response to combined treatment; fever, dyspnea, and pleuritic chest pain disappeared. Both CMV disease and aspergillosis may present as pulmonary disease; thus, the characterization of one may not preclude the search for the other and the timely initiation of treatment is of paramount importance for good outcomes. © 2012 Japanese Society of Nephrology.

KW - Doppler flowmetry

KW - adult

KW - amphotericin B

KW - article

KW - aspergillosis

KW - case report

KW - community acquired pneumonia

KW - computer assisted tomography

KW - corticosteroid

KW - cytomegalovirus infection

KW - deep vein thrombosis

KW - dyspnea

KW - fever

KW - galactomannan

KW - ganciclovir

KW - hospitalization

KW - human

KW - imipenem

KW - itraconazole

KW - loading drug dose

KW - low molecular weight heparin

KW - lung biopsy

KW - malaise

KW - male

KW - methylprednisolone

KW - mixed infection

KW - mycophenolate mofetil

KW - organ transplantation

KW - piperacillin plus tazobactam

KW - pneumothorax

KW - polymerase chain reaction

KW - prednisone

KW - priority journal

KW - tacrolimus

KW - terbinafine

KW - thorax pain

KW - thymocyte antibody

KW - tigecycline

KW - urine culture

KW - valaciclovir

KW - valganciclovir

KW - voriconazole

UR - http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L369039232 http://dx.doi.org/10.1007/s13730-012-0040-3 http://ca3cx5qj7w.search.serialssolutions.com?sid=EMBASE&issn=21924449&id=doi:10.1007%2Fs13730-012-0040-3&atitle=Cytomegaloviru

UR - http://www.mendeley.com/research/cytomegalovirus-aspergillus-spp-coinfection-organ-transplantation-case-report-review-literature-1

U2 - 10.1007/s13730-012-0040-3

DO - 10.1007/s13730-012-0040-3

M3 - Article

C2 - 28509226

VL - 2

SP - 59

EP - 67

JO - CEN Case Reports

JF - CEN Case Reports

SN - 2192-4449

IS - 1

ER -

Access to Document